FAST ONSET AND EFFECTIVE ASTHMA CONTROL * 1, 2 , 4
7 SEPTEMBER 2018 australiandoctor . com . au
Kids on Nauru at risk of death
† 1 – 3
FAST ONSET AND EFFECTIVE ASTHMA CONTROL * 1, 2 , 4
† 1 – 3 minutes onset of LABA component bronchodilation . 1 – 3 * Significant reduction in time to first severe exacerbation # with Symbicort ® maintenance and reliever therapy vs . fixed-dose Seretide ® ( fluticasone / salmeterol ) plus SABA . 1 , 2 , 4
# Severe exacerbation was defined as deterioration in asthma , resulting in hospitalisation / emergency room treatment , oral steroids for ≥3 days or an unscheduled visit ( i . e . patient-initiated ) leading to treatment change . 4 SABA = short-acting beta-agonist ; LABA = long-acting beta-agonist .
PBS Information : Authority required ( STREAMLINED ). Asthma . Refer to PBS Schedule for full authority information .
Sarah Wiedersehn DOCTORS caring for refugee children on Nauru say there ’ s been a spate of incidents of self-harm on the island and fear there will be suicides .
Some 130 children are detained on the island , but many are self-harming , according to reports , including a 14-year-old girl who doused herself in petrol and threatened to set herself alight .
The situation has become so extreme that many of the children have been diagnosed with resignation syndrome — a rare psychiatric condition that presents as progressive social withdrawal and reluctance to engage .
The most serious stage of the disorder is when the child becomes comatose , according to Dr Vernon Reynolds , who worked on Nauru as a child psychiatrist for almost two years .
“ What we see is these young people and adults basically withdraw from life and generally take to their bed , and their whole functioning deteriorates ,” Dr Reynolds told the ABC .
“ So they stop eating much , they stop drinking much , they stop looking after their day-today self care . They stop interacting with people , they stop talking .”
He added : “ Am I concerned that children could die in Nauru , that some of these refugee children could die ?
“ I am absolutely concerned about that . I am reasonably surprised that no one has .”
The claims triggered a call from the Royal Australasian College of Physicians to end offshore processing immediately .
A former government adviser on asylum-seeker and refugee mental health , Professor Louise Newman , said the situation on Nauru had reached a crisis point .
“ We are now seeing this virtual epidemical outbreak on Nauru of very severe traumatic responses , which can be life-threatening ,” Professor Newman said .
“ We had a child last week who had poured petrol on herself and was going to set herself alight , we ’ ve had a young child about to jump off a cliff , so we ’ ve had near , near misses .
“ We have children who have stopped speaking entirely other than to say they want to die , and these are children as young as 10 .”
Professor Newman said she held little hope the situation would change because of the bureaucracy in Canberra .
“ We ’ ve had delays in getting seriously ill people to treatment , which are currently being investigated by coroners .
“ Concerns are being raised about a system that is not governed by health in any way .”
BEFORE PRESCRIBING PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR www . astrazeneca . com . au / PI Symbicort ® Turbuhaler ® ( budesonide and formoterol ( eformoterol ) fumarate dihydrate *) for oral inhalation . Indications : Asthma : Treatment of asthma where use of a combination ( inhaled corticosteroid and long acting β2-agonist ) is appropriate in adults and adolescents . COPD : Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease ( COPD ), ( FEV1 ≤50 % predicted normal ) in adults with frequent symptoms despite long acting bronchodilator use , and / or a history of recurrent exacerbations . Symbicort is not indicated for the initiation of bronchodilator therapy in COPD . Dosage : Asthma : There are two alternative treatment regimens for asthma : Symbicort Maintenance and Reliever Therapy ( SMART TM ) or Symbicort Maintenance Therapy . Refer to Product Information for full details on dosage . Symbicort Maintenance and Reliever Therapy ( SMART TM ) for Asthma : Symbicort 100 / 6 and 200 / 6 : Adults and adolescents ≥12 years : 2 inhalations per day given as either 1 inhalation twice daily or 2 inhalations in either the morning or evening . For some patients , a maintenance dose of Symbicort 200 / 6 2 inhalations twice daily may be appropriate . Patients may take an additional inhalation as needed in response to symptoms , up to 6 inhalations at one time . If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose , the patient should be re-assessed . A total daily dose of up to 12 inhalations can be used temporarily . Symbicort 400 / 12 : The 400 / 12 strength should not be used for Symbicort Maintenance and Reliever therapy . Symbicort Maintenance Therapy for Asthma : Symbicort 100 / 6 and 200 / 6 : Adults and adolescents ≥12 years : 1 – 2 inhalations twice daily . Symbicort 400 / 12 : Adults ≥18 years : 1 – 2 inhalations twice daily . Dosage : COPD : Symbicort 200 / 6 : 2 inhalations twice daily . Symbicort 400 / 12 : 1 inhalation twice daily . Contraindications : Hypersensitivity to any of the ingredients . Precautions : Symbicort therapy should not be initiated to treat a severe exacerbation . Not for initiation of inhaled steroids in patients transferring from oral steroids ; impaired adrenal function ; infections of the respiratory system ; increased susceptibility to sympathomimetic amines ; severe cardiovascular conditions ; hypokalaemia ; diabetes ; impaired renal and hepatic function ; pregnancy ( category B3 ); lactation ; children < 12 years . Pneumonia : Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap . Pneumonia has been reported following the administration of inhaled corticosteroids . Interactions : CYP3A4 inhibitors ( e . g . ketoconazole ); beta-receptor blockers ; beta-adrenergic stimulants ; sympathomimetic amines ( e . g . ephedrine ); MAOIs ; tricyclics antidepressants ; quinidine ; disopyramide ; procainamide ; phenothiazines ; antihistamines associated with QT interval prolongation e . g . terfenadine , astemizole ; if hypokalaemia : xanthine derivatives , mineralocorticoids , diuretics , digoxin . Adverse effects : Common : tremor , palpitations , oropharyngeal candidiasis , headache , throat irritations , coughing , hoarseness ; others , see full PI . Date of first inclusion in the ARTG : 27 May 2002 ( Symbicort Turbuhaler 100 / 6 and 200 / 6 ); 5 May 2004 ( Symbicort Turbuhaler 400 / 12 ). Date of most recent amendment : 19 December 2017 . Symbicort ® Rapihaler ® ( budesonide and formoterol fumarate dihydrate *) for oral inhalation . Indications : Asthma : Treatment of asthma where use of a combination ( inhaled corticosteroid and long acting β2-agonist ) is appropriate in adults and adolescents . COPD : Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease ( COPD ), ( FEV1 ≤50 % predicted normal ) in adults with frequent symptoms despite long acting bronchodilator use , and / or a history of recurrent exacerbations . Symbicort is not indicated for the initiation of bronchodilator therapy in COPD . Dosage : Asthma : There are two alternative treatment regimens for asthma : Symbicort Maintenance and Reliever Therapy ( SMART TM ) or Symbicort Maintenance Therapy . Refer to Product Information for full details on dosage . Symbicort Maintenance and
Reliever Therapy ( SMART TM ) for Asthma : Symbicort 50 / 3 and 100 / 3 : Adults and adolescents ≥12 years : 4 inhalations per day given as either 2 inhalations twice daily or 4 inhalations in either the morning or evening . For some patients , a maintenance dose of Symbicort 100 / 3 4 inhalations twice daily may be appropriate . Patients may take 2 additional inhalations as needed in response to symptoms , up to 12 inhalations at one time . If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose , the patient should be reassessed . A total daily dose of up to 24 inhalations can be used temporarily . Symbicort 200 / 6 : The 200 / 6 strength should not be used for Symbicort Maintenance and Reliever Therapy . Symbicort Maintenance Therapy for Asthma : Symbicort 50 / 3 and 100 / 3 : Adults and adolescents ≥12 years : 2 or 4 inhalations twice daily . Symbicort 200 / 6 : Adults ≥12 years : 2 inhalations twice daily . Dosage : COPD : Symbicort 200 / 6 : 2 inhalations twice daily . Contraindications : Hypersensitivity to any of the ingredients . Precautions : Symbicort therapy should not be initiated to treat a severe exacerbation . Not for initiation of inhaled steroids in patients transferring from oral steroids ; impaired adrenal function ; infections of the respiratory system ; increased susceptibility to sympathomimetic amines ; severe cardiovascular conditions ; hypokalaemia ; diabetes ; impaired renal and hepatic function ; pregnancy ( category B3 ); lactation ; children < 12 years . Pneumonia : Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap . Pneumonia has been reported following the administration of inhaled corticosteroids . Interactions : CYP3A4 inhibitors ( e . g . ketoconazole ); beta-receptor blockers ; beta-adrenergic stimulants ; sympathomimetic amines ( e . g . ephedrine ); MAOIs ; tricyclics antidepressants ; quinidine ; disopyramide ; procainamide ; phenothiazines ; antihistamines associated with QT interval prolongation e . g . terfenadine , astemizole ; if hypokalaemia : xanthine derivatives , mineralocorticoids , diuretics , digoxin . Adverse effects : Common : tremor , palpitations , oropharyngeal candidiasis , headache , throat irritations , coughing , hoarseness ; others , see full PI . First inclusion in the ARTG : 22 February 2006 ( Symbicort Rapihaler 200 / 6 ), 20 April 2011 ( Symbicort Rapihaler 50 / 3 ), 26 July 2012 ( Symbicort Rapihaler 100 / 3 ). Date of most recent amendment : 28 March 2017 .
* Please note changes to Product Information - eformoterol fumarate dihydrate is now known as formoterol fumarate dihydrate
References : 1 . Symbicort ® Turbuhaler ® Approved Product Information , 19 December 2017 . 2 . Symbicort ® Rapihaler ® Approved Product Information , 28 March 2017 . 3 . Seberová E et al . Respir Med 2000 Jun ; 94 ( 6 ): 607 – 611 . 4 . Vogelmeier C et al . Eur Respir J 2005 Nov ; 26 ( 5 ): 819 – 828 . Symbicort , ® Rapihaler ® and Turbuhaler ® are registered trademarks and SMART ™ is a trademark of the AstraZeneca group of companies . Seretide ® is a registered trademark of GlaxoSmithKline Australia Pty Ltd . Registered user AstraZeneca Pty . Ltd . ABN 54 009 682 311 . 66 Talavera Road , Macquarie Park , NSW 2113 . www . astrazeneca . com . au . For Medical Information enquiries : 1800 805 342 or medinfo . australia @ astrazeneca . com . au . To report an adverse event : 1800 805 342 or via https :// aereporting . astrazeneca . com . Date of preparation : August 2018 . AU-4312 . 15057-1 / 2Vb .
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Move over opioids : pregabalin misuse up
Antony Scholefield THE TGA says it is investigating the rapid rise in overdoses and deaths linked with pregabalin misuse .
The decision follows a new study of the neuropathic pain therapy , which reports the schedule 4 drug has been implicated in 82 deaths in NSW since it was listed on the PBS in 2013 .
As part of its investigation , the medicines watchdog is planning to review pregabalin prescribing in general practice though longitudinal GP data held by NPS MedicineWise .
Dr Rose Cairns ( PhD ), the pregabalin study ’ s lead author and a lecturer at the University of Sydney , noted the UK Government announced plans to upschedule pregabalin in 2017 because of similar concerns .
It will prevent UK GPs from issuing repeat scripts , unless special circumstances apply .
Writing in the journal Addiction last month , Dr Cairns ’ team found that one in seven patients were “ high-risk users ” who were seeing multiple doctors , seeking refills less than 20 days later or being prescribed opioids or benzodiazepines in the same month . More than half of all pregabalin by volume was being prescribed to such patients , the researchers said .
And between 2005 and 2016 there were 1158 cases of poisoning in NSW related to intentional misuse of pregabalin .
Perth GP Dr Amanda Stafford wrote on the Australian Doctor website last week : “ Pregabalin has been abused on a grand scale for years now .
“ As someone who works with street homeless patients , I can say that it is highly appreciated for its powerful anxiolytic properties .
“ Since we don ’ t want to prescribe benzos for anxiety , the new antipsychotics are expensive unless you scam the PBS with a diagnosis of ‘ bipolar type 1 ’ and since we don ’ t want to spend the money to really fix broken , shitty lives , we have an epidemic of PBS-subsidised pregabalin use .”
Dr Hester Wilson , chair of the RACGP addiction medicine specific interest group , said the Federal Government ’ s real-time prescribing system needed to cover pregabalin and other dangerous S4 drugs .
Children on Nauru are being diagnosed with resignation syndrome .