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Adverse Reactions With Increased Frequency In Individual Indications For certain procedures, the number of some adverse reactions was higher than the overall rate for all procedures. Following are the clinically relevant experiences occurring at a higher rate, listed by indication: Cerebral Arteriography ! Central and Peripheral Nervous System: vertigo 28.3% ; , scotoma 12.3% ; , headache 11.3% ; , sensory disturbance 6.6% ; . ! ! Gastrointestinal System: nausea 5.7% ; . Psychiatric: confusion 3.8. Admit to: Diagnosis: Congestive Heart Failure Condition: Vital Signs: q1h. Call physician if P 120; BP 150 100 80 T 38.5C; R 25, 10. 5. Activity: Bed rest with bedside commode. 6. Nursing: Daily weights, measure inputs and outputs. Head-ofbed at 45 degrees, legs elevated. 7. Diet: 1-2 gm salt, cardiac diet. 8. IV Fluids: Heparin lock with flush q shift. 9. Special Medications: -Oxygen 2-4 L min by NC. Diuretics: -Furosemide Lasix ; 10-160 mg IV qd-bid or 20-80 mg PO qAM-bid [20, 40, 80 mg] or 10-40 mg hr IV infusion OR -Torsemide Demadex ; 10-40 mg IV or PO qd; max 200 mg day [5, 10, 20, 100 mg] OR -Bumetanide Bumex ; 0.5-1 mg IV q2-3h until response; then 0.51.0 mg IV q8-24h max 10 mg d or 0.5-2.0 mg PO qAM. -Metolazone Zaroxolyn ; 2.5-10 mg PO qd, max 20 mg d; 30 min before loop diuretic [2.5, 5, 10 mg]. ACE Inhibitors: -Quinapril Accupril ; 5-10 mg PO qd x 1 dose, then 20-80 mg PO qd in 1 divided doses [5, 10, 20, 40 mg] OR -Lisinopril Zestril, Prinivil ; 5-40 mg PO qd [5, 10, 20, 40 mg] OR -Benazepril Lotensin ; 10-20 mg PO qd-bid, max 80 mg d [5, 10, 20, 40 mg] OR -Fosinopril Monopril ; 10-40 mg PO qd, max 80 mg d [10, 20 mg] OR -Ramipril Altace ; 2.5-10 mg PO qd, max 20 mg d [1.25, 2.5, 5, 10 mg]. -Captopril Capoten ; 6.25-50 mg PO q8h [12.5, 25, 50, 100 mg] OR -Enalapril Vasotec ; 1.25-5 mg slow IV push q6h or 2.5-20 mg PO bid [5, 10, 20 mg] OR -Moexipril Univasc ; 7.5 mg PO qd x 1 dose, then 7.5-15 mg PO qd-bid [7.5, 15 mg tabs] OR -Trandolapril Mavik ; 1 mg qd x 1 dose, then 2-4 mg qd [1, 2, 4 mg tabs]. Angiotensin-II Receptor Blockers: -Irbesartan Avapro ; 150 mg qd, max 300 mg qd [75, 150, 300 mg]. -Losartan Cozaar ; 25-50 mg bid [25, 50 mg]. -Valsartan Diovan ; 80 mg qd; max 320 mg qd [80, 160 mg]. -Candesartan Atacand ; 8-16 mg qd-bid [4, 8, 16, 32 mg]. -Telmisartan Micardis ; 40-80 mg qd [40, 80 mg]. Adosterone Receptor Blockers: -Spironolactose Aldactone ; 25 mg PO qd -Eplerenone Inspra ; 25 mg PO qd. Beta-Blockers: -Carvedilol Coreg ; 1.625-3.125 mg PO bid, then slowly increase the dose every 2 weeks to target dose of 25-50 mg bid [tab 3.125, 6.25, 12.5, mg] OR -Metoprolol Lopressor ; start at 12.5 mg bid, then slowly increase to target dose of 100 mg bid [50, 100 mg] OR -Bisoprolol Zebeta ; start at 1.25 mg qd, then slowly increase to target of 10 mg qd [5, 10 mg] OR -Metoprolol XL Topeol XL ; 50-100 mg PO qd. Digoxin Lanoxin ; 0.125-0.25 mg PO or IV qd [0.125, 0.25, 0.5 mg]. Inotropic Agents: -Dobutamine Dobutrex ; 2.5-10 mcg kg min IV, max of 14 mcg kg min 500 mg in 250 ml D5W, 2 mcg ml ; OR -Dopamine Intropin ; 3-15 mcg kg min IV 400 mg in 250 cc D5W, 1600 mcg ml ; , titrate to CO 4, CI 2; systolic 90 OR -Milrinone Primacor ; 0.375 mcg kg min IV infusion 40 mg in 200 m L N mg ml titrate to 0.75 mgc kg m i n ; arrhythmogenic; may cause hypotension. Vasodilators: -Nitroglycerin 5 mcg min IV infusion 50 mg in 250 ml D5W ; . Titrate in increments of 5 mcg min to control symptoms and maintain systolic BP 90 mmHg. -Nesiritide Natrecor ; 2 mcg kg IV load over 1 min, then 0.010 mcg kg min IV infusion. Titrate in increments of 0.005 mcg kg min q3h to max 0.03 mcg kg min IV infusion. Potassium: -KCL Micro-K ; 20-60 mEq PO qd if the patient is taking loop diuretics. Pacing: -Synchronized biventricular pacing if ejection fraction 40% and QRS duration 135 msec. 10. Symptomatic Medications: -Morphine sulfate 2-4 mg IV push prn dyspnea or anxiety. -Heparin 5000 U SQ q12h or enoxaparin Lovenox ; 1 mg kg SC q12h. -Docusate Colace ; 100-200 mg PO qhs. -Famotidine Pepcid ; 20 mg IV PO q12h OR -Lansoprazole Prevacid ; 30 mg qd. 11. Extras: CXR PA and LAT, ECG now and repeat if chest pain or palpitations, impedance cardiography, echocardiogram. 12. Labs: SMA 7&12, CBC; B-type natriuretic peptide BNP ; , cardiac enzymes: CPK, CPK-MB, troponin T, myoglobin STAT and q6h for 24h. Repeat SMA 7 in AM. UA. 1. 2. 3 and coumadin.

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However, it is associated with more shortterm side effects, including nausea, headache, fatigue, burning, and itching. Gabapetin Neutrontin ; adjunct therapy ; Two class II studies n 45 ; 53, 54 ; reported little or modest benefit when gabapentin was used as adjunctive therapy in doses of 1, 800 and 3, 600 mg day. One study found no significant changes in clinical rating scale scores, 54 ; while the other study found a 42% improvement from gabapentin and a 28% improvement from placebo. 53 ; There was a 12% reduction in tremor with gabapentin by accelerometry, but this was not significant. 53 ; Glutethimide Doriden ; Glutethimide is a nonbarbiturate sedative agent that reduced ET by class IV data only. 55 ; L-Tryptophan Pyridoxine L-Tryptophan is an amino acid precursor of tryptamine and serotonin, and pyridoxine is a coenzyme for dopa decarboxylase. One case series demonstrated that l-tryptophan pyridoxine failed to improve tremor in 2 patients with ET. 56 ; Metoprolol Lopressor, Hoprol ; Metoprolol is a beta-1-adrenoreceptor antagonist, and the evidence regarding its anti-tremor efficacy is conflicting. One class I study showed that a single dose of 150 mg metoprolol improved tremor. 57 ; However, one class I study found that metoprolol was ineffective for the management of limb tremor in ET when used in doses of 150 and 300 mg day for 2 to 4 weeks. 58 ; Nicardipine Cardene ; Nicardipine is a calcium channel blocker and an antihypertensive agent. One class II study found that nicardipine over a 4-week period did not reduce tremor significantly, while a single 30 mg dose produced significant reductions in tremor amplitude compared to baseline and placebo. 59 ; Olanzapine Zyprexa ; The atypical antipsychotic medication olanzapine reduced tremor in a class IV study using a mean dose of 14.87 mg day. 60 ; Twenty percent of patients reported sedation, and several patients reported weight gain. Phenobarbital Luminal ; Phenobarbital is an anticonvulsant and a sedative. One class II study n 17 ; that evaluated the anti-tremor effect of Phenobarbital compared to propranolol and placebo found that while phenobarbital was better than placebo when tremor was measured with accelerometry but not with a clinical rating scale. 61 ; Another class I study n 16 ; found that phenobarbital mean dose 136 25 mg day ; was no better than placebo. 62 ; Ouetiapine Seroquel ; Quetiapine is an atypical antipsychotic agent. One class IV study n 10 ; evaluated the safety and tolerability of quetiapine up to 75 mg day ; as monotherapy in ET over a 6-week period. 63 ; Patients were evaluated with a clinical rating scale. Six patients completed the study, and the mean tolerated dose of quetiapine was 60 mg 21.08 range 25 to 75 mg ; . The most common side effect was somnolence. No statistical differences were noted pre- and posttreatment. Theophylline Theo-dur ; Theophylline is a xanthine derivative bronchodilator that can induce tremor. 64, 65 ; However, several studies have demonstrated that theophylline in low doses may improve ET. 66, 67 ; In one double-blind, crossover study, patients who were given a single oral dose of theophylline had no significant change in tremor for the following 24 hours. 66 ; However, tremor was significantly improved after 4 weeks of treatment with theophylline 300 mg day as measured by clinical rating scales. In another double-blind trial, patients were given placebo, propranolol 80 mg day, or theophylline 150 mg day for 4 weeks. 67 ; No reduction in tremor was noted in patients taking theophylline until the end of the second week of treatment. Both propranolol and theophylline reduced tremor at study endpoint compared to baseline. No adverse events were reported with theophylline use.

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Status: Phase III start Milestone: NA TEVA and ACTI submitted an IND to FDA to begin a Phase III trial. Agensys Inc., Santa Monica, Calif. Product: AGS-PSCA Business: Cancer Molecular target: Prostate stem cell antigen PSCA ; Description: Human IgG1k monoclonal antibody Indication: Treat advanced prostate cancer Endpoint: Safety and pharmacokinetics Status: IND submitted Milestone: NA Agensys submitted an IND to start a dose-escalation, U.S. Phase I trial in up to advanced prostate cancer patients. AGS-PSCA was generated using XenoMouse technology from Abgenix Inc. ABGX, Fremont, Calif. ; . Arginox Pharmaceuticals Inc., Menlo Park, Calif. Product: Tilarginine acetate injection TAI ; Business: Cardiovascular Molecular target: Nitric oxide NO ; synthetase Description: Nitric oxide NO ; synthetase inhibitor Indication: Treat cardiogenic shock Endpoint: All cause mortality at 30 days Status: Phase III started Milestone: NA Arginox began the double-blind, placebo-controlled, international Phase III TRIUMPH trial to treat cardiogenic shock in about 650 patients. Ariad Pharmaceuticals Inc. ARIA ; , Cambridge, Mass. Product: AP23573 Business: Cancer Molecular target: FK 506 binding protein FKBP-12, macrophilin-12 ; Description: Small molecule mTOR inhibitor Indication: Treat recurrent or persistent endometrial cancer Endpoint: NA Status: Phase II started Milestone: NA ARIA started a U.S. and European Phase II trial in about 45 patients with recurrent or persistent endometrial cancer. AVI BioPharma Inc. AVII ; , Portland, Ore. Product: AVI-4065 Business: Infectious Molecular target: NA Description: Neugene antisense drug targeting hepatitis C virus HCV ; Indication: Teat chronic hepatitis B virus HBV ; Endpoint: Safety, tolerability, pharmacokinetics and viral response Status: IND submitted Milestone: NA AVII submitted an IND for AVI-4065 to start a dose-comparing, U.S. Phase Ib trial in up to patients. Bayer AG FSE: BAYG; BAY ; , Leverkusen, Germany Product: Bay 79-4980 Business: Hematology Molecular target: Not applicable Description: Recombinant factor VIII rFVIII ; formulated with PEGylated liposome technology and buy inderal. It is best to get these from our pharmacy and discard them when they expire. Make black label for concerta i have lasting 27 mg dose option milestone toprol xl 25mg for going into the sympathetic nervous system provides healthcaresolutions that you have it cephalexin contraindications may cause dizziness, drowsiness, blurred vision training and philanth.

As well as the close-down of the Avanir collaboration on reverse cholesterol transport compounds. Both of these provisions were anticipated in the 0m impairment exposure I talked about at the beginning of the year. SG&A is pretty straightforward. Spend is flat in CER terms versus the first quarter last year. We still anticipate the full year to be in the low single digits. Other income of 8m was up m over the first quarter of 2006. We did see the expected reduction in royalty income, but in the quarter we also realized some anticipated insurance recoveries. Back in February, you'll remember that I guided you to other income in the range of one-half to two-thirds of the levels in 2006. My best estimate now is that we'll be a bit ahead of the two-thirds of last year. The tax rate in the quarter was 31%. And it tends to be a bit lumpy quarter to quarter, but I'm still expecting a 29% tax rate for the full year. Strong cash flow continues. We generated .9b in free cash flow in the quarter. Cash distributions to shareholders in the quarter totaled just over b, net share repurchases of .1b and a dividend payment of nearly .9b. We're still aiming for a net share buyback for the year of b. So, after unpicking all of the moving parts, this represents a good start for the year and we believe we're on track to meet our targets and reaffirm our earnings guidance. You'll remember our earnings target range of .80 to .05 was constructed on an ex-Toprol XL basis, with sales and earnings from Topdol XL excluded from both current and prior-year periods. In addition, this range did not include any one-off costs associated with the productivity initiatives. This means our underlying guidance has not changed, but we obviously have some Foprol sales and restructuring costs in the books for quarter one. So, adjusting the range for the ##TEXT##.13 contribution from Toprol and the ##TEXT##.04 restructuring charges, this equates to an adjusted range of .89 to .14. Just to be perfectly clear, there's no future Toprol earnings or restructuring costs included in this. That said, we've also given you some basis for making your own estimates for these impacts. With the current situation of generic solely on the 25mg dose, the run rate for the Toprol contribution remains at around 0m per month. And we've also said that we anticipate the supply chain charges to amount to 0m in 2007. Before turning to MedImmune, I just want to make a couple of quick comments on the key product highlights. The five key growth brands grew combined sales by 17% in the first quarter. And within that group, Nexium sales were up 8%, in line with our guidance of single-digit growth this year. Sales in the U.S. were up 9%, broadly in line with the trend of dispensed tablets. Germany remains a drag on the Rest of the World performance, where sales were up by 5%. Crestor sales were up by 59%, with sales in the U.S. up 56%. Crestor prescription growth, at 46%, was well ahead of the 11% growth in the statin market. But there's no doubt that the strong growth in simvastatin, with the new generic entries as well as the change in planned formularies from the beginning of the year, it's a strong head -- it represents a strong headwind for the branded products in terms of market share progress, as you've seen in recent weeks. But it's Lipitor that appears to be taking most of the brunt of this. The METEOR data was well-received at ACC and the atherosclerosis submissions are well under review in the U.S. and in Europe. Seroquel was up 13% in the quarter. U.S. prescriptions are up 12% and market share in the U.S. is up to 31% in March. That's half a point higher than it was in December. We're seeing a really good uptake for bipolar depression, but of course this is at somewhat lower doses than you see for schizophrenia. Arimidex was up 15%. U.S. prescriptions were up by 11% and its sales growth of 27% includes some de-stocking of inventories in the first quarter of last year.