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Dyspepsia in Pregnancy

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141. Semaglutide (Ozempic) - Diabetes Mellitus

contraception, and cease with semaglutide treatment prior to planned pregnancy as well as during pregnancy and lactation. 2.3.7. Conclusion on non-clinical aspects The pharmacology, safety pharmacology, pharmacokinetics and toxicology programs are considered sufficient. There are no major objections from a non-clinical point of view. 2.4. Clinical aspects 2.4.1. Introduction GCP The clinical trials were performed in accordance with GCP as claimed by the applicant. The applicant has provided a statement

2018 European Medicines Agency - EPARs

144. Prevention of chemotherapy induced nausea and vomiting in adults: netupitant/palonosetron

that netupitant/palonosetron was well tolerated with many adverse reactions likely to be associated with either the underlying condition or associated cytotoxic treatments. Netupitant/palonosetron is contraindicated in pregnancy. Severe constipation and complications due to constipation may also occur (summary of product characteristics [SPC]). In-line with the other 5-HT 3 receptor antagonists the SPC also includes warnings and precautions on the risk of serotonin syndrome and QT prolongation. The SPC lists (...) with many adverse reactions likely to be associated with either the underlying condition or associated cytotoxic treatments. Similarly serious adverse events and deaths reflect the patient population and current treatment. In Aapro et al. (2014) and Gralla et al. (2014) the most common treatment-related adverse events were constipation, dyspepsia, eructation and headache. As stated in the EPAR cases of severe constipation and complications due to constipation were seen during the clinical trial

2016 National Institute for Health and Clinical Excellence - Advice

145. Stretta System for gastro-oesophageal reflux disease

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 15Current NHS options The NICE guideline on gastro-oesophageal reflux disease and dyspepsia in adults recommends lifestyle modifications such as weight reduction or smoking cessation, and gastric acidity-lowering medication to improve symptoms. People whose symptoms do not respond to medication or lifestyle changes, who develop complications despite medication, or who develop intolerance to medication may be considered for anti-reflux surgery (...) and others. In producing guidance and advice, NICE aims to comply fully with all legal obligations to: promote race and disability equality and equality of opportunity between men and women, eliminate unlawful discrimination on grounds of race, disability, age, sex, gender reassignment, marriage and civil partnership, pregnancy and maternity (including women post-delivery), sexual orientation, and religion or belief (these are protected characteristics under the Equality Act 2010). Stretta Therapy

2016 National Institute for Health and Clinical Excellence - Advice

146. Acofide (acotiamide hydrochloride hydrate)

, and early satiation in patients with functional dyspepsia has been demonstrated and its safety is acceptable. As a result of its regulatory review, the Pharmaceuticals and Medical Devices Agency has concluded that the product may be approved for the following indication and dosage and administration. [Indication] Postprandial fullness, upper abdominal bloating, and early satiation in patients with functional dyspepsia [Dosage and administration] The usual adult dosage is 100 mg of acotiamide (...) hydrochloride hydrate administered orally three times daily before a meal. 4 Review Report (1) December 10, 2012 I. Product Submitted for Registration [Brand name] Acofide Tablets 100 mg [Non-proprietary name] Acotiamide Hydrochloride Hydrate [Applicant] Zeria Pharmaceutical Co., Ltd. [Date of application] September 29, 2010 [Dosage form/Strength] Each tablet, containing 100 mg Acotiamide Hydrochloride Hydrate [Proposed indication] Functional dyspepsia (gastrointestinal symptoms such as postprandial

2013 Pharmaceuticals and Medical Devices Agency, Japan

148. Corticosteroids - oral

; and with pre-existing conditions that can be exacerbated by oral corticosteroids such as heart failure, recent myocardial infarction, hypertension, and diabetes mellitus. In pregnancy, the risks of oral corticosteroids should be weighed against the benefits. Prednisolone is the glucocorticoid of choice for breastfeeding women. The adverse effects of oral corticosteroids can be minimized by: Prescribing the lowest effective dose for the minimum time possible. Morning dosing and (if the condition being (...) conditions is based on a drug reference database [ ]. Pregnancy and breastfeeding Can I prescribe oral corticosteroids to a woman who is pregnant or breastfeeding? Pregnancy Oral corticosteroids can be used in pregnancy. However, the risks of treatment (such as cleft lip and/or palate following use in the first trimester) should be weighed against the potential benefits, following specialist advice. Prescribe the lowest effective dose of oral corticosteroid, for the minimum time possible. If long-term

2017 NICE Clinical Knowledge Summaries

149. Vestibular neuronitis

of coma). Prescribe cinnarizine with caution if the person has: Parkinson’s disease – give only if the advantages outweigh the risk of disease exacerbation. Hepatic or renal impairment. Epilepsy. Prostatic hypertrophy. Pyloroduodenal obstruction. Susceptibility to angle closure glaucoma. Urinary retention. [ ; ] Adverse effects What are the adverse effects of cinnarizine? Adverse effects of cinnarizine are more common in older people and include drowsiness, nausea, dyspepsia, and weight gain. Less (...) with immunological pregnancy tests (may give false-positive or false-negative results). It may also give a false negative result with skin tests by inhibiting the cutaneous histamine response — discontinue 72 hours in advance. [ ; ] Supporting evidence Supporting evidence CKS found no management guidelines for vestibular neuronitis, therefore this topic is largely based on expert opinion in review articles. The rationale for the diagnosis, referral, and primary care management of people with vestibular

2017 NICE Clinical Knowledge Summaries

150. Generalized anxiety disorder

in pregnancy. If a woman with GAD who is stabilised on current treatment reports a pregnancy, the risk of relapse must be taken into account when considering discontinuing or switching medication. In cases where drug treatment is continued in pregnancy, the lowest effective dose should be used. Consider discussion with a specialist in obstetrics for women who may require changes to their SSRI or SNRI medication in pregnancy. Treatment with an SSRI or SNRI after around 20 weeks of pregnancy may raise (...) the risk of persistent pulmonary hypertension of the newborn (PPHN) and/or can lead to neonatal withdrawal. Women using these medications should therefore be advised to give birth at a unit with the facilities to provide treatment and support for these conditions. Patient information leaflets on use of drugs to treat GAD in pregnancy are available at . Step 4 — Refer for specialist treatment (including complex drug and/or psychological interventions, possibly administered on an inpatient basis, or via

2017 NICE Clinical Knowledge Summaries

151. Breastfeeding problems

breastfeeding experiences, problems, pain. Any breast or nipple sensitivity before pregnancy. Milk supply issues (engorgement, low or oversupply). Pattern of breastfeeding (frequency, duration, night feeds, one or both breasts offered). Expressing of milk (frequency, hand or pump used). Maternal beliefs, ideas, concerns, and expectations about breastfeeding. Other fluids or foods given (when started, quantity, and frequency). Use of nipple shields or breast shells. Breast and/or nipple pain history: Onset (...) , heat, massage or touch). Previous treatments (analgesia, topical or oral drugs including antibiotics). Maternal history: Any complications during pregnancy, labour, or post-partum. Known medical conditions, such as thyroid disorders, Raynaud's phenomenon, eczema or psoriasis, recent Candida or bacterial infection, chronic pain syndromes, family history of ankyloglossia (tongue-tie). Previous breast surgery and indication. Medications and allergies. Alcohol and smoking history. Associated insomnia

2017 NICE Clinical Knowledge Summaries

152. Boils, carbuncles, and staphylococcal carriage

-day course of oral antibiotics if the person does not need but: The person has a fever. The person has cellulitis (see the CKS topic on ). The lesion is on the face. The lesion is a carbuncle. The person is in pain or severe discomfort. There are other comorbidities (such as diabetes or immunosuppression). Flucloxacillin is recommended first line (erythromycin [preferred in pregnancy and breastfeeding] or clarithromycin are alternatives if the person has a true allergy to penicillin). For further (...) is preferred for pregnant and breastfeeding women as there is more experience with its use than with clarithromycin and most studies do not suggest an association with erythromycin use in pregnancy and adverse effects on the fetus. Only small amounts of erythromycin are present in breast milk and it is not known to be harmful [ ]. Clarithromycin is generally thought to be better tolerated than erythromycin [ ], and also has a more convenient dosing regimen [ ]. Length of antibiotics course

2017 NICE Clinical Knowledge Summaries

153. Meniere's disease

recommendations have been made. January 2010 — minor update. Additional text regarding use of promethazine teoclate in pregnancy added. Issued in January 2010. January 2008 — minor update. References corrected in the Prevalence section. Issued in January 2008. June to October 2007 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. The key message about (...) for people with: Hypersensitivity to betahistine or its excipients. Phaeochromocytoma. Prescribe betahistine with caution for people with: Asthma. History of peptic ulcer. [ ; ] Adverse effects What are the adverse effects of betahistine? Adverse effects of betahistine include: Nausea, dyspepsia, and headache (common). Anaphylaxis and hypersensitivity reactions. Gastrointestinal disorders such as vomiting, pain, abdominal distension, and bloating. Skin disorders such as pruritus, rashes, urticaria

2017 NICE Clinical Knowledge Summaries

154. Vertigo

if the person has: Parkinson’s disease – give only if the advantages outweigh the risk of disease exacerbation. Hepatic or renal impairment. Epilepsy. Prostatic hypertrophy. Pyloroduodenal obstruction. Susceptibility to angle closure glaucoma. Urinary retention. [ ; ] Adverse effects What are the adverse effects of cinnarizine? Adverse effects of cinnarizine are more common in older people and include drowsiness, nausea, dyspepsia, and weight gain. Less common adverse effects include: Anaphylaxis, angio

2017 NICE Clinical Knowledge Summaries

155. Menopause

) may be useful, but the risks and benefits of treatment must be considered for each woman. Adverse effects of HRT include: Oestrogen-related adverse effects, such as fluid retention, bloating, breast tenderness, nausea, headaches, leg cramps, and dyspepsia. Progestogen-related adverse effects, such as fluid retention, breast tenderness, headaches or migraine, mood swings, depression, acne, and lower abdominal pain. Bleeding. For women who are unable or unwilling to use HRT, treatment options

2017 NICE Clinical Knowledge Summaries

156. Incontinence - urinary, in women

. Pregnancy and vaginal delivery — muscles and connective tissue can be weakened during delivery, and damage may occur to pudendal and pelvic nerves. Obesity — due to pressure on pelvic tissues and stretching and weakening of muscles and nerves from excess weight. Constipation — straining may weaken pelvic floor muscles. A deficiency in supporting tissues for example: Prolapse — not a cause of stress urinary incontinence but may be caused by the same underlying deficiency of supporting tissues

2017 NICE Clinical Knowledge Summaries

157. Candida - skin

. Cushing's syndrome. Iron deficiency anaemia — iron is the most common deficient essential micronutrient implicated in the colonization of Candida , as iron deficiency diminishes the fungistatic action of transferrin and other iron-dependant enzymes. See the CKS topic on for more information. High-oestrogen contraceptive pill or pregnancy. Poor hygiene. Complications and prognosis What are the complications and prognosis of candidal skin infections? Complications of candidal skin infection include (...) common: Abdominal discomfort, diarrhoea, nausea, and flatulence. Headache. Rash — discontinue treatment if the infection becomes invasive or systemic. Uncommon: Alopecia. Adrenal insufficiency. Dizziness. Vomiting, dyspepsia, and taste disturbance. Hepatic disorders. Hyperlipidaemia. Seizures. Pruritus, anaphylaxis, angioedema (in children), hypersensitivity reactions (in adults), Stevens-Johnson syndrome, and toxic epidermal necrolysis. Frequency unknown: Hypokalaemia. Leucopenia

2017 NICE Clinical Knowledge Summaries

158. Candida - oral

hypo-endocrine states (such as hypothyroidism or Addison's disease), and pregnancy — due to reduced effectiveness of the immune response. Dental prostheses — possibly due to enhanced adherence of Candida to the acrylic, ill-fitted appliances, decreased saliva flow under the denture surfaces, or inadequate hygiene. Poor dental hygiene — expert opinion in a review article is that regular oral and dental hygiene with periodic oral examination will prevent most cases of oral candidiasis [ ]. Local

2017 NICE Clinical Knowledge Summaries

159. Candida - female genital

, and is not associated with risk factors, such as pregnancy or poorly controlled diabetes. Complicated, which includes recurrent infection (four or more documented episodes in 1 year, with at least partial resolution of symptoms between episodes), severe infection, infection with yeasts other than C. albicans , infection during pregnancy, and infection in women who are diabetic or immunocompromised. Symptoms may include vulval itching (often the defining symptom), vulval soreness and irritation, vaginal discharge (...) pregnancy. The prescription has been removed. Issued in May 2010. March 2010 — minor update. Results of the updated Cochrane systematic review on oral compared with intra-vaginal imidazole and triazole antifungal treatment of uncomplicated vulvovaginal candidiasis have been updated. Issued in March 2010. May 2009 — minor update. Econacort-1 ® pessaries have been discontinued, so the prescription has been removed. Other intravaginal econazole preparations remain available. Issued in June 2009. February

2017 NICE Clinical Knowledge Summaries

160. The Agenda for Familial Hypercholesterolemia (PubMed)

cardiovascular risk factors Pregnancy Costs and insurance Lifestyle behaviors, self-efficacy around lifestyle change CVD indicates cardiovascular disease; and FH, familial hypercholesterolemia. Table 2. Resources for FH Education for Patients and Families Global genes ( ) International FH Foundation ( ) Australia Australian Heart Foundation ( ) FH Australasian Network ( ) Brazil Hipercol Brasil ( ) Spain Fundación Hipercolesterolemia Familiar ( ) United Kingdom Heart UK–The Cholesterol Charity ( ) British

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2015 American Heart Association

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