Positive Results Found In Trial Of Special Diabetes Care Package For UK Asians In UK, some residents of South Asian ethnic origin have received a special diabetes care package that has resulted in some benefits. However, in a Diabetes Special Issue of The Lancet , researchers suggest stricter targets in general practice and additional measures to keep patients motivated in order to lessen impact of diabetes on this segment of population. Patients with type 2 diabetes ( commonly known as adult-onset diabetes ) of Indian, Pakistani, Bangladeshi, and other South Asian backgrounds present certain management challenges for doctors in UK. First, compared to white Europeans, patients with South Asian backgrounds are 4 to 6 times as likely to have type 2 diabetes. In addition, onset of the disease for patients from South Asia often occurs over 10 years earlier than for whites, and risks of cardiovascular and renal complications is greater in this segment population ( including a 50% higher mortality rate ) . Further complications in management are due to cultural, communication, and social deprivation issues. To evaluate the effectiveness of specialized care packages designed to improve cardiovascular risk factors for South Asian patients with type 2 diabetes, Professor Anthony Barnett and Dr Srikanth Bellary ( Heart of England NHS Foundation Trust, Birmingham, UK ) and colleagues conducted a randomized controlled trial. The data were drawn from 21 UK inner-city practices, each assigned either to a control group or an intervention group. The control group consisted of 12 practices with 618 patients; intervention group - enhanced care with additional nurse time, support from link workers, and a diabetes specialist nurse - consisted of 9 practices with 868 patients. The researchers analyzed outcomes of blood pressure changes, total blood pressure, total cholesterol, and glycemic control at two years. Over the two year trial, researchers found that in the intervention group, systolic blood pressure decreased by about 4. 9 mm Hg, diastolic blood pressure decreased by about 3. 8 mm Hg, and cholesterol decreased by about 0. 45 mmol/l, all with statistical significance. There was no notable change, however, in glycemic control. Even though enhanced care package resulted in small, sustained reductions in blood pressure, which have associated health benefits, the authors conclude that, " Improvement in glycaemic control remains a major challenge, and further work to enhance effectiveness of health-care delivery in general practice and to improve motivation is clearly needed for this group if health-care inequalities are to be reduced. " Dr Tahseen Chowdhury and Professor Graham Hitman ( Barts and The London NHS Trust and School of Medicine and Dentistry, London, UK ) write in a Comment that accompanies this research: " These findings should equate to substantial reductions in cardiovascular disease in this population over time. However, similar reductions in glycaemic control haven't been achieved, emphasising that this challenge in diabetes care remains, particularly for South Asian patients. " Enhanced diabetes care to patients of south Asian ethnic origin ( United Kingdom Asian Diabetes Study ) : a cluster randomised controlled trial S Bellary et al. The Lancet ( 2008 ) . 371 [9626]: pp. 1769 - 1776. Click Here to View Abstract Written by: Peter M Crosta Copyright: Medical News Today Not to be reproduced without permission of Medical News Today
|
Trusted information about Zoloft. Zoloft: uses Zoloft is used to treat depression, panic attacks, obsessive compulsive disorders, post-traumatic stress disorder, social anxiety disorder ( social phobia ) , and a severe form of premenstrual syndrome ( premenstrual dysphoric disorder ) . It's known as a selective serotonin reuptake inhibitor ( SSRI ) .
Zoloft may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks ( compulsions such as hand-washing, counting, and checking ) that interfere with daily living. This medication works by helping to restore balance of certain natural chemicals ( neurotransmitters such as serotonin ) in brain. Zoloft: how to use Read the Medication Guide ( US ) or Patient Information Leaflet ( Canada ) available from your pharmacist before we start using Zoloft and each time we get a refill. If you have any questions, consult your doctor or pharmacist.
This liquid medication must be mixed with another fluid before use. Remove prescribed amount of liquid medication from bottle with dropper provided. Mix medication with half a cup ( 4 ounces or 120 milliliters ) of water, ginger ale, lemon-lime soda, lemonade, or orange juice. Do not use any other fluid for mixing Zoloft. The mixture may appear cloudy. This is normal and harmless.
Mix each dose just before taking it. Don't prepare a supply for future use.
Take Zoloft/liquid mixture by mouth, usually once daily with or without food or as directed by your doctor. Zoloft may make we sleepy or wakeful. Therefore, depending on how Zoloft affects you, your doctor may direct we to take entire dose once daily either in the morning or evening.
If we are taking Zoloft for premenstrual problems, your doctor may direct we to take Zoloft every day of month or just for 2 weeks before your period through first full day of your period.
The dosage is based on your medical condition and response to therapy. Follow your doctor's instructions carefully. Don't take more or less medication or take it more frequently than prescribed. Your condition won't improve any faster and your risk of side effects will increase. Use this medication regularly in order to get the most benefit from it. To help we remember, use it at same time each day.
It is important to continue taking Zoloft as prescribed even if we feel well. Do not stop taking Zoloft without consulting your doctor. Some conditions may become worse when Zoloft is abruptly stopped. Your dose may need to be gradually decreased to reduce side effects. Consult your doctor or pharmacist for more details.
It may take up to 4 weeks before full benefit of this drug takes effect.
Inform your doctor if your condition persists or worsens. Zoloft: side effects See also Warning section.
Nausea, dizziness, dry mouth, loss of appetite, increased sweating, drowsiness, diarrhea, upset stomach, or trouble sleeping may occur while use Zoloft. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed Zoloft because he or she has judged that benefit to you is greater than the risk of side effects. Many people using Zoloft do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects occur:
Tell your doctor immediately if any of these highly unlikely but very serious side effects occur:
Zoloft may rarely cause a very serious condition called serotonin syndrome. The risk increases when Zoloft is used with certain other drugs such as " triptans " used to treat migraine headaches ( e. g. , sumatriptan, eletriptan ) , certain antidepressants including other SSRIs ( e. g. , citalopram, paroxetine ) and SNRIs ( e. g. , duloxetine, venlafaxine ) , lithium, tramadol, tryptophan, or a certain drug to treat obesity ( sibutramine ) . Before taking Zoloft, tell your doctor if we take any of these medications. Serotonin syndrome may be more likely when we start or increase dose of any of these medications. Seek immediate medical attention if we develop some of following symptoms:
For males, in very unlikely event we have a painful or prolonged erection lasting 4 or more hours, stop using Zoloft and seek immediate medical attention, or permanent problems could occur.
A very serious allergic reaction to Zoloft is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include:
This is not a complete list of possible side effects. If we notice other effects not listed above, contact your doctor or pharmacist. Zoloft: precautions Before taking Zoloft, tell your doctor or pharmacist if we are allergic to it; or to latex; or if we have any other allergies.
Before using Zoloft, tell your doctor or pharmacist your medical history, especially of:
This liquid medication contains alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease. Some medications ( e. g. , metronidazole, disulfiram ) can cause a serious reaction when combined with alcohol. Ask your doctor or pharmacist about safe use of this product.
Zoloft may make we drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Avoid alcoholic beverages.
Caution is advised when using Zoloft in the elderly because they may be more sensitive to the side effects of drug. The elderly are also more likely to develop a type of mineral imbalance ( hyponatremia ) , especially if they're also taking " water pills " ( diuretics ) with this medication.
Caution is advised when using Zoloft in children because they may be more sensitive to side effects of drug, especially loss of appetite and weight loss. It is important to monitor weight and growth in children who are taking Zoloft.
Zoloft is not recommended for use during pregnancy. It may harm an unborn baby. Also, babies born to mothers who have used Zoloft during the last 3 months of pregnancy may infrequently develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.
Since untreated depression can be a serious condition, do not stop taking Zoloft unless directed by your doctor. If we are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss benefits and risks of using Zoloft during pregnancy with your doctor.
Zoloft passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding. Zoloft: interactions See also Precautions.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop or change dosage of any medicine before checking with them first.
Avoid taking MAO inhibitors ( e. g. , furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine ) within 2 weeks before, during, and after treatment with this medication. In some cases a serious, possibly fatal drug interaction may occur.
Zoloft should also not be used with the following medications because very serious interactions may occur while use Zoloft:
If we are currently using any of these medications, tell your doctor or pharmacist before starting Zoloft.
Before using Zoloft, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:
Zoloft can affect removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include cimetidine, cisapride, clozapine, and certain drugs for heart rhythm such as flecainide/propafenone, among others. Consult your doctor or pharmacist for more details.
Also report use of drugs which might increase seizure risk ( decrease seizure threshold ) when combined with Zoloft such as bupropion, isoniazid ( INH ) , theophylline, or tramadol, among others. Consult your doctor or pharmacist for details.
Tell your doctor or pharmacist if we also take drugs that cause drowsiness such as: certain antihistamines ( e. g. , diphenhydramine ) , anti-seizure drugs ( e. g. , carbamazepine, phenytoin ) , medicine for sleep or anxiety ( e. g. , alprazolam, diazepam, zolpidem ) , muscle relaxants, narcotic pain relievers ( e. g. , codeine, meperidine ) , psychiatric medicines ( e. g. , chlorpromazine, risperidone, thioridazine ) .
Check labels on all your medicines ( e. g. , cough-and-cold products ) because they may contain drowsiness-causing ingredients, pain relievers/fever reducers ( NSAIDs such as aspirin, ibuprofen, or naproxen ) or the cough suppressant dextromethorphan. Ask your pharmacist about the safe use of those products.
Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention ( usually at dosages of 81-325 mg per day ) , should be continued. Consult your doctor or pharmacist for more details.
This document doesn't contain all possible interactions. Therefore, before using Zoloft, tell your doctor or pharmacist of all products you use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.
|
