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See detailMedical therapy for rheumatic heart disease: is it time to be proactive rather than reactive?
Rajamannan, Nalini M.; Antonini-Canterin, Francesco; Moura, Luis et al

in Indian Heart Journal (2009), 61(1), 14-23

Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the ... [more ▼]

Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population. [less ▲]

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See detailMedical Treatment in Cushing’s Syndrome : Dopamine Agonists and Cabergoline
Petrossians, Patrick ULg; Thonnard, Anne-Sophie ULg; Beckers, Albert ULg

in Neuroendocrinology (2010), 92((supp. 1)), 116-19

Dopamine (DA) is a catecholamine with a wide range of functions and whose five subtype receptors are found in different organs where they exert a mainly inhibitory action. Since this action may also ... [more ▼]

Dopamine (DA) is a catecholamine with a wide range of functions and whose five subtype receptors are found in different organs where they exert a mainly inhibitory action. Since this action may also appear in a number of secretory tumors in various locations, DA agonists have elicited some interest as a medical treatment for hypercorticism. Non-iatrogenic Cushing’s syndromes are due in 70% of the cases to a pituitary adrenocorticotropic hormone (ACTH) producing adenoma, and, less frequently, to an adrenal adenoma or an ectopic ACTH secretion by a neuroendocrine tumor. First-line treatment in Cushing’s syndrome consists of the surgical removal of the secreting tumor. However, surgery may not achieve a complete cure in a number of cases, hence emphasizing the potential benefit of a medical complementary treatment, which could also benefit patients as an alternative approach, either when waiting for, or when the patient is not eligible for surgery. Studies of corticotropic adenomas have shown that 80% of these tumors express D2 receptors. Clinical trials of DA agonists in Cushing’s disease have shown an inhibitory effect of these drugs with an inhibition of ACTH secretion and/or a decrease of tumor size. There are only a few cases of documented use of DA agonists in ectopic ACTH secretion, but when the tumor expresses DA receptors, DA agonists may represent a useful complementary treatment. DA receptors are also expressed in normal and tumoral adrenals, suggesting a potential use of DA agonists in Cushing’s syndrome secondary to adrenal tumors. However, clinical data regarding this specific situation are very scarce, maybe due to the relatively high rate of surgical cure of adrenal adenomas. In conclusion, DA agonists represent a potential preparatory or complementary treatment for endogenous Cushing’s syndrome, especially in Cushing’s disease. These compounds may be underused as suggested by the scarce number of publication and case reports in the literature. In the future, association of these drugs with somatostatin analogs may also prove beneficial. [less ▲]

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See detailThe Medical Treatment of hyperprolactinemia
Beckers, Albert ULg

Scientific conference (1997, June)

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See detailMedical treatment of pituitary adenomas
Beckers, Albert ULg

Scientific conference (2011, November 18)

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See detailLe medicament du moi. Dabigatran etexilate (Pradaxa): anticoagulant oral, inhibiteur direct selectif de la thrombine
Lancellotti, Patrizio ULg; Scheen, André ULg

in Revue Médicale de Liège (2010), 65(10), 588-92

Dabigatran (Pradaxa) is a new oral, direct, selective and reversible thrombin inhibitor (factor IIa) acting as anticoagulant. Pradaxa does not require monitoring or dose adjustment, except in cases of ... [more ▼]

Dabigatran (Pradaxa) is a new oral, direct, selective and reversible thrombin inhibitor (factor IIa) acting as anticoagulant. Pradaxa does not require monitoring or dose adjustment, except in cases of moderate renal insufficiency or in elderly patients (>75 years old). It is currently indicated for prophylaxis against venous thromboembolism after total hip or knee replacement surgery. Pradaxa has been shown to be as effective as enoxaparin in reducing the risk of venous thromboembolism after total hip or knee replacement surgery, with a similar safety profile. The recommended dose of 220 mg is administered once-daily, starting with a half-dose 1-4 h after surgery. The total duration of treatment is 10 days for knee surgery and 28-35 days in case of hip replacement. Contrary to enoxaparin, with Pradaxa there is no risk of drug-related thrombocytopenia. Of note, this promising new anticoagulant has also shown to be more effective than warfarin for stroke prevention in patients with non-valvular atrial fibrillation and as effective as warfarin for the treatment of acute venous thromboembolism (indications not recognized yet). [less ▲]

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See detailLe médicament du mois - Le Valaciclovir (Zelitrex)
Pierard, Gérald ULg; Nikkels, Arjen ULg

in Revue Médicale de Liège (1997), 52(8), 553-555

Un progrès important vient d'être réalisé dans le traitement du zona. Le valaciclovir (Zelitrex) est un nouveau médicament oral qui est en fait un précurseur de l'aciclovir. Sa biodisponibilité supérieure ... [more ▼]

Un progrès important vient d'être réalisé dans le traitement du zona. Le valaciclovir (Zelitrex) est un nouveau médicament oral qui est en fait un précurseur de l'aciclovir. Sa biodisponibilité supérieure à celle de l'aciclovir est à l'origine d'un progrès thérapeutique majeur dans la prise en charge du zona cutané chez des sujets immunocompétents de plus de 50 ans et du zona ophtalmique quel que soit l'âge du sujet. Le valaciclovir réduit tant la prévalence que la sévérité des douleurs associées au zona. [less ▲]

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See detailLe medicament du mois : Preterax, la premiere association fixe faiblement dosee contenant un inhibiteur d'enzyme de conversion et un diuretique thiazide
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2004), 59(10), 601-606

Preterax is the first fixed very- low - dose combination of an angiotensin--converting enzyme inhibitor and a diuretic for first line treatment of hypertension. Its antihypertensive efficacy is remarkable ... [more ▼]

Preterax is the first fixed very- low - dose combination of an angiotensin--converting enzyme inhibitor and a diuretic for first line treatment of hypertension. Its antihypertensive efficacy is remarkable due to the presence of 2 drugs with additional effects. The tolerance is also excellent, with adverse effects similar to placebo. The 24 h blood pressure control is maintained. If necessary, the dose can be doubled (BiPreterax). The medical practitioner must keep in mind that it is an association of perindopril 2 mg and indapamide 0.625 mg with their own contra-indications. These low dose associations are now recommended as one of the 2 options to initiate an antihypertensive drug treatment, with the hope of an improvement in the percentage of well controlled blood pressure in the hypertensive population. Let us remember that the blood pressure target to be reached is at least < 140/90 mmHg. Up till now, no antihypertensive class has demonstrated a superiority over the others. Only the blood pressure fall magnitude is important to prevent cardiovascular complications. [less ▲]

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See detailLe médicament du mois Le voriconazole (Vfend).
Pierard, Gérald ULg; Arrese Estrada, Jorge ULg; Quatresooz, Pascale ULg et al

in Revue Médicale de Liège (2003), 58(5), 351-5

Invasive fungal infections are a rare but important cause of morbidity and mortality among patients with severely compromised host defenses. Despite considerable advances in antifungal therapies over the ... [more ▼]

Invasive fungal infections are a rare but important cause of morbidity and mortality among patients with severely compromised host defenses. Despite considerable advances in antifungal therapies over the past years, invasive mycoses remain a stubborn and dramatic problem. Voriconazole is a new triazole antifungal agent which confers a relative survival benefit in fluconazole-resistant invasive candidiasis, and in invasive aspergillosis, fusariosis and Scedosporium infections as well. [less ▲]

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See detailLe médicament du mois, EXFORGE® : première association d'un antagoniste calcique (bésylate d’amlodipine) et d'un inhibiteur des récepteurs de l'angiotensine II (valsartan)
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale de Liège (2007), 62

Hypertension is a common treatable risk factor for cardiovascular disease. Even when identified and treated, most patients with hypertension do not get to blood pressure goal and they often need at least ... [more ▼]

Hypertension is a common treatable risk factor for cardiovascular disease. Even when identified and treated, most patients with hypertension do not get to blood pressure goal and they often need at least two antihypertensive agents to achieve blood pressure control. Although various combination therapies are currently available for the treatment of hypertension, development of more powerful therapies is necessary to help implement guideline recommendations that call for more aggressive treatment options and early blood pressure control. Amlodipine/valsartan (Exforge®) is a new combination of antihypertensive agents that lower blood pressure via calcium channel blockade and angiotensin receptor antagonism. This potent dual mechanism of action is also likely to attenuate compound-specific adverse events, such as amlodipine-related peripheral oedema. Currently available data show that such a combination is a well-tolerated treatment that gets different kinds of patients with all grades of hypertension to their blood pressure goal. [less ▲]

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See detailLe médicament du mois, SEVIKAR/HCT° : association d'un antagoniste calcique (bésylate d'amlodipine), d'un inhibiteur des récepteurs de l'angiotensine II (olmésartan médoxomil) et d'un diurétique thiazide (hydrochlorothiazide)
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2011), 66(12), 636-642

Hypertension is a common treatable risk factor for cardiovascular disease. Even when identified and treated, most patients with hypertension do not reach the blood pressure goal and they often need in ... [more ▼]

Hypertension is a common treatable risk factor for cardiovascular disease. Even when identified and treated, most patients with hypertension do not reach the blood pressure goal and they often need in fact three antihypertensive agents to achieve blood pressure control. Although various combinations of two therapies are currently available for the treatment of hypertension, development of more powerful therapies with 3 molecules is necessary to control more hypertensive patients. Amlodipine/Olmesartan/hydrochlorothiazide (Sevikar/HCT°) is a new triple combination of antihypertensive agents that lower blood pressure via calcium channel blockade, angiotensin receptor blockade and diuretic action. Its potent triple mechanism of action is also likely to attenuate compound-specific adverse events, such as amlodipine-related peripheral oedema or sartan-induced hyperkalemia. Moreover, by reducing the number of pills to be taken every day, the compliance should be better. Currently available data show that such a combination is very powerful and well-tolerated allowing more patients with all grades of hypertension (especially those with the most severe forms) to reach the blood pressure target. The contraindications are those of each compound. [less ▲]

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See detailLe medicament du mois. Combinaison fixe ezetimibe/simvastatine (Inegy).
Scheen, André ULg; Radermecker, Régis ULg

in Revue Médicale de Liège (2007), 62(9), 585-90

Inegy, recently launched by Merck Sharp & Dohme and Schering Plough, is a fixed combination of simvastatin, which inhibits hepatic cholesterol synthesis, and ezetimibe, which selectively inhibits the ... [more ▼]

Inegy, recently launched by Merck Sharp & Dohme and Schering Plough, is a fixed combination of simvastatin, which inhibits hepatic cholesterol synthesis, and ezetimibe, which selectively inhibits the intestinal absorption of cholesterol and phytosterols. The two mechanisms of action are complementary and result in a synergistic cholesterol-lowering effect. Three formulations of Inegy are commercialized and reimbursed in Belgium, ezetimibe 10 mg/simvastatin 20 mg, ezetimibe 10 mg/simvastatin 40 mg and ezetimibe 10 mg/ simvastatin 80 mg. By blocking both synthesis and absorption of cholesterol, the fixed combination exerts a cholesterol-lowering effect as important as, or even greater than, that observed with the highest dosage of simvastatin and other statins, with a good tolerance profile. Inegy is indicated, as adjuvant treatment to diet, in patients with primary hypercholesterolaemia (homozygote or heterozygote familial form and non-familial polygenic form) not well controlled with a statin alone. Ongoing trials aim at proving the efficacy of such a fixed combination in reducing cardiovascular morbidity and mortality. [less ▲]

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See detailLe medicament du mois. Combinaison fixe perindopril-amlodipine (Coveram) dans le traitement de l'hypertension arterielle et de l'insuffisance coronaire.
Scheen, André ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2009), 64(4), 223-7

Coveram is a new fixed combination of an angiotensin converting enzyme inhibitor, perindopril, and a calcium antagonist, amlodipine. This new medication is indicated for the treatment of arterial ... [more ▼]

Coveram is a new fixed combination of an angiotensin converting enzyme inhibitor, perindopril, and a calcium antagonist, amlodipine. This new medication is indicated for the treatment of arterial hypertension and/or stable coronary heart disease. Such fixed combination of two molecules that have been extensively evaluated according to evidence-based medicine offers the advantage of an excellent efficacy, associated with a good tolerance profile, and favours patient's compliance. The marketing of different formulations of Coveram combining various dosages allows easy adjustment and titration of each of the components according to the individual patient's characteristics. [less ▲]

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See detailLe medicament du mois. Etoricoxib (Arcoxia)
Leclercq, P.; Malaise, Michel ULg

in Revue Médicale de Liège (2004), 59(5), 345-349

Etoricoxib (Arcoxia) is a novel non steroidal anti-inflammatory drug (NSAID) that selectively inhibits the inducible form of cyclo-oxygenase (COX), COX-2. Etoricoxib has a higher COX-1/COX-2 selectivity ... [more ▼]

Etoricoxib (Arcoxia) is a novel non steroidal anti-inflammatory drug (NSAID) that selectively inhibits the inducible form of cyclo-oxygenase (COX), COX-2. Etoricoxib has a higher COX-1/COX-2 selectivity ratio than the other COX-2-selective NSAIDs as rofecoxib, valdecoxib or celecoxib. Tablets of 60, 90 and 120 mg are available. The recommended dosage of etoricoxib is 60 mg/day for osteoarthritis, 90 mg/day for rheumatoid arthritis and 120 mg/day for acute gouty arthritis. Etoricoxib's efficacy has been widely studied in comparative studies, showing the same efficacy as non-COX-2 selective NSAID, with fewer gastro-intestinal adverse effects. [less ▲]

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See detailLe medicament du mois. Everolimus (RAD001/Afinitor) dans le traitement du cancer du rein métastatique.
Gennigens, Christine ULg; Sautois, Brieuc ULg; Jerusalem, Guy ULg

in Revue Médicale de Liège (2010), 65(4), 212-6

Renal cell carcinoma accounts for 3% of all malignant tumours. Until a few years ago, immunotherapy (interferon and/or interleukin-2) was the only approved option in the metastatic setting. Better ... [more ▼]

Renal cell carcinoma accounts for 3% of all malignant tumours. Until a few years ago, immunotherapy (interferon and/or interleukin-2) was the only approved option in the metastatic setting. Better knowledge of renal cell cancer biology drew attention on the fundamental role of angiogenesis. Several strategies targeting angiogenesis have been developed including VEGF ("Vascular Endothelial Growth Factor") and VEGFR inhibitors. They are now the usual treatment in first line. Until recently, no standard treatment was available after failure under or after these inhibitors. Everolimus (Afinitor), a mTOR ("mammalian Target Of Rapamycin") inhibitor, has just been validated and reimbursed in this setting. In this paper, we will review the mechanism of action and the clinical results of everolimus. [less ▲]

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See detailLe medicament du mois. Exenatide (Byetta). Incretinomimetique indique dans le traitement du diabete de type 2 apres echec et en complement des antidiabetiques oraux.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2008), 63(3), 158-65

Exenatide (Byetta) is a synthetic derivative of exendin-4 and an agonist of receptors of glucagon-like peptide-1 (GLP-1). It is resistant to the rapid inactivation by dipeptidylpeptidase-4 and acts as an ... [more ▼]

Exenatide (Byetta) is a synthetic derivative of exendin-4 and an agonist of receptors of glucagon-like peptide-1 (GLP-1). It is resistant to the rapid inactivation by dipeptidylpeptidase-4 and acts as an incretin mimetic. It stimulates insulin secretion by the B cell in a glucose-dependent manner whereas it inhibits glucagon secretion. Exenatide improves mainly postprandial glucose concentrations and lowers glycated haemoglobin (HbA(1c)) levels, without being directly responsible for hypoglycaemia or requiring mandatory home blood glucose monitoring. Furthermore, it slows down gastric emptying and promotes sustained body weight reduction, even in absence of frequently reported nausea following treatment initiation. Exenatide is recommended and reimbursed in Belgium for the treatment of type 2 diabetes, in combination with metformin and a sulfonylurea, in patients not adequately controlled with maximal tolerated doses of these oral glucose-lowering agents. Exenatide is presented as pre-filled pens for subcutaneous injection. The recommended initial dose is 5 microg before morning and evening meals, to be up titrated to 10 microg twice daily. Exenatide may represent a valuable alternative to insulin therapy, especially in overweight or obese patients with type 2 diabetes and not ready to perform home blood glucose monitoring. [less ▲]

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See detailLe medicament du mois. Exforge HCT: premiere association fixe d'un antagoniste calcique (besylate d'amlodipine), d'un inhibiteur des recepteurs de l'angiotensine II (valsartan) et d'un diuretique (hydrochlorothiazide).
LANCELLOTTI, Patrizio ULg

in Revue Médicale de Liège (2010), 65(7-8), 471-5

Because of the multifactorial nature of hypertension, most patients require combination therapy to achieve blood pressure control. Very often the antihypertensive regimen includes a renin-angiotensin ... [more ▼]

Because of the multifactorial nature of hypertension, most patients require combination therapy to achieve blood pressure control. Very often the antihypertensive regimen includes a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic. Currently, several associations combining two antihypertensive agents with complementary mechanisms of action are available. These combination therapies are more efficient to control blood pressure through synergistic and additive effects, can reach target blood pressure more quickly, are likely to attenuate the side effects of each molecule, and could improve patient adherence. Exforge HCT is the first fixed-dose combination of three antihypertensive drugs including amlodipine besylate, valsartan and hydrochlorothiazide (HCTZ) in a single pill. The association of these three drugs improves, with an equal tolerance, blood pressure control compared to dual therapies (valsartan/HCTZ, amlodipine/valsartan, or HCTZ/amlodipine). This triple therapy attenuates the diuretic-induced hypokalemia. The benefits of triple therapy over dual therapy are observed regardless of age, sex, race, ethnicity, or baseline mean sitting systolic blood pressure. Exforge HCT is currently indicated for the treatment of essential hypertension, as replacement therapy for adult patients whose blood pressure is adequately controlled by the combination of amlodipine, valsartan and HCTZ. [less ▲]

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See detailLe medicament du mois. Ezetimibe (Ezetrol).
Scheen, André ULg

in Revue Médicale de Liège (2004), 59(4), 246-50

Ezetimibe (Ezetrol), recently launched in Belgium by Merck Sharp& Dohme and Schering Plough, is presented as 10 mg tablets. It belongs to a new class of lipid-lowering agents that selectively inhibit the ... [more ▼]

Ezetimibe (Ezetrol), recently launched in Belgium by Merck Sharp& Dohme and Schering Plough, is presented as 10 mg tablets. It belongs to a new class of lipid-lowering agents that selectively inhibit the intestinal absorption of cholesterol and phytosterols. Its mechanism of action results in a synergistic cholesterol-lowering effect together with a statin that inhibits cholesterol synthesis by the liver. Ezetimibe, at a daily dose of 10 mg, is indicated, in combination with a statin, as adjuvant treatment to diet in patients with primary hypercholesterolaemia (homozygote or heterozygote familial form and non-familial polygenic form) not well controlled with a statin alone. In case of statin contra-indication or intolerance, ezetimibe can be used in monotherapy. Its tolerance profile is excellent. Statin-ezetimibe combination allows to significantly reduce total and LDL cholesterol levels and increases the percentage of hypercholesterolaemic patients who will reach the target levels recommended in the international guidelines against atherosclerosis. However, such a combination should still prove its efficacy in reducing cardiovascular morbidity and mortality in large prospective clinical trials. [less ▲]

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See detailLe medicament du mois. Femoston Low (0,5 mg d'estradiol plus 2,5 mg de dydrogesterone) comme traitement hormonal de substitution a la menopause.
SCHEEN, André ULg; Gaspard, Ulysse ULg

in Revue Médicale de Liège (2011), 66(4), 209-14

Femoston Low is a hormone replacement therapy that combines low dosages of steroids, i.e. 0.5 mg of estradiol and 2.5 mg of dydrogesterone. This oral preparation should be taken continuously to treat ... [more ▼]

Femoston Low is a hormone replacement therapy that combines low dosages of steroids, i.e. 0.5 mg of estradiol and 2.5 mg of dydrogesterone. This oral preparation should be taken continuously to treat climacteric symptoms in menopausal women. Femoston Low is in agreement with the recent recommendations for menopausal hormone replacement therapy, which give the preference to low dosage therapy whenever possible. The goals are to potentially minimize the risk of breast cancer, the danger of venous or arterial thrombosis and the glucose and lipid metabolic disturbances. Nevertheless, the preparation should efficaciously oppose to endometrial hyperplasia and yield a high degree of amenorrhea. [less ▲]

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See detailLe medicament du mois. Gliclazide a liberation modifiee (Uni Diamicron).
Scheen, André ULg

in Revue Médicale de Liège (2003), 58(10), 641-5

Gliclazide modified release that has been recently launched by Servier (Uni Diamicron 30 mg) is a new formulation of gliclazide to be given once daily. The original hydrophilic matrix improves the ... [more ▼]

Gliclazide modified release that has been recently launched by Servier (Uni Diamicron 30 mg) is a new formulation of gliclazide to be given once daily. The original hydrophilic matrix improves the biodisponsibility of gliclazide and allows a progressive release of the drug that better parallels the 24-hour glycaemic profile of patients with type 2 diabetes mellitus. Such characteristics may explain the rather low risk of hypoglycaemic episodes and the morning administration should contribute to improve patient's compliance. As the common formulation of gliclazide, the modified release formulation is indicated in the treatment of type 2 diabetes, in adult subjects, when diet, exercise and weight loss are insufficient to restore an adequate metabolic control. It may be used alone or in combination with metformin, glitazones, acarbose or insulin, with the same general principles of use as for the classical formulation of gliclazide. [less ▲]

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See detailLe medicament du mois. Glucovance dans le diabete de type 2, une association fixe metformine-glibenclamide pour faciliter le traitement d'une maladie bipolaire.
Scheen, André ULg

in Revue Médicale de Liège (2003), 58(6), 448-52

Glucovance, recently launched by Merck-Lipha (Glucovance 500 mg/2.5 mg and Glucovance 500 mg/5 mg), is a fixed combined therapy of a sulphonylurea (glibenclamide 2.5 or 5 mg) and a biguanide (metformin ... [more ▼]

Glucovance, recently launched by Merck-Lipha (Glucovance 500 mg/2.5 mg and Glucovance 500 mg/5 mg), is a fixed combined therapy of a sulphonylurea (glibenclamide 2.5 or 5 mg) and a biguanide (metformin 500 mg), indicated for the treatment of type 2 diabetes in adult patients. The only current official indication in Belgium is the substitution of a dual therapy with metformin and glibenclamide in patients with a stable and adequate metabolic control. The fixed combination aims at simplifying patient's treatment in order to improve compliance despite polymedication. In addition, it allows targeting synergistically the two main abnormalities of type 2 diabetes, i.e. the insulin secretory defect and the insulin resistance. [less ▲]

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