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Each issue will include an editorial on a topic that is important for the profession of pharmacy, as well as a review of a new drug that includes a comparison of the new drug with previously marketed drugs that are most similar in activity, and a New Drug Comparison Rating (NDCR) for the new drug. Read on for this month's issue.

December 2012 Issue
• Feature • New Drug Review
• Index for Volume 7, 2012

Click Here to download PDF format

A Christmas Letter

Editor's note: The following letter (author unknown), intended to be a communication from Jesus Christ regarding the celebration of his birth, includes a message that can be of value for each of us, regardless of our personal faith. I included this letter in the December 2006 issue of The Pharmacist Activist and its message is equally important today.

Dear children,

It has come to my attention that many of you are upset that folks are taking my name out of the season. Maybe you have forgotten that I wasn't actually born during this time of the year and that it was some of your predecessors who decided to celebrate my birthday on what was actually a time of pagan festival. Although, I do appreciate being remembered anytime.

How I personally feel about this celebration can probably be most easily understood by those of you who have been blessed with children of your own. I don't care what you call the day. If you want to celebrate my birth, just get along and love one another.

Now, having said that, let me go on:

If it bothers you that the town in which you live doesn't allow a scene depicting my birth, then just get rid of a couple of Santas and snowmen and put a small Nativity scene on your own front lawn. If all of my followers did that there wouldn't be any need for such a scene on the town square because there would be many of them all around town.

Stop worrying about the fact that people are calling the tree a holiday tree instead of a Christmas tree. It was I who made all trees. You can and may remember me any time you see any tree. Decorate a grapevine if you wish. I actually spoke of that one in a teaching explaining who I am in relation to you and what each of our tasks are. If you have forgotten that one, look it up in John 15: 1-8.

If you want to give me a present in remembrance of my birth, here is my wish list. Choose something from it.
  1. Instead of writing protest letters objecting to the way my birthday is being celebrated, write letters of love and hope to soldiers away from home. They are terribly afraid and lonely this time of year. I knowÑthey tell me all the time.

  2. Visit someone in a nursing home. You don't have to know them personally. They just need to know that someone cares about them.

  3. Instead of giving your children a lot of gifts you can't afford and they don't need, spend time with them. Tell them the story of my birth, and why I came to live with you down here. Hold them in your arms and remind them that I love them.

  4. Pick someone that has hurt you in the past and forgive him or her.

  5. Did you know that someone in your town will attempt to take his own life this season because he feels so alone and helpless? Since you don't know who that person is, try giving everyone you meet a warm smile-it could make the difference. Also, you might consider supporting the local Hot-Line; they talk with people like that every day.

  6. Instead of nitpicking about what the retailers in your town call the holiday, be patient with the people who work there. Give them a warm smile and a kind word. Even if they aren't allowed to wish you a "Merry Christmas," that doesn't keep you from wishing them one. Then stop shopping there on Sunday. If the store didn't make so much money on that day, they would close and let their employees spend the day at home with their families.

  7. If you really want to make a difference, support a missionary, especially one who takes my love and good news to those who have never heard my name. You may already know someone like that.

  8. Here's a good one. There are individuals and whole families in your town who not only will have no "Christmas" tree, but will also not have any presents to give or receive. If you don't know them (and I suspect you don't) buy some food and a few gifts and give them to the Marines, the Salvation Army or some other charity which believes in me and they will make the delivery for you.

  9. Finally, if you want to make a statement about your belief in and loyalty to me, then behave like a Christian. Don't do things in secret that you wouldn't do in my presence. Let people know by your actions that you are one of mine.
P.S. Don't forget; I am God and can take care of myself. Just love me and do what I have told you to do. I'll take care of all the rest. Check out the list above and get to work. Time is short. I'll help you, but the ball is now in your court. And do have a most blessed Christmas with all those whom you love and, remember, I love you.



New Drug Review [To Top]

Mirabegron
(Myrbetriq - Astellas)
Agent for Overactive Bladder
New Drug Comparison Rating (NDCR) = 4
(significant advantage[s])
in a scale of 1 to 5, with 5 being the highest rating

Indication:
Treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.

Comparable drug:
Tolterodine extended-release (e.g., Detrol LA).

Advantages:
  • Has a unique mechanism of action (a beta-3 adrenergic receptor agonist);
  • Does not cause anticholinergic adverse events (e.g., dry mouth, blurred vision);
  • May be satisfactorily tolerated by patients at risk of complications with agents having anticholinergic activity (e.g., patients with uncontrolled narrow-angle glaucoma);
  • May be less likely to cause prolongation of the QT interval of the electrocardiogram.
Disadvantages:
  • May be more likely to increase blood pressure.
Most important risks/adverse events:
Risk of urinary retention in patients with bladder outlet obstruction and in patients taking anticholinergic drugs for overactive bladder; increases in blood pressure (blood pressure should be periodically measured; should not be used in patients with severe uncontrolled hypertension); is a moderate inhibitor of the CYP2D6 pathway and may increase the action of CYP2D6 substrates (concurrent use should be monitored and it may be necessary to reduce the dosage of narrow therapeutic index CYP2D6 substrates [e.g., thioridazine, flecainide, propafenone]); may increase the action of digoxin (the lowest dosage of digoxin should be considered for initial use in patients also taking mirabegron); use is not recommended in patients with end stage renal disease or severe hepatic impairment.

Most common adverse events:
Hypertension (8%), nasopharyngitis (4%), urinary tract infection (3%), headache (3%).

Usual dosage:
Initially, 25 mg once a day; effectiveness should be evident within 8 weeks; based on efficacy and tolerability, dosage may be increased to 50 mg once a day; dosage should not exceed 25 mg once a day in patients with severe renal impairment or moderate hepatic impairment.

Products:
Extended-release tablets - 25 mg, 50 mg; should be swallowed whole, and not chewed, divided, or crushed.

Comments:
Overactive bladder is characterized by contraction of the detrusor muscle while the bladder is filling with urine rather than when it is full. Anticholinergic agents acting as muscarinic receptor antagonists have been the primary treatment and include tolterodine, oxybutynin (e.g., Ditropan XL), darifenacin (Enablex), solifenacin (Vesicare), trospium (e.g., Sanctura XR), and fesoterodine (Toviaz). Mirabegron is a beta-3 adrenergic receptor agonist and its activation of these receptors relaxes the detrusor muscle during the storage phase of the urinary bladder fill-void cycle, thereby increasing bladder capacity. Its effectiveness was demonstrated in placebo-controlled studies in which it reduced the mean number of incontinence episodes and the mean number of micturitions per 24 hours, and increased the volume of urine voided per micturition. Data from limited studies in which mirabegron was compared with tolterodine suggest that the efficacy of the two agents is similar.

Because mirabegron does not have an anticholinergic action, it is likely to be a better tolerated alternative for patients who experience adverse events (e.g., dry mouth, blurred vision) that often occur with the previously marketed drugs. In addition, drugs with anticholinergic activity are usually contraindicated in patients with uncontrolled narrow-angle glaucoma and mirabegron should be better tolerated in patients who experience both overactive bladder and narrow-angle glaucoma. Mirabegron is a substrate for multiple metabolic pathways but studies of its concurrent use with certain inhibitors and inducers of these pathways have not demonstrated a need to recommend dosage adjustments.

Daniel A. Hussar




Index for Volume 7, 2012
[To Top]

January 2012 (No. 1)
 • Pharmacy Must Establish its Own Prescription Benefit Program
• New Drug Review: Belimumab (Benlysta)

February 2012 (No. 2)
 • CVS - Criminal Charges are Needed!
• New Drug Review: Roflumilast (Daliresp)

March 2012 (No. 3)
 • Many Prescription Medications Should be Available Without a Prescription from a Pharmacist
• New Drug Review: Fidaxomicin (Dificid)

April 2012 (No. 4)
 • We Must Prevent "Reform" from Taking the "Care" out of Health Care!
• New Drug Review: Indacaterol maleate (Arcapta)

May 2012 (No. 5)
 • The "Tyranny of the Urgent" Must Not Compromise our Commitment to our Priorities
• New Drug Review: Ingenol mebutate (Picato)

June 2012 (No. 6)
 • Is Patient Safety at Risk at CVS? There is a Whistleblower!
• New Drug Review: Aflibercept (Eylea)

July 2012 (No. 7)
 • The Restrictive and Risky Mail-order Distribution Program for Qsymia Must be Rescinded
• New Drug Review: Ezogabine (Potiga)

August 2012 (No. 8)
 • Accreditation of Community Pharmacies Can Have Important Benefits - But the Program Must Have Credibility and Value for the Participants
• New Drug Review: Spinosad (Natroba)

September 2012 (No. 9)
 • Our Professional Autonomy and the Health of our Patients are at Risk! We Need More Independence in our Practice Responsibilities and More Independent Pharmacies
• New Drug Review: Peginesatide acetate (Omontys)

October 2012 (No. 10)
 • The Meningitis Tragedy - More Regulation is Not the Answer
• New Drug Review: Elvitegravir/Cobicistat (Stribild)

November 2012 (No. 11)
 • Pharmacy-Assisted Suicide - at CVS, Rite Aid, Walgreens, Walmart, etc.
• New Drug Review: Tofacitinib citrate (Xeljanz)

December 2012 (No. 12)
 • A Christmas Letter
• New Drug Review: Mirabegron (Myrbetriq)
• Index for 2012