Late last year, Janssen's (actually Miles Pharmaceuticals) powerhouse fluroquinolone - LEVAQUIN, had its patent protection expire. What had been a $29.00 USD (per tablet, with a ten-tablet average per script) medication) as of July, 2011, has three generic rivals. Dr.Reddy's Labs (India, Mexico), Teva Pharmaceuticals (Israel, USA), and Greenstone, Ltd (Michigan, USA) each have approved versions of the medication available to the pharmaceutical market.
It has taken almost six months for availability and distribution to "hit every corner" of the U.S., Dr. Reddy's was the first available in my hometown in Pennsylvania. I've had no problems with the quality of any of Reddy Labs' offerings in the past, even though they've had issues . Teva is a first-rate producer of pharmaceuticals, the "Cadillac" of generic drug makers (IMHO, Mylan is of equivalent stature). My pharmacist, whom I interviewed for this post, has had little experience with Greenstone, so I won't elaborate with regards to them.
Why has levofloxacin been so slow to saturate the market?? Primarily because of the costs involved with product liability insurance coverage borne by the manufacturer, distributor, and the pharmacy's liability carrier. Levofloxacin has a myriad of bad side effects, including effects on the heart, tendons, severe insomnia, and more. At least 50% of the retail cost of the generic med will reflect that liability cost, all of this adds up, and is the main reasoning behind the "slow to market" appearance of this life-saving, powerful anti-infective.
Per: Moderator Tim
Many thanks to MSP, R.Ph. for his help in compiling this info!!
Monday, December 5, 2011
Your urologist is recommending urethrotomy PART 2
The big day is here, you have arrived at the appointed coordinates, signed-in, filled out 739 individual sheets of paper asking everything from your mother's maiden name to your preferred brand of underwear (Hanes). You'll be instructed to disrobe and change into a cotton gown (you know, the famous type where your ass hangs out), told to hop on up into a hospital bed where the nurse will again ask what type of surgery you are having (this is a good thing, a safety procedure which helps assure that you won't receive an incorrect surgery), have your vital's checked (temp, pulse, BP, pulse oximetry), and have an IV started (usually in the hand, one "prick", and it's done). You may be given an IV sedative or other pre-surgical medication at this time, also, an IV antibiotic such as gentamycin may be administered prior to your being wheeled into the surgical theater.
After your surgeon's fifth cup of coffee and a pit-stop in the bathroom, the OR staff will transfer you over to a gurney for transport to the OR. You will again be asked which procedure you are having performed (this is one time when being a smartass doesn't pay), asked to transfer onto the operating table, and placed into the lithotomy (OB/GYN) position, stirrups and all. Your choice of anesthesia will be started and this is what happens next:
THE PROCEDURE:
After your surgeon's fifth cup of coffee and a pit-stop in the bathroom, the OR staff will transfer you over to a gurney for transport to the OR. You will again be asked which procedure you are having performed (this is one time when being a smartass doesn't pay), asked to transfer onto the operating table, and placed into the lithotomy (OB/GYN) position, stirrups and all. Your choice of anesthesia will be started and this is what happens next:
THE PROCEDURE:
- Your urinary meatus will be exposed and cleansed with a Povidone-iodine wipe (Betadine), and approximately 30 cc's (one fluid ounce) of a viscous topical anesthetic containing lidocaine (usually Anestacon) will be instilled into your urethra, then held in the urethra by applying a crown clamp to the base of the head of the penis (the penile corona). Depending upon your choice of anesthesia, your physician may choose to begin immediately (using the viscous anesthetic as a lubricant for the cystoscope), or wait a few minutes for it to take effect.
- A cystoscope with a trans-urethral injection system will be inserted into the urethra, and the surgeon will inject lidocaine (a local anesthetic) into the length of the stricture at various points using a technique called "infiltration".
- The cystoscope/injection system will be withdrawn, and a cutting device called a urethrotome will be attached to the cystoscope and inserted. A safety guide filament will be threaded through the stricture, and into the bladder. This helps the surgeon position the urethrotome in a safe aspect for performing the incisions into the stricture Next, the surgeon will guide the urethrotome to the face of the stricture and a small blade towards the tip of the instrument will be deployed using a trigger mechanism to cut the stricture at locations he or she believes will provide optimum relief. The urethrotome/safety guide/cystoscope will then be withdrawn, and an appropriately sized catheter will be inserted and connected to a urinary drainage system (catheter hose and bag).
- You will be instructed on the care and emptying of the catheter/drainage system/bag, and given prescriptions for an antibiotic/systemic antibacterial, a urinary analgesic (pyridium or prosed), a few days of a minor pain medication (there is usually very little pain associated with urethrotomy), and instructed to see the surgeon in three to seven days for removal of the catheter.
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