My Canadian Pharmacy vs. Canada Pharmacy: which is the best drug provider?

2018-04-10 / Health&Care / Comments Off

Consumers merit the very best: the best service, the best prices, the best quality, the best selection. In this roundup, we will compare the most reputable Internet pharmacies in Canada for the purpose of helping you, dear customer, find the right dealer, which can offer you what you really deserve. Today, there are two online pharmaceutical giants, My Canadian Pharmacy and Canada Pharmacy, which have come under our scrutiny.

My Canadian Pharmacy vs. Canada Pharmacy: drug ranges

Rewarding online drug shopping starts with a huge choice of prescription and non-prescription medications. Any customer wants options. Many options. A buyer should be able to find both a specific remedy as well as an over-the-counter product.

My Canadian Pharmacy boasts an astounding variety of approved pharmaceuticals: men’s and women’s health solutions, general health medications, antidepressants, anti-allergic medicines, antibiotics, herbal supplements, birth control means, and a great many of other official drugs. Notably that the pharmacy offers both brand-name medicines and their generic counterparts that are available at a much lower price in comparison to the original preparations. All the drugs on their website are divided into categories what makes it much easier for a visitor to find a necessary product. To make it even more convenient and quick, there is also a search line in plain sight to help to-be buyers find an item by name. Obviously, My Canadian Pharmacy takes painstaking care with making their product search a breeze and affording their customers an opportunity to order quality drugs at an affordable price.

It is not by coincidence that My Canadian Pharmacy has a widely assorted range of ED drugs for the best prices. Since this cluster of pharmaceuticals is traditionally believed to be lifestyle drugs and thus looked upon as means of secondary necessity, the cost of such pills as Viagra, Cialis and Levitra is exuberant.

Canada Pharmacy does not have intuitive site interface and it is not clear, what drugs they dispense as there are no drug categories in plain view. To find a product, you need to type a keyword into a search line and enjoy a cascade of results. They claim to offer the largest selection of branded and generic treatments but their drug ranges are limited to prescription drugs, OTC drugs, and pet medications. We can well believe it but suggest making their web portal navigation more user-friendly and delivering a visitor from a necessity to type anything and analyze avalanche results.

My Canadian Pharmacy vs. Canada Pharmacy: prices

My Canadian Pharmacy is this rare one-stop place where a huge medicament choice collides with great prices. A trusted cheap drug finder, My Canadian Pharmacy makes it possible to compare prices on any medication both generic and branded from different e-pharmacies scattered around the Internet and find the most tempting offers and specials for today! Should you find any bid or offer too expensive or unfair, this pharmacy is ready to negotiate lower prices and custom discounts on your behalf with a drug provider, setting forth your terms. Therefore, the clients of My Canadian Pharmacy can rest assured that they are offered the cheapest offers currently available.

Canada Pharmacy encourages everyone to enjoy discount meds in conjunction with an excellent level of customer service. Though the portal does not allow its users to compare drug costs on a global scale, it guarantees the lowest prices on all of their prescription products. In case you find a cheaper medication floating around the Internet, this e-pharmacy ensures they will match the price to your credit.  At the same time guaranteed the lowest costs are only valid during the sale time and they can only match the current advertised price provided both products are identical in brand and size, strength, quantity, and country of production. Actually, there are some other exceptions under which Canada Pharmacy will not match the price. Well, their words speak louder than their actions.

My Canadian Pharmacy vs. Canada Pharmacy: loyalty programs

One of the ways to provide online drug buyers with an exceptional shopping experience is to offer them generous gifts like promotion coupons, seasonal offs, weekly specials, motivating affiliate programs, and themed day discounts. In this respect, My Canadian Pharmacy is second to none: the service offers its clientele lots of ways to save considerably on medical expenses. For each order placed at their website, they propose a promotion code/coupon to bring an already low cost even lower. Above this, the company adds free sample pills of your choice to every parcel they send you. Signed up regulars have an ability to earn customer loyalty gratitude points and exchange them for valuable bonuses. Free worldwide delivery is guaranteed for $200 orders. Bigger orders ($400 worth) are loaded with personal savings (up to 30 % off) that are given after you send a message to their contact center with a query for a custom discount.

Regulars of My Canadian Pharmacy know very well that the opportunities to cut down the expenses of pharmacy shopping with our company are endless. Actually, the idea behind our service is synonymous with mail-order economy. Our e-pharmacy was designed to help customers find the best drugs at the prices that will save their checking accounts from roasting. Here is exactly what we do in order to make this vision become reality…

Canada Pharmacy offers a somewhat more limited amount of loyalty programs but that is very well when you know that there is the Buy Now, Pay Later initiative that allows subscribed users to purchase medicinal preparations now and pay for them a month later. This helps consumers delay the payment for the goods. To reap the benefits of such an enjoyable program, a customer only is required to provide banking/checking account information and have a sufficient sum of money on an account. Their referral program is also interesting: for every customer you recommend Canada Pharmacy to, they give you a $50 credit on future orders. The company also gives the people you bring $50 to spend on their own to-be-placed orders. There also three shipping options: Free shipping for life (with a one-time cost equal to $50), $20 shipping for a year, and standard $10 pay as you go.

My Canadian Pharmacy vs. Canada Pharmacy: testimonials

My Canadian Pharmacy in every way shows that the satisfaction of their customers is of critical importance to them. There is a page on their website, where visitors and shoppers can leave a feedback and propose suggestions. The platform most warmly welcomes the users to share their ideas in return for receiving personal discount coupons via email! Analyzing these reviews, it is possible to say that the service earns 9 stars out of 10. Consumers praise the company for a proactive and friendly customer support, safe and effective drugs, huge savings in prescription filling bills, and the lowest drug price policy. At the same time, there are some drawbacks with My Canadian Pharmacy associated with certain delivery issues. In particular, there can be several day order delays, about which customers are always informed in their inbox.

I am so glad I gave My Canadian Pharmacy a go some half a year ago. My savings in prescription filling bills have been huge ever since then. I recommend My Canadian Pharmacy to friends and family, and if you are reading this while in doubt if you should order or not, I say that you should. Deliveries are accurate, drugs are safe, customer support is proactive and friendly…

There is a convenient online form at Canada Pharmacy site to leave a comment and share your experience with others. There are only positive testimonials presented, which invites the assumption that they just do not allow negative feedback to appear at their 5-star testimonial page. OK, let it be. According to only flattering reviews, the platform can offer a smooth transaction from the first attempt, top-quality medications, a fantastic selection of products, high level of customer service, and heavy promotional discount offers.

In this article, we did our best to demonstrate the main differences between these two online pharmacies: their policy, product range and customer treatment. We think you’ll make your own conclusions in the correct direction, since we tried to be an effective judge.

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Taking Viagra After 50: Pros and Cons

Despite the title of this article, we want to emphasize that process of extinction of the sexual function in most males is activated long before the age of 50. Sometimes people with bad lifestyle choice start to lose the normal sexual functions after turning 30 years old. But normal men with healthy lifestyle start to notice the first significant decrease in hormonal activity level of their testes and problems with erection after turning 50 years.

Causes of decreased sexual ability in men after 50 years

Viagra After 50

The onset of middle age of a man leads to gradual decreased production of male sex hormone. Decreased testosterone levels in a male body causes lowering of level of sexual attraction. The process of slowing down the hormonal secretion is natural and occurs in bodies of healthy men.

What factors impact on decreased sexual functions in men after 50 years old:

  • hard physical labor;
  • increased nervous stress;
  • chronic fatigue syndrome;
  • poor environmental conditions, living near the areas affected by radioactive contamination;
  • poor diet, fatty foods abuse;
  • smoking, which provokes vascular spasms and increase the risk of blood clots, impeding blood flow;
  • abuse of alcohol, destroying a liver, brain cells that causes severe erectile dysfunction;
  • minimum level of physical activity. Physical inactivity leads to the formation of blood stagnation and weight gain;
  • neuro-psychiatric disorders and depression. Psychogenic pathology caused loss of activity of the nerve cells responsible for the transportation of sexual excitation signals;
  • cardiovascular disease and the nature of endocrine system, neurological lesion, the pathology of urinary and reproductive systems, brain tumors;
  • systemic administration of certain drugs (for the treatment of depression, cancer lesions or Parkinson’s disorder) and the use of low-quality dietary supplements;
  • injuries, entailing defeat genital nerve and vascular walls.

Age treatment of impotence

Sexual disorders occurring in patients of older age have expressed staunch character. That is why elderly patients with erectile dysfunction should receive systemic treatment after preliminary diagnostic examination. The therapy includes:

  1. Psychotherapeutic aid

In the presence of negative psychogenic factors, oppressive work of a reproductive system, patients should get psychotherapy with their sexual partner. During individual therapy sessions with a doctor a man can get rid of the negative impact of childhood trauma and psycho-emotional turmoil that occurred in adolescence. And overcome its sexual fears that are the common causes of erectile dysfunction in elderly age as well.

  1. Drug correction of erectile dysfunction

The beneficial effects on the reproductive system is provided by a number of drugs, including phosphodiesterase inhibitors and hormonal agents. A doctor may prescribe injection therapy when the administration of oral drugs carried out in the corpora cavernosa of a penis or urethra.

The widespread use of tonics receive pharmacological agents based on plant extracts. In addition, patients with erectile lesions and reduced libido gets restorative treatment and receives funds for neutralization of somatic disorders.

Preventing early impotence in men younger than 50 years

  • maintaining a normal level of physical activity;
  • balanced nutrition;
  • receiving medicinal herbal decoctions and infusions (ginseng, ginger, St. John’s wort) to enhance immunity and stimulate sexual ability;
  • avoiding the drugs that suppress the work of reproductive organs;
  • refusal of smoking, receiving narcotic drugs and alcoholic beverages;
  • regular sexual activity with stable sexual partner.

The FAQs about using Viagra in elderly age

Q: If a healthy person takes Viagra, if she changes his sexual feelings?

A: Weird and unpleasant sexual situations can happen anywhere and with anyone, anytime can be expected. When a normal erection is still strong, it is unlikely to be, may reduce or increase the duration of sexual intercourse.

But whether it makes sense for this to take Viagra pills? Another case, if a healthy male erection is unstable due to fatigue, over-voltage disturbances. Drugs for erectile dysfunction (impotence) are prescribed in cases when it comes to cardiovascular problems, spinal cord injuries, diabetes, side effects of certain drugs, as well as age-related changes, psychogenic disorders. Those who truly suffer from impotence pill in most cases do not help.

Q: Can you become dependent on drugs like Viagra if to take them regularly?

A: Purely psychological one. Do not be afraid to get hooked on these funds. they are not addictive. On this occasion, U.S. researchers conducted the survey including 150 men taking Viagra or similar pills. If patients are satisfied with the first dose of 25 – 100 mg, then after two years it is allowed to increase the dose to 50 milligrams. At the same time doctors could not find the link between the frequency of the drug use and to increase the dosage.

However, other researchers on the subject have a different point of view. In particular, with increasing doses due to the fact that a drug is often not given the effect that was expected. When an elderly man is taking Viagra for erectile dysfunction the pill blocks the enzyme nitric oxide and remains in the blood. Over time, the body with received Viagra pills begins to struggle with it, trying to eliminate interference. The effect of the drug is reduced – a person begins to increase the dose and at some point the drug is no longer valid. Like it or not, but the fact that the reception must be under the supervision of a doctor – there is no doubt.

Q: What Viagra’s dose is considered to be hazardous to health in men after 50 years?

A: Typically, the recommended dose is 50 mg, the maximum – not more than 100 times a day. Low dosages of 25 milligrams prescribed to patients with liver disease, renal insufficiency. The maximum daily dose does not cause various complications. Therefore, the effective dose for each patient is chosen individually. Especially carefully medical preparations should be used in patients with anatomical deformation of a penis and suffering from diseases that predispose to the development of priapism.

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Priligy (Dapoxetine): Long-Awaited Premature Ejaculation Solution

Priligy is the medication used to treat one of the most bothering sexual dysfunctions in men – premature ejaculation. Its active ingredient, Dapoxetine, belongs to the class of selective serotonin reuptake inhibitors (widely known as antidepressants), which have proved high effectiveness in treatment of persistent or recurrent PE. Developed to combat the symptoms of PE in men aged between 18 and 64, Priligy can be taken on demand rather than daily that most SSR inhibitors require. Nowadays this drug is the only one among health and care medications, which formula is aimed at treatment of Premature Ejaculation solely.

Priligy (Dapoxetine) and Other Oral Premature Ejaculation Meds

Priligy (Dapoxetine): Long-Awaited Premature Ejaculation Solution

Oral medications are among basic treatment options of premature ejaculation. There are three groups of meds commonly used to increase brain serotonin delaying chemical reactions that cause ejaculation. These are antidepressants, analgesics and phosphodiesterase-5 inhibitors. Delayed ejaculation caused by most antidepressants and analgesics intake is nothing but a desirable side effect, where the latter can be prescribed when the former have been ineffective. Phosphodiesterase-5 inhibitors, widely known as erectile dysfunction meds, are also used to help with premature ejaculation. These work by decreasing refractory time so that a man could achieve another erection after ejaculation. Priligy, or rather its active ingredient dapoxetine, belongs to the class of antidepressants; however, it differs from other drugs of the class.

Why Priligy Is the Only Solution

Although Priligy is one of SSR inhibitors, it has become the first drug developed for treatment of Premature Ejaculation specifically. Basically, nowadays it is the only oral medication recommended as the most appropriate solution of PE problem. Like a medication with the narrowest intended use, Priligy has a number of decisive advantages over all other oral medications prescribed for treatment of Premature Ejaculation. Thus, unlike other antidepressants, Priligy can be taken when required and not on a day-to-day basis. Besides, it’s better to think of an intended use rather than a side effect. Viagra, Cialis and other PDE5 inhibitors work by decreasing the refractory time and increasing overall confidence, sexual satisfaction, and perception of control over ejaculatory. Increase in intravaginal ejaculation latency time caused by analgesics is almost twice shorter than that caused by Priligy.

What to Consider

First off, it would be wise and thrifty to purchase Priligy at some reliable online pharmacy. Second off, it would be double wise and thrifty to purchase it at some highly regarded Canadian online pharmacy. Finally, it would be a real bargain, safe and secure one, if you buy it at Canadian Pharmacy The pharmacy  is widely known as a reliable and trustworthy international distributor specializing in meds for men primarily. So it’s not hard to imagine the overall level that the pharmacy can boast of.

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How to avoid impotency with Viagra?

2015-09-10 / Impotence / No Comment

To avoid impotency, it is necessary to know who belongs to the risk zone. Specialists claim that impotency never arrives all at once, it always has some conditions. Only in a small amount of cases it is caused by injury. In most cases it is the result of our way of living. If we take measures in advance we can not only maintain erectile function, but also improve the general health.

The main steps necessary to maintain your health:

1. Cessation of smoking.
2. Physical exercises and loads.
3. The control of body weight.
4. Accurate choice of the medication and the rejection of those that may cause impotency.
5. Administration of medications following the doctor’s guide.
6. Cessation of alcohol consumption, the reduction of consumption to minimum.
7. Cessation of taking superpotent substances and drugs.
8. Careful treatment of diseases that may lead to impotency (Diabetes, kidney diseases and so on)

Smoking disrupts blood circulation, alcohol negatively influences the body in general and nervous system. The lack of necessary physical loads, unhealthy diet and the lack of set order of day lead to stresses. With aging it all leads to impotency. Besides, it not always happens after forty.

Online Viagra Pharmacy vs Impotence

Direct cooperation with trusted and reputable manufacturers has enabled Canadian pharmacy number one to provide thousands of affordable drugs for hundreds of common and rare diseases. Men’s and women’s health, heart conditions and mental health, allergy and diabetes, depression and cancer, etc. – at Online Viagra Pharmacy ( you will find almost any medication and, which is more vital, at a reasonable price only.

There are real people behind the online pharmacy and exactly these people are deeply convinced that medicines must be affordable which we can see through the pricing policy they have formulated. The drugstore provides generic medications which are not as expensive as brand-name ones, but CHCM Pharmacy has introduced another degree of customer-friendliness charging the lowest prices on the market for top quality meds they deliver.

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Canadian Health&care Incident Management

2015-07-07 / Health&Care / No Comment

As an organization, it’s unavoidable that events will happen in the course of running the organization. Events reference events that may result in interruption or the loss of the regular operations of the business. If events aren’t handled right, they become catastrophe or a catastrophe. Event direction describes the actions that the organization does to avoid the incidence of the events until they happen. Correct and the actions also make an effort to assess the risks having a function to avoid return. Most organizations may have a designated team that can manage these tasks. This team is put in place either through the function or prior to the occasion happens. The primary aim of event direction will be to restore normal operations of the business when you possibly can. Canadian Health and Care Industry

The health&care industry is prone to getting events which may hinder the ordinary functioning of an organization just like a hospital. A hospital is usually quite active and it may mean loss of several lives, if ordinary operations are hampered with. RGP health care services offer distinct options that help in handling events in hospital. The services include advice saved and used to generate the correct choices and software applications that may help the hospital in ensuring that events are reported correctly. It’s important for hospitals to get health care event management systems in place to avoid events from escalating to catastrophes.

RGP health care services comprise distinct options which assist in the managing of the incident command system in a hospital. The incident command system mainly consists of five components such as finance/management, operations, preparation, logistics and command. Each one of these components aid in hospital conformity with coping with events. Health care patient safety is included by among the options which might be on offer. The alternative that they offer tracks events that cope with all the security of patients; they make sure it is dealt with promptly and attach the applicable files to it. These events will also be monitored in a central place, making the procedure more suitable. That is more efficient than awaiting an event so that you can act to happen.

Corrective action plans are another option that helps in health care event direction. These help you in getting control back by developing an action plan whose goal would be to correct the issue that’s happened after an event happens. The action plan that this option offers entails working with all the staff of the hospital to develop alternatives. This option helps to ensure the staff can collaborate efficiently to plan for it when it’s happened but additionally to avoid the event of events.

One other significant option that RGP services offer is a remedy to handle grievances and complaints. When you can it is necessary in a hospital to take care of a patient’s grievance. This service provides a remedy for the hospital to record the patients’ criticism and connect it to the man that will help promptly. There’s also in tracking the strategies that worked so they can be properly used in the event of an event, an audit option that helps. These options are ideal for hospitals to make use of in health care incident conformity.

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How to Keep Your Hair Intact With Propecia: Research canadian health mall

2015-06-22 / Treatment / No Comment

Baldness is 1 of the key causes of hair loss in guys. The dilemma with this condition is that it can’t be cured. As such, some folks feel embarrassed and distressed when they understand that they have a baldness difficulty. Given that there is no way that you can treat this variety of hair loss dilemma, the answer is to prevent it. In any case, prevention is often much better than cure.

So, how do you stop baldness and other hair loss problems? It is quite easy certainly. Health-related specialists have revealed that the use of  Propecia is one of the greatest preventive measures of baldness and the other connected issues. By going through this passage you will be able to learn a handful of issues about the use of Propecia and some of the possible benefits that it offers to the user.

As a young man, you need to have to hold your intact simply because it is part of your beauty. Having a bald head at the age of thirty will make you appear old and weary. That is why you need to make positive that you learn about the ideal ways in which you can stop your self from baldness and other related problems. Studying these preventive measures will assist you to retain your great and youthful looks all through your life. One of the most typical techniques of preventing these issues is the use of Propecia.

Buy Propecia online in Canadian HealthCare Mall pharmacy –

These are tablets that are especially made to counter the problem of baldness. They function by stopping the conversion of the male’s testosterone hormones to DHT (dihydrotestosterone). Nevertheless, ahead of you set out to acquire Propecia, there are some essential points that you need to often bear in mind. These points are meant to ensure that your Propecia is successful and with no any side effects.

Firstly, you need to only commence to use Propecia soon after you notice the 1st symptoms of hair loss. It is a huge error to get Propecia on-line before you acquire a doctor’s prescription. You need to see your physician first so that they can guide you on how to use this medicine safely without having causing any detrimental effects on your well being. It is also critical for you to note that the effects of Propecia begin to show following several months of its usage. These tablets are supposed to be taken on a regular basis failure to that, their favorable effects stop. Propecia tablets are fairly pricey but you need to not worry so significantly about the value since their effectiveness is unmatched.

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Diabetes and Life – You have Chance?

2015-03-25 / Diabetes / No Comment

I have worked as a bus driver all my working life. I first got diabetes five years ago and have been well controlled till about six months ago. My doctor tells me that tablets are no longer working and that I must go onto insulin. This means I will lose my job, my source of income and probably my house. Diabetes and Life

This tragic situation is all too common. Some people in your situation have no difficulty in finding another way of earning money and paying the mortgage. However, others find it hard to give up their driving and believe no other job will match their present salary. There is no easy solution when you are faced with deciding between your health and your job. The choice becomes easier if you are feeling unwell, perhaps with symptoms of high sugars such as thirst and tiredness. We know some people in your situation who feel perfectly fit and cannot believe that there is a problem with their health. This makes their decision particularly difficult as they have to take their doctor’s word that they need to have insulin.

I recently read a newspaper article that implied that people with diabetes who are breathalysed can produce a positive reading even though they have not been drinking alcohol. What does this mean?

Diabetes has no effect on breathalyser tests for alcohol even if acetone is present on the breath. However, the Lion Alcolmeter, widely used by the police, does also measure ketones, though this does not interfere with the alcohol measurement. Anyone breathalysed by the police may also be told that they have ketones and that they should consult their own doctor. These ketones may be caused either by diabetes that is out of control or by a long period of fasting. Awc Canadian Pharmacy believes that we should not give up and succumb to the disease, more info here.


My husband likes a pint of beer in the evening. He has now been found to have diabetes and has to stick to a diet. Does this mean he will have to give up drinking beer?

No. He can still drink beer but, if he is trying to lose weight, he will need to reduce his overall calorie intake and, unfortunately, all alcohol contains calories. There are about 180 calories in a pint of beer and this is equivalent to a large bread roll. Special ‘diabetic’ lager contains less carbohydrate but more alcohol so in the end it contains the same number of calories, with the drawback of being more expensive and more potent. He should probably also avoid the ‘strong’ brews, which are often labelled as being low in carbohydrate, as these are higher in alcohol and calories than the ordinary types of beer and lager. Low-alcohol and alcohol-free beers and lagers often contain a lot of sugar, so, if he decides to change to these, he should look for the ones also labelled as being low in sugar.

Overall your husband is probably better off drinking ordinary beer, but if he is overweight he should restrict the amount he drinks.

We recommend to pay attention to cool Canadian news blog that often writes about the health care system, and much moreclick now.

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Canadian Health and Care: Diagnosis and Management of Work-Related Asthma

2015-03-18 / Asthma / No Comment

Clinical Course

Our patient was treated with systemic corticosteroids and had rapid resolution of the rash and pulmonary infiltrates (Fig 5). All culture findings were sterile. The patient underwent a bone marrow biopsy, and the findings were consistent with a myelodysplastic syndrome. Subsequently, a cutaneous recurrence of Sweet syndrome developed during tapering of systemic corticosteroid. Four months after the initial diagnosis, the patient underwent allogeneic stem-cell transplantation but later died of multisystem organ failure.

Clinical Pearls

1. Acute febrile neutrophilic dermatosis (Sweet syndrome) is a well-recognized clinical entity with a diverse clinical spectrum that not only includes characteristic dermatologic manifestations but also may present with extracutaneous involvement of almost any organ system. Management of Work-Related Asthma

2. Criteria have been established to aid in the diagnosis of Sweet syndrome, which include a combination of clinical, pathologic, and laboratory findings, as well as response to treatment with corticosteroids.

3. If the diagnosis of Sweet syndrome is made, it should be classified as classical (idiopathic), malignancy associated, or drug induced, and the potential for associated clinical conditions should be recognized based on this classification.

4. Extracutaneous manifestations can involve a variety of organ systems, and if pulmonary involvement is noted an underlying hematologic dyscrasia is more likely to be an associated clinical condition.

5. Due to the fact that treatment with corticosteroids typically induces rapid improvement, Sweet syndrome should be promptly recognized in order to provide timely treatment and potentially prevent clinical deterioration.

Background: A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA).

Interesting canadian health blog you can read here.

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Health and Care: Centrally acting drugs

2015-02-17 / Drugs, Treatment / No Comment




Hydralazine is a peripherally acting vasodilator that relaxes vascular smooth muscle. There are very few reports of undesired effects on sexual function and most of these implicate combination therapy such as hydralazine and propranolol or hydralazine and a thiazide diuretic. There has been one report of priapism developing during hydralazine therapy and the suggestion has been made that the drug even has aphrodisiac properties. However, this occurred in a patient who was changed from a thiazide diuretic (known to cause decreased libido) to hydralazine
(Stevenson & Umstead, 1984).



Thiazides act by producing a reduction in blood volume associated with initial diuresis. Thereafter, a sustained vasodilator action is probably responsible for their effects. A Medical Research Council Working Party in 1981 reported a 16% incidence of impotence in patients taking thiazide diuretics after 12 weeks of treatment (Medical Research Council Working Party, 1981). A recent randomised study of diuretics in mild hypertension showed a significant increase in sexual dysfunction compared with placebo. This was still observable after controlling for confounding factors such as older age, diabetes mellitus and use of other (non-diuretic) antihypertensive therapy. The disorders noted included a reduction in libido, difficulty in obtaining or maintaining erection and problems with ejaculation. Patients on diuretics were two to six times more likely to experience sexual dysfunction than those on placebo (Chang et al.9 1991). Reduced vaginal lubrication has been described in females. A recent large multicentre study evaluated the effects of a thiazide diuretic (chlorthalidone), atenolol and different diets on sexual function. In a group of men on their normal diet receiving chlorthalidone, 28% experienced problems with erection compared with 3% of those on placebo and a normal diet. However, men on chlorthalidone with a weight-reducing diet were less affected. In this study, the authors specifically questioned women about sexual side effects. In the group of women treated with chlorthalidone, 22% of those on a normal diet but only 8% of those on a weight-reducing diet had a worsening of their sexual problems. This illustrates the multifactorial influences on sexual function in hypertensive individuals.

A recent study of men starting antihypertensive medication for the first time demonstrated a significant increase in anorgasmia within 30 days of commencing medication in men receiving hydrochlorthiazide (Kroner, Mulligan & Briggs, 1993). The mechanisms behind the sexual side effects are not readily apparent as thiazides lack significant hormonal, autonomic or central nervous system effects. Decreased peripheral resistance has been suggested, but sexual side effects have not been reported with vasodilators that have a similar mode of action. It has also been proposed that it may be the result of a direct effect of thiazides on smooth muscle or by interference with catecholamine responsiveness.


This potassium-sparing diuretic has been associated with a variety of sexual side effects. Dose-dependent gynaecomastia is well recognised and occurred in 100% of patients treated with 400 mg/day (used to differentiate primary from secondary hyperaldosteronism); 30% also developed impotence. Both recovered following discontinuation of spironolactone (Spark & Melby, 1968). Similar effects have been less commonly reported on lower doses of 50-100 mg/day (Buffum, 1982; Smith and Talbert, 1986). The 400 mg study also included women all of whom developed menstrual irregularities.

Spironolactone is an antiandrogen (it is also used in the treatment of hirsutism) and the adverse sexual effects are probably hormonally induced. It prevents the binding of dihydrotestosterone to androgen receptors, which leads to increased metabolic clearance of testosterone and increased peripheral conversion to oestradiol. In women, the menstrual irregularity is probably related to defective ovulation and could be a cause of subfertility. High doses of spironolactone inhibit 17-hydroxylase, which is an important component of the steroid biosynthetic pathway. 17-Hydroxylase blockade causes anovulation in women.

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Canadian Health and Care Mall: Venous Thromboembolism

2014-12-16 / Prevention, Treatment / No Comment

The optimal duration of thromboprophylaxis has also been assessed in patients undergoing HFS. In a cohort study of 897 HFS patients who received perioperative prophylaxis with enoxaparin, 40 to 60 mg per day for about 5 weeks, objectively confirmed, symptomatic VTE occurred in only 7 patients (0.8%), with no cases of PE. However, major bleeding was encountered in 5% of patients, including 5 cases of intracranial bleeding (2 patients had intracranial hemorrhage that may have directly related to the drug and 3 patients had ICH subsequent to the fall and 20 cases (2.2%) of wound hematomas requiring surgical evacuation. A recent double-blinded clinical trial provided 656 HFS patients with fondapa-rinux, 2.5 mg SC once daily for about 7 days, followed by randomization to continuation of prophylaxis with fondaparinux or placebo for an additional 3 weeks. Venography, performed after 4 weeks of prophylaxis, documented DVT in 1.4% of the extended prophylaxis patients and in 35.0% of placebo recipients (RRR, 96%; p < 0.001). The rates of symptomatic VTE were 0.3% and 2.7%, respectively (RRR, 89%; p = 0.02). Bleeding rates were not significantly different.

Venous Thromboembolism

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The results of a number of economic studies have suggested that extended, post-hospital discharge prophylaxis may be cost-effective in comparison with in-hospital prophylaxis. Based on all of the data about duration of prophylaxis in orthopedic surgery, patients undergoing major orthopedic surgery should receive prophylaxis with LMWH, fondaparinux, or a VKA for at least 10 days. Given that current hospital stays are generally < 5 days, this recommendation implies that post-hospital discharge prophylaxis should be provided to most pa-tients. For patients undergoing THR or HFS, more prolonged prophylaxis for up to 28 to 35 days is recommended for those patients who are considered to be at high risk for VTE. Although further studies are needed to define who is at high risk, factors shown to predispose patients to VTE following major orthopedic surgery include a history of VTE or current obesity, delayed mobilization, advanced age, or cancer. Other risk factors that might be clinically important include a history of congestive heart failure or COPD, as well as female gender. The extended use of a VKA (INR target 2.5, range, 2.0 to 3.0) is an acceptable alternative to LMWH, although the incidence of major bleeding may be higher with oral anticoagulants. The pentasaccharide fondaparinux is recommended for extended prophylaxis following HFS. The use of either LMWH or an oral VKA also may be effective in HFS patients, although prolonged use of these agents has not been properly studied in this patient group.

Recommendations: Duration of Prophylaxis

1    We recommend that patients undergoing THR, TKA, or HFS receive thromboprophylaxis with LMWH (using a high-risk dose), fondaparinux (2.5 mg daily), or a VKA (target INR, 2.5; INR range, 2.0 to 3.0) for at least 10 days (Grade 1A).

2   We recommend that patients undergoing THR or HFS be given extended prophylaxis for up to 28 to 35 days after surgery (Grade 1A). The recommended options for THR include LMWH (Grade 1A), a VKA (Grade 1A), or fondaparinux (Grade 1C + ). The recommended options following HFS are fondaparinux (Grade 1A), LMWH (Grade 1C+), or a VKA (Grade 1C+).

3 Elective spine surgery

Unfortunately, most data about thromboprophylaxis in patients undergoing elective spine surgery come from small, retrospective studies of poor methodological quality. Although the incidence of VTE in these patients appears to be considerably lower than that following major lower extremity surgery, some patients seem to be at high enough risk to consider prophylaxis. A systematic review of 20 studies reporting complications after lumbar spinal fusions noted a 3.7% incidence of symptomatic DVT and a 2.2% rate of PE. In the only two studies that performed routine venography in patients undergoing spine surgery who did not receive VTE prophylaxis, DVT was detected in 18% of the 205 patients. In one of these studies, increased age and surgery of the lumbar spine (21%) vs surgery of the cervical spine (6%; p = 0.003) were independent predictors for DVT. Other possible risk factors include an anterior or combined anterior/posterior surgical approach (possibly related to intraoperative manipulation of the iliac veins or inferior vena cava), surgery for malignancy, a prolonged procedure, and reduced preoperative or postoperative mobility.

Symptomatic VTE and fatal PE are occasionally observed in spinal surgery patients despite prophylaxis using IPC and/or GCS.

Symptomatic VTE and fatal PE

Symptomatic VTE and fatal PE

In a prospective but observational study of 306 patients undergoing elective spinal surgery, venographic DVT was found less frequently in patients who received IPC (6%) than in those who had received no prophylaxis (21%). DUS identified DVT in 2% of 1,527 spinal surgery patients from 11 prospective studies, all of whom routinely used mechanical prophylaxis. Unfortunately, the absence of control subjects in these studies prevents one from validly estimating the degree of protection afforded by mechanical prophylaxis in this patient group. In one small clinical trial, no cases of symptomatic VTE or abnormal DUS findings were noted among any of the 110 patients randomized to receive prophylaxis with GCS alone, GCS plus IPC, or GCS plus warfarin. Another randomized clinical trial compared LDUH with no prophylaxis among 38 laminectomy patients, using the FUT to screen for thrombosis. DVTs were detected in none of the 18 LDUH patients and in 5 of 20 control subjects. Another small clinical trial randomized spinal surgery patients to receive enoxaparin, 40 mg SC daily, or IPC. No venographically detected DVTs were detected in any of the 30 patients who received enoxaparin, and in 3 of the 30 who had received prophylaxis with IPC.

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