Therapeutic equivalency of low-molecular-weight heparins.

OBJECTIVE: To review the recent literature on the approved uses of enoxaparin, dalteparin, ardeparin, and tinzaparin and the evidence for therapeutic equivalence. DATA SOURCES: A MEDLINE search (1993-January 2001) was conducted to identify English-language literature available on enoxaparin, dalteparin, ardeparin, and tinzaparin. STUDY SELECTION: All controlled trials evaluating low-molecular-weight heparins (LMWHs) versus standard therapy powered to detect a significant difference were reviewed. DATA EXTRACTION: Agents were reviewed with regard to safety and efficacy. DATA SYNTHESIS: As a class, LMWHs have chemical, physical, and clinical similarities. LMWHs have greater bioavailability, longer half-lives, a more predictable pharmacologic response, possible improved safety, and similar or greater efficacy compared with unfractionated heparin (UFH). Because of this, enoxaparin, dalteparin, ardeparin, and tinzaparin are being considered as alternatives to UFH or warfarin, and there is potential for therapeutic interchange. Evaluation of clinical trials is limited because of differing diagnostic methods, drug administration times, dose equivalencies, and outcome measurements. CONCLUSIONS: Only 1 trial has evaluated 2 LMWHs in a direct comparison in the same study. There is insufficient evidence for determining the therapeutic equivalence of LMWHs.

Assessment of an online consumer "Ask Your Pharmacist" service.

OBJECTIVE: To describe consumer demographics and the types of questions submitted to an online Ask Your Pharmacist (AYP) drug information service. METHODS: This is a retrospective review of a sample of consecutive queries submitted online to an AYP service between 1999 and 2000. All data were coded, transcribed, and evaluated in a Microsoft Excel spreadsheet. Data regarding gender, age, patient relationship to consumer, allergies, medical conditions, products, and question types were evaluated. RESULTS: One thousand eighty-seven queries involving drug information or health-related questions were evaluated: 65% of the queries were from consumers requesting information for themselves; 55.2% of queries originated from women; 61% of consumers were between 19 and 55 years of age. The 5 most listed medical conditions were depression-related, hypertension, allergies, pain, and infectious disease. More than 60% of the questions involved prescription or over-the-counter (OTC) medications; another 10% targeted herbal products or dietary supplements. Consumers were most interested in drug efficacy, safety, and drug interactions. CONCLUSIONS: An AYP online service is a relatively new, unique way for consumers to receive medication information. Consumers of all ages use AYP services for both acute and chronic conditions. Most consumers asked questions related to their own health or medications. Consumers were more likely to ask questions related to prescription and OTC medications than to botanical and dietary supplements. Consumers were primarily interested in drug efficacy and adverse effects.