Transcript Pharmacy Campaigns

A Personalized Medicine
Pharmacy ™
Bringing personalized medicine to the
community
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Prepared by:
Mr. Dipen Kalaria, B.Sc. Phm
and
Medical Director, Willem (Bill) Wassenaar, MD
August 2006
Pharmacy.ca
311 Sherbourne St.
Toronto, Ontario
M5A 3Y1
1-800-727-5048
Email: [email protected]
The authors would be glad to answer any inquiries you may have about this presentation’s content
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What is Personalized
Medicine?
• The right drug;
• At the right dose;
• For the right person;
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Discussion Points
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Drug Development and Delivery Process
Evidence of Problems
How Patients Cope
Personalized Medicine
When to Seek Personalized Medicine
Services
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Drug Development Process
• Efficacy is based on population statistics
• Uniform study populations
• Moderate to severe illness
• Maximizes the probability of success
• Medication tested in fixed strengths
• Patient body size is not considered
• But drugs work at specific concentrations
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Drug Delivery Model
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Emphasis is on the product not the patient
Only 1, 2 or 3 standardized strengths
Strength increments usually 100%
Prescribing focus
• What is commercially available not what is the
minimum actually required by a given patient
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Is It A Problem?
What is the evidence?
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Adverse Drug Reactions
• ADRs are the leading cause of hospitalizations*
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2.2 million serious cases
100,000 deaths
76% of ADR’s were dose dependent
Risk ratio of women to men of 1.5:1
Other factors
• Patient age
• Number of drug exposures
* Does not include errors in administration, non-compliance, over dosage, drug
abuse & therapeutic failures
Lazarou JAMA (1998) 279:1200-1205
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The ‘Usual Dose’ Problem
• Strength confused with dose
• “I usually start with the 50 mg”
• This could result in a dose of :
• 1 mg per kilo for a 50 kg female
• 0.55 mg per kilo in a 90 kg male
• e.g. Cerivastatin (Baycol)
• Strength range 4 fold (0.2 to 0.8 mg)
• Dose range 7 fold (2 to 14 microgram/kilo)
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Clinical Trial Exclusion Rates*
• Up to 79 % of patients with a given condition are
excluded from drug efficacy trials, based on the
manufacturer’s exclusion criteria
• Chief basis for exclusion
– Illness severity too mild to show benefit over placebo
– Significantly chronically ill patients
* Zimmerman et al Am J Psychiatry 2005;162:1370-1372
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Clinical Trial Drop Out Rates
In patients meeting trial screening criteria:
• Zyprexa: 15% discontinued treatment due
to adverse events.
• Paxil: 21% of patients in worldwide
clinical trials discontinued treatment due to
an adverse experience.
• Zoloft: 15% discontinued treatment due to
adverse events.
CPS 36th edition
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Major Drug Withdrawals
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Cerivastatin (Baycol)
Terfenadine (Seldane)
Cisapride (Prepulsid)
Rofecoxib (Vioxx)
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How Patients Cope
• Patients suffering medication side effects
typically do the following:
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Try another drug in the same class
Try another drug in another class
Skip doses
Split pills in half to lower the dose
Suffer the side effects in silence
Stop therapy altogether
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Personalized Medicine
• What we do:
– Provide custom strengths for individual patients
• How we do it:
– Unique patented technology
• What we use:
– Well known active ingredients
– Ingredients are placed into capsules
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Personalized Medicine
Best possible benefit for the individual patient
with the minimum of side effects
• Side effects impact quality of life
• Major problem of adherence to treatment
• More humane treatment
• Gently move up the dose to get the desired benefits
• Minimizes the amount of drug taken
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Personalized Medicine In Practice
No. of Strengths we
have dispensed
Venlafaxine
No. of
Commercial
Strengths
3
Citalopram
3
20
Paroxetine
3
17
33
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Discontinuation Titrations
Abruptly stopping some medications may
cause patients to experience ‘side effects’.
• May be mistaken for resurgence of illness.
• Personalized Medicine provides a solution:
• Paroxetine reduced by 10% per week.
• Benzodiazepines reduced by 10% per month.
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A Commercial Product’s Typical
Strength Increments
• Manufacturer’s medication available in
strengths of 10, 20, 40, 80 mg
• Each step up represents 100% increase
• Is an intermediate strength adequate?
• Titrate to effect: BP, Lipid profile
• Minimize the amount of drug to be eliminated
by liver and kidney
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Impact of Taking A Little Less
Than the Standard Strength
Daily Dose
40 mg / day
Consumed in 10 yrs
146,000 mg
32 mg / day
117,000 mg
Difference
29,000 mg
1.
2.
3.
4.
725 Drug free days (2 Drug free years)
2 Drug free months every year
Annual savings per patient $200
Reduced level of environmental contamination
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When To Seek Personalized
Medicine
• Family history of drug sensitivities
• Personal history of medication intolerance
• Lowest available strength is effective but the
side effects are intolerable
• Lowest strength not effective, next highest
strength gives too many side effects
• Taking many different medications
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How To Use Our Service
• Send us an email or call us about a particular
patient and let us know what you would like to do
• We will
• Tell you about our experience with similar patients
• Make recommendations for writing the prescription
• Deal directly with the patient after you sign off
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For More Information on
Personalized Medicine
Pharmacist: Mr. Dipen Kalaria, B.Sc. Phm
Medical Director: Willem (Bill) Wassenaar, MD
Pharmacy.ca
311 Sherbourne St.
Toronto, Ontario
M5A 3Y1
1-800-727-5048
Email: [email protected]
Mr. Kalaria and Dr. Wassenaar are available for small group presentations to physicians, allied
healthcare professionals and National/Provincial patient advocacy agencies.
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