Journal of Pharmaceutical Research

Abstract

Many surveys showed that people of age 65years or more are usually diagnosed with AD. The main treatment of AD includes Donezepil, Alantimine, Rivastigmine and Tacrine which belong to cholinesterase inhibitors. Memantine is an N-methyl-D-aspartate-receptor inhibitor which works by blocking excess activity of glutamate in brain and helps reduce the symptoms of AD. Memantine is a first and only member of a new class of medication showing clinical benefit and good tolerability in AD. Memantine has also exhibited efficacy and safety in a placebo-controlled trial.

This review is about the many theories proposed for the administration of memantine to AD patients receiving stable donezepil therapy would result in clinical benefit and are safe and well tolerated which has been researched. Many clinical trials are still ongoing.

This review is based on study on two groups of AD patients where one group is given placebo withdonezepil and other group is given 20mg memantine with donezepil; then both the groups are compared. Many clinical trial results are based on the comparative study of both the group of patients where the patients (40%) receiving memantine added to donezepil significantly outperformed those patients (52%) receiving placebo with donezepil.

Therefore many clinical trials had produced positive results when the drugs memantine and donezepil were concomitantly administered. Based on the studies the patients receiving antiglutamatergic treatment showed an improvement in the cognition scores for moderate to severe AD patients.

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Abstract

The two main indications for the long-term use of PPIs are gastro esophageal reflux disease and concomitant use with the maintenance dose of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

PPIs block the gastric H⁺,K⁺-ATPase, inhibiting gastric acid secretion. If the drug is discontinued, there is a potential risk for rebound hypersecretion, creating a sort of dependency on the drug because the body is acclimated to having acid suppressed.

The potential adverse effects relating to PPIs are Hypochlorhydria (11%- 24%) leading to pernicious anaemia and bone fractures(elevated risk after 7 years of continuous PPI therapy) and Hypergastrinemia (20%- 25%). Review of various literatures have shown that long-term PPI use is associated with upto fourfold increase in the risk of fundic gland polyps(upto 36%).

Other potential consequences of chronic PPI use are malabsorption of key minerals (calcium and magnesium) in the body, increased risk of infections, cancer (5%-12%), severe drug interactions and birth defects.

The most commonly seen infections with chronic PPI use are Enteric Infections and Community Acquired Pneumonia(CAP).A case-controlled study discovered an associated 2.5-fold risk of infection with concomitant PPI therapy. A population-based case-controlled study of7642 CAP cases identified, 11% were chronic PPI users.

Another study found that 50% of chronic PPI users are more likely to develop CAP.Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from longterm therapy.

In conclusion, based on the above evidences, pharmacists are poised to educate patients about the benefits and risks associated with chronic PPI use.

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