DURA LAUNCHING TORNALATE (BITOLTEROL powder MESYLATE) BRONCHODILATOR

DURA LAUNCHING TORNALATE (BITOLTEROL MESYLATE) BRONCHODILATOR six months after approval of the beta agonist on Feb. 19 as a "3S" drug. The San Diego-based asthma and allergy product firm Dura Pharmaceuticals began shipping (bitolterol) .02% solution for nebulization in August. The delay in the product's launch has been due, in part, to labeling and advertising discussions with FDA, the company said. wisepoqder bitolterol
Dura licenses Tornalate from Sterling Winthrop. Dura plans to position Tornalate as a bronchodilator with a longer duration of action than albuterol sulfate. Ads are planned for the October issues of medical specialty journals. Tornalate's duration of action was six or more hours for most patients in clinical trials and eight hours in 40% of the patients studied.
By comparison, albuterol inhalation solution labeling states that pulmonary function improvements are seen in some patients up to six hours following treatment. In April, Dura said it planned to launch bitolterol under the trade name Produral ("The Pink Sheet" April 20, p. 2). Dura's 92-person sales force also will market a Tornalate metered-dose inhaler licensed from Sterling Winthrop last June. Both products are being manufactured by Sterling Winthrop; Dura has exclusive rights worldwide except Italy (and Puerto Rico for the MDI). Tornalate was approved six years after Sterling filed the NDA.

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ALUPENT-10 (ORCIPRENALINE SULPHATE BP) - 10MG

What is ALUPENT-10?
Alupent-10 belongs to a class of medications called bronchodilators. The active ingredient orciprenaline sulphate relaxes and opens the air passages in the lungs, making it easier to breathe. The medication will treat symptoms such as wheezing, shortness of breath and trouble breathing caused by conditions such as asthma, emphysema, chronic bronchitis and chronic obstructive pulmonary disease (COPD).wisepoqder Orciprenaline sulphate

How is ALUPENT-10 used?
Alupent-10 should be taken orally as directed by a doctor, usually 3 to 4 times per day. The tablets can be taken with or without food but should be taken with plenty of water to prevent an upset stomach. Contact a doctor for the correct dosage and length of treatment as it will depend on the condition being treated and the patient�s response to the treatment. The medication can control the symptoms of asthma and other lung disease but cannot be used as a cure for the conditions.

Adverse effects
Alupent-10 may cause unwanted side effects such as:

Contact a doctor immediately should side effects persist or encounter more severe side effects such as:

Increased difficulty breathing
Irregular heartbeat
Muscle cramps
Chest pain
Warnings
Tell your doctor if you are using other bronchodilators as it may cause an unwanted drug interaction.

Immediately proceed to your nearest emergency department if you suffer an allergic reaction. Symptoms usually associated with such a reaction include difficulty breathing or swallowing, chest tightness, swelling, skin rashes, and hives.

ALUPENT-10 is not always suitable for all patients. Always consult your health care provider prior to using this medication if you are pregnant, breastfeeding, trying to conceive, using any other medication (prescription or non-prescription), using any herbal products or supplements, or if you have any allergies or other health problems.The correct dosage and prescription commonly depend on the patient and the condition being treated. Do not adjust your dosage without the approval of your health care provider. This product is only for use as prescribed and instructed.

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Brovana (arformoterol tartrate)

Brovana (arformoterol tartrate) is an inhalation solution that contains a long-acting beta2-adrenergic agonist (LABA). Brovana is administered twice daily using a standard jet nebulizer, and is indicated for use as a long-term maintenance treatment for adults with COPD. Brovana is not a rescue therapy, meaning it is not designed to treat sudden, severe COPD symptoms. However, Brovana can be used in addition to a rescue treatment if needed to treat acute bronchospasms when necessary. Individuals with asthma or liver, cardiovascular, or convulsive disorders should not take Brovana. Overdose of Brovana or use with other LABAs may be fatal.wisepoqder Arformoterol tartrate powder

What are the ingredients in Brovana?

The active ingredient in Brovana is arformoterol tartrate.

How does Brovana work?

Arformoterol tartrate is a LABA. This means that it activates beta2-adrenergic receptors in the body. Activation of these receptors sets off a chain of events on a molecular level that leads to smooth muscle relaxation, including relaxation of muscles in the airways. This smooth muscle relaxation can open the airways and reduce bronchospasms. Additionally, when these muscles are relaxed, common COPD symptoms like chest tightness, shortness of breath, and wheezing may be improved. Brovana is considered a maintenance therapy for COPD, meaning that it is used for long-term management of the condition, and not for sudden, severe symptoms or exacerbations. Rescue therapies, including medications classified as short-acting beta2-adrenergic agonists (SABAs), are used for immediate symptom relief, and can often be used alongside LABA medications when necessary. If you think you may benefit from adding a rescue medication to your maintenance therapy regimen, talk with your doctor or healthcare provider.
Individuals with asthma should not take Brovana. LABA medications, like Brovana, may increase the risk of asthma-related death. Brovana is not to be used as a rescue therapy or for immediate symptom relief. Individuals with liver impairment or a history of liver issues should use Brovana cautiously. Individuals with cardiovascular disorders, thyroid disorders, convulsive disorders, or who are sensitive to sympathomimetic drugs (stimulating medications that mimic the effects of the fight-or-flight response of the nervous system) should not take Brovana. If your symptoms or breathing difficulties worsen after taking Brovana, or if you develop increased blood pressure or irregular heartbeat, stop use immediately and seek medical attention.

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Glycopyrrolate-Indacaterol powder (Utibron Neohaler) for COPD

The combination of glycopyrrolate and indacaterol (brand name, Utibron Neohaler; Novartis) is a long-term maintenance treatment of airflow obstruction or to prevent bronchospasm in people with COPD. It is not a rescue medication, and will not work fast enough to treat a sudden bronchospasm attack or acute COPD symptoms.wisepoqder indacaterol

Glycopyrrolate is a LAMA (long-acting muscarinic antagonist) bronchodilator, and indacaterol is a LABA (long-acting beta2-agonist) bronchodilator.
How does glycopyrrolate-indacaterol for COPD work?Glycopyrrolate and indacaterol work by relaxing the muscles in the airways to improve breathing.

Glycopyrrolate is a long-acting muscarinic antagonist, also known as anticholinergic. It connects to the muscarinic receptors subtypes M1 to M5. The M3 receptors are located in the muscle of the bronchi, and are responsible for bronchoconstriction. As glycopyrrolate has affinity to the M3 receptors, it works by inhibiting them on the muscle of the bronchi, leading to bronchodilation.

Indacaterol is a long-acting beta2-agonist (LABA), and its effects are due to the stimulation of an enzyme, called adenyl cyclase, that is in the interior of the lung muscle cells. This enzyme helps convert adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). When the levels of cAMP increase, bronchial muscle cells relax, and inhibit release of mediators of immediate hypersensitivity, especially from mast cells.Beta2-receptors are predominant in the muscle cells of the lungs, but they are also present in the heart, which means indacaterol may have cardiac effects, such as irregular heartbeats.
Studies of glycopyrrolate-indacaterol

The U.S. Food and Drug Administration (FDA) approved Utibron Neohaler (glycopyrrolate-indacaterol) in 2015 based on the results of the Phase 3 EXPEDITION trial program, which included more than 2,500 COPD patients and consisted of two 12-week efficacy studies, FLIGHT1 (NCT01727141) and FLIGHT2 (NCT01712516), and one 52-week safety study, FLIGHT3, (NCT01682863). All participants were current or former smokers and had moderate-to-severe airflow limitation (post-bronchodilator FEV1 ≥ 30% and <80% of the predicted normal).

Twice daily glycopyrrolate-indacaterol treatment during the 12-week studies showed superior and sustained improvement in lung function at the study’s end, compared to either drug individually or to placebo. Treated patients also needed less rescue medication (albuterol) than those given placebo.At 52 weeks, Utibron Neohaler treatment showed "significant treatment effect,” as seen by improvements in FEV1, a measure of lung function, Novartis reported.

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Tinder makes dating smoother and more straightforward – or it should. Scammers can spoil any user’s experience, and Tinder bots are one of the main ways they do so. Here’s how to stay safe.

Bots comprise more than half of the web traffic. Not all of them are malicious, but scammers can use them to extract information or infect you with malware. Planting bots on Tinder lets scammers reach a large number of potential victims in a relatively short time.

Fake Tinder profiles vs. Tinder bots
Tinder bots are not the same as fake Tinder profiles. A bot is an account run by a computer program, while fake accounts have real people hiding behind fake identities for various reasons. Even though fake profiles might remind you of bots at first sight, it takes much longer to identify them in conversation. Some of them might even have stolen identities to back-up their agenda.

However, here are a few signs of fake tinder profiles:

Avoiding live contact. If you’ve been chatting for a very long time and your match is avoiding any calls or meet-ups, they might not be who they seem;
Asking for money and claiming that they’re in trouble;
Asking too many personal questions;
Inviting you to click on a link to play a game or check a photo. It will most likely be a malware infection or an advertising page;
Immediately asking for a long-term relationship or some form of commitment to gain trust while avoiding meet-ups, calls or providing a social media profile;
You can find their photos online and they turn out to be stock images or famous people.
Even though some fake profiles are relatively harmless, others can facilitate serious crimes such as blackmail or robbery. They might also cause you emotional damage, especially if you only discover the scam after establishing an emotional connection. Be aware of the signs described above and never give out your info or agree to meet-up in a remote location.

Bot or not?
Even though bots are widespread and gradually getting more advanced, they aren’t too difficult to identify on Tinder. Tinder scammers rarely have the resources to make them very sophisticated. Although you might get hooked at the first impression, further conversation will most likely show you are not talking to a real person.

Here are a few ways to identify a typical bot while swiping:

A profile not linked to an Instagram or Facebook account. If you see that a person’s profile is not linked to external social networks, that might be a red flag. Establishing a reliable-looking social media context around a fake profile is quite a difficult task, so scammers usually don’t bother;
A profile linked to a social media account that looks fake. It’s always worth doing a quick social media search in case you have any doubts. If you notice that all the images and interests are too common and the profile lacks a personal touch, it might not be authentic;
The bio looks fishy. If the bio includes lots of grammar mistakes, invitations to suspicious links, or personals details that do not make sense, you might have encountered a bot. If a simple search reveals that details from the bio are false or don’t make sense, that’s also a serious warning;
The photos look too good to be true. If you notice that a person’s profile consists of professional studio images, the scammer may have lifted them from some other account. Some people like to put extra effort into their Tinder accounts, but professional or perfect photos should prompt you to take another look before you continue.
If you already matched with someone, here are the red flags you should look out for when chatting to avoid a Tinder scam:

Immediate response. If you get the first message unusually quickly after matching with someone, it might be a bot. Bots can reply within milliseconds, which is quite difficult for a real person;
The conversation feels unnatural. A simple Tinder bot usually uses a string of messages to reply. They might answer some of your questions in a very basic way. However, they cannot maintain a natural conversational flow. Their replies might be completely unrelated to your message or they might immediately send you straightforward and provocative messages. Try asking something unexpected like "What color is the sky” or type a few random letters and see whether the responses make sense;
Conversations turn into a request to click on a link to continue chatting outside of Tinder, verify your profile, or check some photos. Never click on those links. They might snatch your data, enroll you in an expensive porn subscription, infect you with malware, provide annoying ads, etc. The bot will most likely stop chatting with you if you refuse;
Requests for personal details. If a person requests details such as your name, address, or credit card info, it is a sign that something is not right. Definitely don’t provide any sensitive data.
What to do if you encounter a bot
If you have strong suspicions that you’ve encountered a bot, Tinder has tools to report it:

1. When in chat, click on the red flag in the top right corner;

Tinder bots

2. Tap Report;

Tinder bots

3. Select the reason for reporting and click Submit.

Report a bot or fake account before unmatching it as you won’t be able to report it after it disappears from your chat list. You can also report an account before matching by:

1. Clicking on I (info) letter in the bottom right corner of the image;

2. Tapping Report (username) below the profile name or bio.

Tinder bots

Moreover, you should:

Not provide any personal info to a person you find suspicious;
Not agree to meet-up in remote or suspicious places;
Always double-check photos and social media profiles, and check search engines if you have any doubts;
Never open any suspicious links;
If you feel unsafe or threatened, click on your profile icon and then go to Settings. Scroll down to find Show Me on Tinder option and turn it off.
Tinder bots

Is Tinder safe?
Tinder is a relatively safe platform, but you should always take precautions. According to the Daily Mail, there have been 500 Tinder-related crimes reported during its six years of existence. Always stay alert when communicating with strangers, double-check their details in case of doubt, and instantly back-off if you notice any threatening signs.

In terms of privacy, Tinder is a dating app linked with Facebook, so much of your data will be collected while using it. Thus, do not give away too much personal data, as it will be used for marketing purposes or passed to third-parties.
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Spam text messages are more than just an annoying waste of your time. Scammers use them to get your personal information, make you pay extortionate amount of money for replies or calls, or install malware on your device. Don’t fall for such scams. Continue reading to find out what to do to stop spam messages.
What to do if you received a spam text message
ï‚·Never reply to spam text messages, even if they ask to reply to opt-out. If you do, it will confirm to the scammer that your phone number is active and they might use it for future attacks or to get more information out of you.
Never click on any linksas they might hide malicious software that can be installed on your device. Don’t clink on them even if they say ‘click to opt-out’. If the message claims to be from a company you trust, navigate to their website yourself to log in instead of using the link.
ï‚·Never give away any personal information.Legitimate companies would never ask you to reply with your login details, passwords, payment details or any other sensitive information. If you have any doubts, contact the company directly.
How to block spam text messages
ï‚·Block the number on your iOS or Android phone. However, this might not always work as scammers might send you messages from a spoofed number and could use a different one to text you next time.
On iPhone: Go to the text message > click on theSender ID> click onInfo> click on theSender ID> and tapBlock this caller.
ï‚·
On Android: Go to the text message > tap thethree-dot iconin the upper-right hand corner > chooseBlock number.
ï‚·
(Note: these instructions may vary if you use asecure messaging app)
ï‚·
Contact the company directly and ask to opt out. However, do not reply or call back to the number you received the text from. They may be coming from scammers pretending to be from the company you trust. It’s better to find their number online on their official webpage and give them a call.
ï‚·Put your mobile phone number on theNational Do Not Call Registry. This should stop sales people from buying or in other ways obtaining your number from various databases.
ï‚·Check whether your carrier can block the caller ID. However, they will usually focus on blocking unwanted calls rather than unwanted texts.
ï‚·You can try using third party apps. However, they also mostly block spam calls rather than texts. If you do decide to use such apps, beware that some of them might gather your data without your permission or even sell it to other companies. Read their privacy policies carefully.
How to report spam text messages
You should also consider reporting spam messages and their senders:
It’s illegal to send unsolicited commercial email messages to wireless devices, including cell phones and pagers, unless the sender gets your permission first. It’s also illegal to send unsolicited text messages from an auto-dialer that stores and dials phone numbers using a random or sequential number generator.
– Federal Trade Commission
Reporting such messages might also prevent further spam from being sent to your phone and might help other people avoid spam. You can do so by:
Filing an online complaint onthe FTC’s pageor on a similar regulatory body in your country.
ï‚·Reporting these messages and senders to your carrier. Copy or select the original message and text it to 7726. You can do so if you are an AT&T, Verizon Wireless, T-Mobile, or Sprint customer. They will use this information to try and block future spam messages.
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Hackers have once again found a way to exploit a security feature you trust. The Google Critical Security Alert designed to warn users about potentially unauthorized access has been turned into a phishing scam. Find out how hackers are using this feature to their advantage and what to do if you receive such an email.

How does the Google Critical Security Alert scam look?
Google’s Critical Security Alert is a useful security feature that notifies you every time a new device is used to log into your account. It may be you, or it may be a perpetrator. Either way, you will receive an email from Google double-checking whether the login was intended. If it wasn’t you, you should immediately check your Gmail account for any suspicious activity.

Many users receive these warnings after buying a new device, signing in from their work computer, or when browsing behind a proxy or a VPN server. The latter will change your IP address; therefore, Google will identify your connection as coming from a new device.
However, hackers wouldn’t be hackers if they wouldn’t find ways to exploit a trustworthy security feature and turn it into a phishing attack. Gmail users have been reporting phishing emails that seemed to be coming from Google. They usually present one of these two scenarios:

The email notifies users of a new attempted sign-in, claims that Google blocked the attempt, and asks the user to check their activity. However, the button that would normally lead to your Google security page here is spoofed. It leads to a malicious website or downloads malware directly onto your device;
The email notifies users of unauthorized access and asks them to reset their password immediately. In this scenario, the button to reset your password leads to a spoofed website that looks very similar to a legitimate Google login page. However, if a user enters their details here, they’re sent directly to the hacker.
What to do if you received a Google Critical Security Alert email
.Ask yourself whether it might be legitimate. Are you using a new device? Did you use a new device at work or borrow a friend’s device to log in? Or maybe your VPN launched automatically, and Google recognizes a new IP address? If so, the email might be a legitimate false alarm.
.Check who the sender is. Did the email come from a legitimate Google account? Hover over the sender but don’t click on it or reply to the email.
.Check the quality of the text. Does it have any grammatical errors? What about the writing style? Is it formal enough to pass for Google? Legitimate companies usually painstakingly proofread emails they send to users. If you spot any mistakes, it’s a good indication that it’s a phishing email.
.Never click on any links or buttons or download any files. Don’t give into temptation, even if the email ‘urges’ you to do so.
.Whether or not the email is legitimate, you cansafely check your account activityby going to yourGoogle account security checkup page. Here, you can see what devices and how many of them are currently signed in, check recent security events, and see which third-party apps have access to your account. Check all these tabs for suspicious activity. If you can’t see anything, it was likely a phishing scam.
.If you went through the steps above and are sure that the alert was legitimate,change your passwords immediately. Also,read these tipsto check for suspicious activity and what else needs to be done to reclaim your account.
What if you fell for the Google Critical Security Alert scam?
If you clicked on any links, downloaded attached files, or entered your details on a spoofed website, you may be in trouble. This means that hackers may already have your password or have installed malicious software onto your device.
It’s time to act fast. Hackers may now be able to:
ï‚·Take screenshots of your desktop;
ï‚·Steal passwords you saved on your drive or your web browser;
ï‚·Steal, amend or delete your files;
ï‚·Download more malware or adware onto your device;
ï‚·Install copies of the same malware and run it in secret, especially if you managed to spot it and manually delete it.
Here’s what you should do next if you have a suspicion that someone might have accessed your personal information or got into your device:
.Makestronger passwords. Delete them from your browser and use a password manager likeNordPass instead;
.Locate the malware and manually delete it. This may require some technical know-how. If you are not comfortable doing this, try a third-party malware detection/antivirus program or speak to a professional and let them take care of it.
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How to create a digital signature and sign your online documents
Electronic vs. digital signatures
Before signing anything, you need to know the difference between an electronic signature and a digital signature. You can use either to sign legally binding documents, so these terms are often used interchangeably. However, there is one key difference between them — one can be easily forged, the other cannot.

Electronic signatures are any electronic marks made by you with the intent to approve a document. This could be you your name typed in a different font, a mouse-drawn sign, or an image of your signature. Electronic signatures can be easily forged and we would not recommend using them. Just imagine — all someone has to do to sign a document under your name is print-screen your signature and paste it in!
Digital signatures are the more secure alternative, using cryptographic keys to attach your identity to a document. This lets the receiver to verify that the document was signed by you and wasn’t altered in transit. Digital signatures are considered to be as unique as handwritten ones, and they are almost impossible to forge. As such, banks and corporations often use them to confirm financial transactions and sign digital contracts.
For the purposes of this blog, we will only talk about digital signatures as they are more secure and more difficult to forge.

How to create your own digital signature
Creating a digital signature for yourself isn’t easy. You will need some technical know-how to generate cryptographic keys and set them up on different platforms. However, even then, your signature will not be considered secure.

Your public key needs to be approved by a Certificated Authority (CA) or a Trust Service Provider (TSP). They need to provide you with a digital certificate that is used to authenticate documents. Without it, the receiver has no way of knowing that the digital signature is really yours, which defeats the purpose of using one.

That’s why many organizations and individuals obtain digital signatures and digital certificates from a CA or a TSP. Once you have yours, you can start signing PDF and Word documents — read on to learn how.

How to create a digital signature in Adobe
How to create a digital signature in Adobe

To sign your PDFs, you need an Adobe Sign subscription with digital signatures enabled by your Adobe Sign administrator. Then:

Open Adobe Sign dashboard, choose Fill & Sign. Open the document you need to sign.
Click Sign and then Add Digital Signature.
Choose how to apply your digital signature. The most convenient way is to choose Cloud Signature. This way you’ll have to sign in with your Digital ID provided by a CA or TSP. However, you can also download the document and sign a PDF using a smart card, a USB token, or a file-based Digital ID. Then click Next.
If you chose Cloud Signature, select your Digital ID certificate provider from the drop-down menu, or click the link to get a new digital ID.
Enter your login details. Depending on your Digital ID provider, you may be asked for additional verification, like a PIN or a one-time passcode.
Preview your digital signature and make any edits if needed.
Congrats! You have digitally signed your PDF document.
You can watch the Adobe Acrobat tutorial here.

How to create a digital signature in Word
How to create a digital signature in Adobe

Open the Word document you need to sign and double-click on the signature line.
Instead of X, type in your name.
Then look for Signing as field and the Change button next to it.
If your certificate had been added previously, you should see its details. If not, click More choices and select your digital certificate.
Once your certificate has been added, tap on Click here to view certificate properties.
The Certificate Details box will pop up. Click on the Details tab, scroll down, and click on Key Usage. The text below should now say Digital Signature, Non-Repudiation. If that’s correct, click OK.
You’ll then be asked to sign in to confirm your digital signature — for example, by entering your passcode or your Smart Card PIN.
A box will appear confirming that your signature has been added to the document. From now on, if you or anyone else try to edit the document, the digital signature will disappear.
When come to the issue of online privacy and security, we suggest to use aVPN, and our recommendation is RitaVPN. RitaVPNisan excellent tool for protecting your online privacy and security. And with the using of RitaVPN, you can also access your favorite geo-blocked content. Itallows P2P connectionson all servers and offersspecialized servers for Netflixand other favorite streaming channels. RitaVPNis a relatively newVPN service, but it’s already making a name for itself，which makes it one of thebest VPNin 2019.
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How to avoid bandwidth throttling in Germany
How throttling in Germany works
Internet providers use traffic shaping to limit resources used by certain networks, users, and content providers. Traffic shaping techniques include bandwidth throttling, rate limiting, etc.

Traffic shaping can have legitimate uses, but it can also be used by ISPs to squeeze more money out of users and content providers. For example, some ISPs throttle bandwidth for certain services at certain times unless those services pay up. Content providers who can’t or won’t pay get slower speeds and their users experience slower connections. This is especially painful for streaming websites, where good connection speeds are essential for the quality of their content.

This principle violates net neutrality, which says that all ISPs must treat all communications equally.

Who’s throttling German users?
Deutsche Telekom (DT) has been notorious for throttling practices. It maintains a monopoly in the German telecommunication market and provides internet services in many other European countries. This allows DT to prioritize certain content and provide certain content providers with better speeds than others. This has caused download speeds to drop significantly for some users. These limitations make streaming especially slow on weekends and evenings and introduce inequality on the web.

Though a German court has ordered DT to discontinue this policy and uphold net neutrality, the problem persists.

How to avoid throttling in Germany
If you connect to the internet in Germany and try to reach a German IP, your traffic is more likely to pass through slower DT hubs and to be throttled. However, if you use a VPN and pick another country, your route will bypass those DT servers. Plus, the encryption will prevent servers from using filters to throttle your traffic. Thus, ISP will not be able to monitor you and shape your traffic and you will avoid speed restrictions.

NordVPN encrypts your data and hides your IP. This gives you the bandwidth you pay for without additional fuzz.
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No Evidence Furosemide Contributes To Breakdowns

The Scientific Advisory Group of the Association of Racing Commissioners International (ARCI) has reported that there is no current science linking furosemide treatments to muscular skeletal issues that may be a contributing cause of equine breakdowns in racing.wisepoqder Furosemide

The group reported to a meeting of the RCI's Drug Testing Standards and Practices Committee that they discussed the issue at their meeting on April 2, 2019 and were not aware of any published studies or papers providing any evidence of such a link.

The Scientific Advisory Group members participating in the meeting were: Dr. Scot Stanley, Dr. Heather Kynch, Dr. George Maylin, Dr. Ken McKeever, Dr. Cynthia Cole, Dr. Mary Robinson, Dr. Rick Sams, and Dr. Thomas Tobin.

"There remains an attempt on the part of some organizations and individuals to leave the impression that the current equine welfare policy of permitting the voluntary race day use of furosemide under controlled and transparent circumstances is somehow tied to the tragic equine deaths that have occurred at Santa Anita and elsewhere,” said ARCI President Ed Martin in a statement.The ARCI is never averse to examining an existing policy and we were concerned that such statements might be based upon solid scientific information we have yet been able to analyze. Apparently, they are not. Our science advisors were asked to review this matter and make us aware of any new information that might be relevant to the equine tragedies that have occurred,” he said.

In 2011, after two RCI officers called for the phase out of race day furosemide treatments, an industry debate on the issue was reignited. The Drug Testing Standards and Practices Committee conducted a review of the existing policy and held a public hearing during the Saratoga meet.

Input was received from a variety of experts, including Dr. N. Edward Robinson from the Center for Integrative Toxicology at the Veterinary Medical Center at Michigan State University. Dr. Robinson is a recognized expert in the study of animal lung dysfunction, particularly equine airway disease. He directs the Equine Pulmonary Research Laboratory at MSU which is dedicated to studying the pathogenesis and treatment of diseases of the air passages (airways) of the horse.

After completion of that review, the committee decided that there was insufficient science to justify change to the current policy.

The rationale for current furosemide policy was strengthened by a 2014 Consensus statement from the independent American College of Veterinary Internal Medicine (ACVIM) published in the Journal of Veterinary Internal Medicine entitled Exercise Induced Pulmonary Hemorrhage in Horses.

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Digoxin-furosemide reduces viral load, diameter of cutaneous warts

Topical ionic contraviral therapy decreased the size of cutaneous warts caused by human papillomavirus virus (HPV) by a mean of 3 mm, a significant improvement compared with placebo, in a proof-of-concept study, Dr. Melanie Rijsbergen and her associates reported in the British Journal of Dermatology.wisepoqder Furosemide powder

The mean HPV load also declined by 94% in warts treated with the treatment, a combination of digoxin and furosemide in a topical gel, Dr. Rijsbergen of the Center for Human Drug Research, Leiden, the Netherlands, and her coauthors wrote.

"It has been shown that DNA viruses, such as HPV, rely on potassium influx ... for replication. The cardiac glycoside digoxin and loop diuretic furosemide both inhibit potassium influx by interacting with the cell membrane ion cotransporters,” they said, noting that in 2006, an in vitro study found that "the inhibitory effect on DNA replication was most potent when digoxin and furosemide were combined.”

The placebo-controlled phase 2a trial randomized 80 patients with at least two plantar or common warts to one of four arms: digoxin 0.125% plus furosemide 0.125%; digoxin 0.125%; furosemide 0.125%; or placebo applied once a day for 42 consecutive days. A subset of 20 warts underwent histopathology and immunohistochemistry. In all, 139 warts were treated.
Patients were a mean of 26 years old and had developed warts a mean of 6 years before study onset. They had a mean of three warts each; about half were common and half were plantar.

In an analysis of all treated warts, each active treatment conferred a significant benefit, compared with placebo. The combination treatment was the most effective, with a mean diameter reduction of 3 mm. Warts exposed to digoxin alone or furosemide alone showed a mean reduction of about 2 mm.

At the study’s end, primary wart clearance rates were similar in all treatment groups – around 15%. None of the primary warts in the placebo group cleared. Common warts were more responsive to treatment than were plantar warts (24%-27% vs. 8%-15%). "The increased treatment resistance of plantar warts was previously described and seems to be mainly due to callus formation resulting in a decrease in cutaneous permeability of a drug,” the authors wrote.

The HPV viral load decreased by 94% in warts exposed to the combination therapy – a significant benefit, compared with placebo.There were no discontinuations because of adverse events, and no serious adverse events related to treatment. There was no topical irritation associated with the treatment.One author is an employee of Cutanea Life Sciences, which funded the study. Dr. Rijsbergen and the remaining authors declared no financial conflicts.

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Budesonide-formoterol reliever therapy outperforms maintenance plus

Data from the PRACTICAL study showed that budesonide-formoterol reliever therapy in a single inhaler for patients with mild to moderate asthma was associated with a 31% reduction in the risk for severe exacerbations, as compared with maintenance budesonide plus terbutaline reliever therapy.wisepoqder Formoterol powder

"The budesonide-formoterol reliever regimen in mild to moderate asthma is based on the proven efficacy of the budesonide-formoterol maintenance and reliever regimen in moderate to severe asthma,” Richard Beasley, DSc, from the Medical Research Institute of New Zealand and the Capital and Coast District Health Board, wrote in an email to Healio Pulmonology. "This regimen has the potential to overcome the problem of underuse of inhaled steroids in asthma by using the reliever as its vehicle for administration.”
Investigators conducted the open-label, parallel-group, superiority trial at 15 primary care or hospital-based clinical trial units and primary care practices in New Zealand. They randomly assigned 890 adults aged 18 to 75 years with asthma to reliever therapy with one inhalation of budesonide 200 g–formoterol 6 g (Symbicort Turbuhaler, AstraZeneca) as needed or maintenance budesonide 200 g (Pulmicort Turbuhaler, AstraZeneca) twice daily plus two inhalations of terbutaline 250 g (Bricanyl Turbuhaler, AstraZeneca; not available in the U.S.) as needed.

All patients were using short-acting beta-agonists for symptom relief with or without maintenance low to moderate doses of inhaled corticosteroids during the previous 12 weeks. The study included six visits over 52 weeks and the primary outcome was the number of severe exacerbations per patient per year.

Fewer exacerbations

The final analysis included 885 patients. Results showed that the rate of severe asthma exacerbations was lower in the as-needed budesonide-formoterol group than in the maintenance budesonide plus as-needed terbutaline group (relative rate = 0.69; 95% CI, 0.48-1), as was the rate of combined moderate and severe asthma exacerbations (relative rate = 0.7; 95% CI, 0.51-0.95). Both time to first severe exacerbation and time to first moderate or severe exacerbation were longer with budesonide-formoterol vs. maintenance budesonide plus as-needed terbutaline, the researchers noted.

The most common adverse event in both treatment groups was nasopharyngitis, occurring in 35% of patients receiving as-needed budesonide-formoterol and 32% of those receiving maintenance budesonide plus as-needed terbutaline.

"This is the first independent study showing that budesonide-formoterol reliever therapy outperforms maintenance inhaled corticosteroid and [short-acting beta-agonist (SABA)] reliever therapy in mild to moderate asthma in reducing severe exacerbation risk,” Beasley said. "Taken together with the three earlier studies of budesonide-formoterol reliever therapy in mild asthma published in The New England Journal of Medicine, and the studies of the budesonide-formoterol maintenance and reliever regimen in moderate to severe asthma, there is now strong evidence that budesonide-formoterol outperforms SABA therapy across the spectrum of asthma severity.”

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Edecrin(Ethacrynic Acid) side effects drug center

Edecrin (ethacrynic acid) is a loop diuretic (water pill) used to treat fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. Common side effects of Edecrin include:wisepoqder Ethacrynic acid

Using too much Edecrin can lead to serious water and mineral loss (dehydration). Tell your doctor if you have unlikely but serious symptoms of dehydration including loss of appetite, confusion, severe dizziness, fainting, unusual dry mouth, thirst, severe headache, fast or irregular heartbeat, muscle cramps or spasms, nausea, vomiting, numbness and tingling, seizure, decrease in amount of urine, or unusual weakness or tiredness.

The smallest dose of Edecrin should be given to produce gradual weight loss (about 1 to 2 pounds per day). Onset of diuresis usually occurs at 50 to 100 mg for adults. After diuresis has been achieved, the minimally effective dose (usually from 50 to 200 mg daily) may be given on a continuous or intermittent dosage schedule. Edecrin may interact with lithium, digoxin, blood thinners, other diuretics, steroids, cancer medicines, cephalosporin antibiotics, aspirin and other salicylates, NSAIDs (nonsteroidal anti-inflammatory drugs), amikacin, gentamicin, netilmicin, streptomycin, or tobramycin. During pregnancy, Edecrin should be used only when prescribed. It is unknown if this drug passes into breast milk. Consult your doctor before breastfeeding.

Our Edecrin (ethacrynic acid) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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Lupin receives USFDA approval for Ethacrynic Acid Tablets USP

Indian Pharma major Lupin Limited (Lupin) on 9 Sep 2019, announced that it has received approval for its Ethacrynic Acid Tablets USP, 25 mg, from the United States Food and Drug Administration (U.S. FDA).wisepoqder Ethacrynic acid powder

Lupin’s Ethacrynic Acid Tablets USP, 25 mg, is the generic version of Edecrin® Tablets, 25 mg, of Bausch Health Americas, Inc. It is indicated for treatment of edema when an agent with greater diuretic potential than those commonly employed is required.

Treatment of the edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome.
Short-term management of ascites due to malignancy, idiopathic edema, and lymphedema.
Short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or the nephrotic syndrome.
Intravenous ethacrynic acid sodium is indicated when a rapid onset of diuresis is desired, e.g., in acute pulmonary edema, or when gastrointestinal absorption is impaired or oral medication is not practicable.
Ethacrynic Acid Tablets USP had annual sales of approximately USD 24 million in the US (IQVIA MAT June 2019).

Lupin announced that it has received approval for its Ethacrynic Acid Tablets USP, 25 mg, from the United States Food and Drug Administration (USFDA).Lupin's Ethacrynic Acid Tablets USP, 25 mg, is the generic version of Edecrin Tablets, 25 mg, of Bausch Health Americas, Inc.Ethacrynic Acid Tablets USP (RLD: Edecrin Tablets) had annual sales of approximately USD 24 million in the US (IQVIA MAT June 2019).

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Generic Esmolol Hydrochloride Product Launched for Tachycardia

Mylan has launched the first generic version of esmolol hydrochloride (Brevibloc, Baxter) in the United States for treatment of tachycardia.1 According to Mylan, Esmolol Hydrochloride in Sodium Chloride Injection, 2,500 mg/250 mL (10 mg/mL) Single-Dose Plastic Bag, and 2,000 mg/100 mL (20 mg/mL) Single-Dose Plastic Bag products are being offered to the global pharmaceutical company’s institutional customers.wisepoqder Esmolol powder

Mylan’s esmolol hydrochloride products are in the market following FDA approval of an Abbreviated New Drug Application (ANDA). Esmolol Hydrochloride in Sodium Chloride Injection is indicated for the short-term treatment of control of ventricular rate in supraventricular tachycardia, including atrial fibrillation and atrial flutter, and control of heart rate in noncompensatory sinus tachycardia, and control of perioperative tachycardia and hypertension.1

Brevibloc is contraindicated in patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock, or overt cardiac failure. The drug should also not be used for treatment of hypertension due primarily to vasoconstriction associated with hypothermia or to prevent tachycardia and/or hypertension.2 In addition, Baxter is cautioning Brevibloc users to carefully monitor during infusion for patients with LV dysfunction, CHF, hypotension, reactive airway disease, and diabetes. Generally, patients with bronchospastic disease should not receive beta blockers, according to Baxter. Due to the relative beta1 selectivity and titratability, esmolol hydrochloride may be used with caution in patients with bronchospastic disease, titrated to the lowest possible dose.2

The most common adverse effect with Brevibloc is hypotension; asymptomatic (25%) and symptomatic (12%), mainly dizziness and diaphoresis. Hypotension usually reverses within 30 minutes of decrease of dose or termination of infusion. Infusion site reactions (8%) have also been reported.2

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Cyclofenil powder (2624-43-3)

wisepoqder Cyclofenil powder (INN, USAN, BAN) (brand names Fertodur, Menopax, Ondonid, Ondogyne, Sexovid, others) is a selective estrogen receptor modulator (SERM) used as a gonadotropin stimulant which is or has been marketed in Europe, South Korea, Mexico, and Brazil, among other countries.

Cyclofenil powder is a gonadal stimulant and inducer of ovulation. It is used in the treatment of infertility and amenorrhea, but is thought to be less effective than CLOMIPHENE.
05 Cyclofenil powder (2624-43-3) History

Cyclofenil powder (INN, USAN, BAN) (brand names Fertodur, Menopax, Ondonid, Ondogyne, Sexovid, others) is a selective estrogen receptor modulator (SERM) used as a gonadotropin stimulant which is or has been marketed in Europe, South Korea, Mexico, and Brazil, among other countries.

Cyclofenil was first introduced in 1970 under the brand name Ondogyne in France. Subsequently, it was introduced under the brand names Sexovid in Japan in 1972, Ondonvid in the United Kingdom in 1972, and Fertodur in West Germany in 1972 and Italy in 1974. It was also marketed as Sexovid in Sweden, Neoclym in Italy, and Klofenil in Turkey.

Cyclofenil was studied in the 1970s as an agent to induce ovulation in infertile women. It was then investigated as a possible treatment for scleroderma in the 1980s, but was found to be ineffective. Later study of its efficacy in treating Raynaud’s phenomenon in people with scleroderma also found no statistically significant benefit.
Cyclofenil powder is a nonsteroidal antiestrogen that is used in the treatment of menstrual disturbances and anovulatory infertility due to hypothalamic-pituitary insufficiency
Cyclofenil is an analytical reference standard categorized as an anti-estrogen. 1,2 Anti-estrogens, including cyclofenil, have been used as performance-enhancing drugs in sports doping. This product is intended for research and forensic applications

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Bisoprolol Transdermal Patch Is Effective

Atrial fibrillation (AF) is an irregular and often rapid heart rate that can increase the risk of stroke, heart failure, and other heart-related complications. Its incidence increases with age and the presence of concomitant heart disease. We present the cases of a 93-year-old woman, an 82-year-old man, and an 87-year-old woman who developed AF tachycardia. This report highlights the use of a bisoprolol transdermal patch to treat AF tachycardia in 3 adult elderly patients. In this paper, we report an initial treatment strategy using a bisoprolol transdermal patch and show heart rate trends for 24 hours.wisepoqder Bisoprolol powder

1. Introduction

Clinical atrial fibrillation (AF) is associated with increased rates of stroke, heart failure, mortality, hospitalization, and cognitive decline, much of which may present suddenly and constitute irretrievable harm [1, 2]. AF symptoms often include heart palpitations, shortness of breath, and weakness. Rate control is possible in the majority of patients with AF. Beta- (β-) blockers have been the most effective drugs [3]. However, swallowing tablets or capsules is sometimes difficult for elderly people because of dysphagia [4]. Moreover, aspiration pneumonia can be associated with dysphagia [5]. Bisoprolol is also available as a transdermal patch in Japan. Medication adherence is better with the use of a transdermal patch than with the use of tablets, particularly in elderly patients who might have difficulty with oral administration. In this paper, we report an initial treatment strategy for AF tachycardia using a bisoprolol transdermal patch in elderly patients.

2. Case Presentation

This 93-year-old woman, a resident of a special elderly care nursing home, was referred to our hospital for the treatment of cellulitis. She related a history of treatment for hypertension and atrial fibrillation (AF). Upon arrival, her blood pressure (BP) was 119/83 mmHg and heart rate (HR) was 82 bpm. An electrocardiogram (ECG) demonstrated AF and a complete right bundle branch block (Figure 1(a)). During the treatment for cellulitis using antibiotics, she complained of dyspnea. Her HR increased to 140 bpm and her chest X-ray (CXR) showed pulmonary edema and congestion (Figure 1(b)). Echocardiography demonstrated preserved cardiac contractility with an ejection fraction (EF) of 60%, indicating heart failure with a preserved EF. She was administered furosemide (20 mg/day) to treat heart failure. In addition, a bisoprolol transdermal patch (2 mg) was applied to her chest. Her HR trends were significantly decreased within 8 hours and the control of HR continued for 24 hours (Figure 2). Eventually, her CXR and symptoms improved.
An 82-year-old man was admitted to our hospital for the treatment of ileus. He related a history of treatment for persistent AF and hypertension. He was administered bisoprolol fumarate tablets (2.5 mg/day) for AF before admission. His HR on admission was 87 bpm. However, he could not take oral medicine because of fasting for treatment of ileus. After 3 days of fasting, he developed AF tachycardia and his HR increased to 150 bpm. Bisoprolol transdermal patch (4 mg) was applied to his chest. This dose was equal to a 2.5 mg bisoprolol fumarate tablet. His HR trends were significantly decreased after 8 hours of bisoprolol transdermal patch, and the frequency and duration of AF decreased until 24 hours after administration (Figure 3).

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Upsher-Smith Receives FDA Approval For Bumetanide Tablets

Upsher-Smith Laboratories, LLC (Upsher-Smith) today announced that it has received U.S. Food and Drug Administration (FDA) approval of its abbreviated new drug application (ANDA) for Bumetanide Tablets, USP, 0.5 mg, 1 mg, and 2 mg. Bumetanide Tablets are a generic version of the brand product, Bumex (bumetanide) Tablets.* wisepoqder Bumetanide

The bumetanide tablet market had U.S. sales of approximately $84.5 million for the 12 months ending November, 2017 according to IMS Health."Last year was an exciting one for Upsher-Smith," said Rusty Field, President and CEO of Upsher-Smith. "We were part of one of the largest pharmaceutical transactions of the year and continued to expand our generic product portfolio. We are pleased to begin this year by adding Bumetanide Tablets to our portfolio of quality generic products."

Upsher-Smith Laboratories, LLC is a trusted U.S. pharmaceutical company that has strived to deliver quality, affordable generic medications for nearly a century. In June 2017, Upsher-Smith was acquired by Sawai Pharmaceutical Co., Ltd., a large publicly traded generics company in Japan that had been seeking entry into the U.S. market. Upsher-Smith and Sawai share a strikingly similar family history and hold many of the same cherished goals and values— most importantly, the philosophy of always putting patients first. Upsher-Smith will continue to do those things it does best, which is provide a consistent supply of quality, affordable medications and invest in its historically strong industry relationships. Ultimately, Upsher-Smith believes the acquisition by Sawai represents a tremendous opportunity to leverage each company for growth worldwide and embark together on an exciting new chapter in generics.

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Bumetanide is a potent diuretic

Bumetanide belongs to a group of medicines called loop diuretics or "water pills." Bumetanide is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. It works by acting on the kidneys to increase the flow of urine .
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For bumetanide, the following should be considered:wisepoqder Bumetanide powder

Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to bumetanide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of bumetanide in the pediatric population. Safety and efficacy have not been established .

Geriatric
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of bumetanide in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving bumetanide .There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking bumetanide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using bumetanide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.Using bumetanide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using bumetanide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

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