New Vastarel MR Hits Philippine Market
Servier Philippines recently launched a modified release formulation of its antiischemia drug trimetazidine. Called Vastarel MR, the 35mg tablet has a hydrophilic matrix that allows for controlled and sustained release of the drug. This makes it possible to give only two doses of Vastarel daily instead of the thrice-daily dosing with the previous 20mg preparation. This new formulation ensures better compliance and lower cost.
The launch was made in a series of scientific lectures that began at the annual convention of the Philippine Society of Echocardiography (PSE) on October 3 and ended at the Philippine Diabetes Association (PDA) confab on November 26.
Cardiologist and echocar-diographer May Ann Lao was the speaker in the PSE meeting while renowned endocrinologist-diabetologist Ricardo Fernando spoke during the PDA symposium. Philippine society of Hypertension president Dr. Esperanza Cabral spoke in a separate symposium organized by Servier on October 28, which served as the formal launch.
All three lectures dealt on addressing ischemia by metabolic means.
Cabral said that compared with the old formulation, Vastarel MR has a pharmacokinetic profile that better matches the natural circadian rhythm for myocardial ischemia and "confers better protection over 24 hours because of its higher concentration at trough than the old formulation."
Cabral and Lao noted that a four-month study showed that Vastarel MR achieved sustained anginal efficacy at trough with greater change in time to 1-mm ST-segment depression and increase in time to onset of angina. It also decreased the number of anginal attacks over time (50-percent better than placebo) and showed excellent tolerability profile.
Both Lao and Cabral said that Vastarel, a metabolically acting drug, helps the heart generate energy with less oxygen expenditure. They explained that Vastarel works by inhibiting the enzyme 3-ketoacyl Coenzyme A Thiolase (3-Kat). This enzyme is one of several responsible for fatty acid beta oxidation, the body process for generating energy in the form of ATP at the expense of a large amount of oxygen. When fatty acid beta oxidation is inhibited, the body shifts to glycolysis for energy production, which uses up less oxygen.
Fernando zeroed in on the benefits patients suffering from obesity, diabetes, hypertension, dyslipidemia, and coronary heart disease may get from Vastarel. Noting that these so-called lifestyle disorders are all characterized by insulin resistance, Fernando said the increased level of fatty acid metabolism under these conditions aggravates the imbalance between glucose metabolism and fatty acid oxidation, which is bad for patients with ischemic heart disease and diabetes.
Fernando noted that Vastarel shifts the myocardial energy source from the predominantly fatty acid metabolism to the more efficient glucose metabolism. This ensures that the heart's demand for energy is met despite the limited substrate delivery to the mycoardium caused by coronary artery disease. He said this mode of drug action is beneficial because "you are not just aiming at ischemic heart disease but at a balance between two substrates, which is tilted in the presence of insulin resistance."
Fernando recalled that when Vastarel was introduced several years ago, there where questions if it worked at all, or of it can be used in diabetic patients who have no signs of coronary artery disease. "My answers to those questions have always been yes," he said. He noted that there is plenty of proof that there exists a metabolic discrepancy between fatty acid and glucose consumption for energy in diabetic patients. Vastarel can potentially balance the use of these two substrates, he summed up.
L. Victor Jr.
Lantus Targets A1C<7%
The struggle for blood glucose control could now be eased with Aventis Pharma's launch on September 8 of the A1C<7% "Treat to Target" concept and Lantus (insulin glargine), a 24-hour peakless basal insulin.
The "Treat to Target" concept acknowledges that HbA1C or A1C is a better measure than fasting blood sugar of a patient's compliance with blood sugar control.
In the management of diabetes, the American Diabetes Association (ADA) recommends that glycated hemoglobin or HbA1C be lowered to less than seven percent. This is based on studies-of which the United Kingdom Prospective Diabetes Study is the largest on type 2 diabetes-that say that a decrease in HbA1C to normal or close to normal levels greatly reduces the risk of developing complications.
The measure of fasting blood glucose is still relevant, but patients often use it to deceive their physicians about their compliance to treatment by fasting some time before consultation.
Meanwhile, insulin controls blood sugar levels, but the A1C control of intermediate or long-acting insulins could be erratic. The blood sugar of a patient with diabetes would suddenly drop, whereas, just a minute ago, it was fine.
This is characteristic of insulin therapy which go through peaks of action and decline. Patients are at risk of hypoglycemic events, which could be very distressing for them.
Lantus could resolve this dilemma, since it works by steadily releasing insulin over a 24-hour period, very like the way the body releases its own insulin in response to changes in blood sugar.
The amount of insulin working to supply the body's cells with energy, therefore, is consistent throughout the day, even during sleep. This kind of medication needs to be taken only once daily, which is a welcome benefit to diabetic patients fearful of injections.
Lantus is the world's only insulin with this kind of mechanism of action. It was developed by Aventis Pharma to make achieving the treatment goal of less than seven percent A1C easier for diabetics.
SLMC's Pedia-Pulmo Devoted F4 Fans
At St. Luke's Medical Center (SLMC), the F4 devotion is by no means a passing craze. Even before the stars of the chinovela Meteor Garden created such incredible excitement in the country this year, the SLMC's pediatric pulmonology has already been converting F4 devotees out of its patients and those involved in its Pediatric Asthma Education Program (PAEP).
Unlike the Taiwanese boy band though, PAEP F4 has more to do with improved quality of life for asthmatics than cool looks and heart-tickling smiles. According to Dr. Madeleine Sumpaico, it is about making the life of an asthmatic no different from an asthma-free child's.
But only as long as the rights of asthmatic child-Free asthma education, Freedom from symptoms and exacerbations, Family empowerment, and Fulfillment of life's expectations-are upheld will this happen, she explained.
PAEP makes sure the F4 is met for each asthmatic child brought to SLMC. In its fourth anniversary celebration last August 26, this was stressed.
Consistent with PAEP's goals, the anniversary celebration was turned into a learning environment where the participants-residents of the hospital, the asthmatic children, their parents and care-givers-were encouraged to express their feelings and share their experiences regarding asthma.
A panel of specialists composed of adult pulmonologist Janeth Samson, pediatric pulmonologist Regina Canoni-zado, allergologist and pediatrician Jean Jaucian Poblete explained the triggers, identi- fication of asthma signs and symptoms, and the preventers and relievers being used in management.
The participants had the following concerns:
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What are the causes of asthma?
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Can asthma be prevented? How?
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How do I know if my child's asthma is controlled already?
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Will my child outgrow asthma?
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My child is coughing phlegm but not wheezing-does my child have asthma?
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What will happen if my child is not immediately given medication, or if my child's asthma is not immediately controlled?
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Is asthma contagious? Is it hereditary?
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What medications should I give my child? What do these medicines do?
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Do I need to restrict my child's physical activities?
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What is skin asthma?
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Does a long-time asthmatic have a tendency to develop heart problems?
PAEP includes first-Saturday-of-the-month workshops/classes on asthma prevention and management. SLMC's pediatric pulmonology under the Institute of Pulmonary Medicine gives this for free in line with addressing the public health burden imposed by asthma.
M. Ciriacruz
Making Medical Sense
The demand for easily understood medical information grows. Merck &
Corresponds with the publication of The Merck Manual of Medical
Information-second Home Edition, consumer reference book on medicines and
diseases. It has been expanded by nearly 400 pages with 35 new chapters to
capture the significant advances in medicine and changes in society since
the previous edition was published in 1997.
The book was launched at
National Bookstore Shangri-la Mall and Powerbooks Live! Greenbelt 4 on
November 15 and 29. Both launches had lay discussions on heart and
bone-joint disorders.
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