OPTIMINE
Indications: OPTIMINE (azatadine maleate) tablets are indicated for the symptomatic relief of respiratory allergic conditions which include acute and chronic allergic rhinitis, pollenosis (hay fever), and vasomotor rhinitis. OPTIMINE is also indicated in the symptomatic relief of such allergic dermatological conditions as acute and chronic urticaria, angioneurotic edema, allergic eczema, contact dermatitis, insect bites, pruritus vulvae and ani, pruritus of nonspecific orig in, drug and serum reactions, dermographism; for anaphylactic reactions, as adjunctive therapy to epinephrine and other standard measures. Contraindications: OPTIMINE (azatadine maleate) is contraindicated in patients with a history of hypersensitivity to any of the components. As with all anticholinergic agents, azatadine maleate is also contiaindicated in patients with glaucoma, prostatic hypertrophy, and in patients predisposed to urinary retention, stenosing peptic ulcer or pyloroduodenal obstruction. It is also contraindicated with concurrent monoamine oxidase inhibitor therapy, tricyclic antidepressants, in elderly debilitated patients suffering from depression and in acute asthmatic attack. Warnings: Until the safety of OPTIMINE in regards to adverse effect on human fetal development has been established, the drug is not recommended for use in pregnant or lactating women. Precautions: Although drowsiness is infrequent, patients taking the drug should be cautioned against engaging in mechanical operations requiring mental alertness. Azatadine maleate may potentiate central nervous system depressants. Therefore, patients should be cautioned against ingestion of alcohol and other central nervous system depressants. Overdosage of antihistamines, particularly in infants and children may produce convulsions and death. Prolonged therapy with antihistamines may cause blood dyscrasias. Adverse Reactions: OPT1MINE is well tolerated and side effects are generally doserelated and transient. Among these are: weakness, nervousness, dry mouth, increased appetite, anorexia, nausea, headache, drowsiness, dysuria and blurring of vision. Although not reported with azatadine maleate, antihistamines cause central nervous system stimulation such as agitation, confusion, visual hallucinations. Dosage and Administration: Each OPTIMINE tablet contains 1 mg of azatadine maleate. Available in bottles containing 100 white, compressed, scored tablets. For most conditions, 1 mg of OPTIMINE - 1 tablet - in the morning and evening is recommended for the majority of patients. In refractory or more severe cases, 2 mg twice daily may be used. For children between the ages of six and twelve, 1Ato 1 tablet of OPTIMINE twice daily is recommended. Full information is published in the Compendium of Pharmaceuticals and Specialties and available on request from Schering Canada Inc.. Pointe Claire, Quebec H9R 1B4.
*R.TM
MEM6ER
IPAABI IPMACI
other supplements. The mind-bending and drug-pushing has gone on long enough. ZOLTAN RONA, MD
Medical Arts Primary Care Center Mississauga, Ont.
Health insurance To the editor: Dr. J.D. Brown (Can Med Assoc 1 120: 524, 1979) may be knowledgeable about his medical practice but seems less so when it comes to medical history or social reality. Prior to state-subsidized medical care the care of the sick poor was frequently paid for by those more generously endowed with wealth and health. This was effected through charitable institutions, religious groups, voluntarism and direct subsidies to the poor by doctors, who often used a sliding scale so that the higher fees paid by the wealthy compensated for the uncollectable debts. Dr. Brown should also be aware that any insurance scheme is simply a method of risk-spreading in which the premiums paid by the healthy contributors are managed by a third party and eventually pay for the care of contributors who become sick. The second point I wish to contest is the moral model of ill-health implied in the final paragraph of Dr. Brown's letter. This ignores the fact that the elderly, irrespective of social class, are over-represented as consumers of health care; they are also frequently of slender means. Should we consign them to charity and handouts? Finally I wish to point out that to be born poor in Canada is likely not only to condemn one to a lifetime of relative poverty1'2 but also to endow one with a heritage of inadequate nutrition, inadequate housing and certainly an increased likelihood of congenital or genetic abnormalities. How unfair can one be in selectively discriminating against certain groups by stating that good health is a personal responsibility without at least adding some riders? P.R.W. KENDALL, MB, BS
SCHERING
2041 Vanness Ave. Vancouver, BC
References 1. MARCHAK MP: Ideological Perspectives on Canada, McGraw-Hill Ryerson, Scarborough, Ont, 1975 2. FORCESE D: The Canadian Class Structure, McGraw-Hill Ryerson, Scarborough, Ont, 1975
Dialysis for psoriasis To the editor: The following is a preliminary report on a case of psoriasis treated by peritoneal dialysis. A 62-year-old woman had suffered from extensive psoriasis for more than 13 years. Her condition was so severe that during the last 5 years she had spent about a third of each year in hospital. During this time she received many of the standard treatments for psoriasis: cold tar preparations and ultraviolet light; topical or systemic steroids; systemic methotrexate, to which she eventually had a severe reaction; and hydroxyurea, which produced an excellent but shortlived remission. During the 12 months prior to this treatment the patient spent 152 days in hospital. Moderately severe angina pectoris complicated the situation. Recent reports have suggested that remissions of psoriasis may occur in patients being treated by peritoneal dialysis1'2 or hemodialysis.3'4 This patient, desperate that something be achieved, was offered peritoneal dialysis in the renal unit of the Royal Inland Hospital, Kamloops, BC. The dangers of the procedure were carefully explained, and it was pointed out that the therapeutic process was still experimental for psoriasis and that, whereas dialysis in renal failure is offered as the alternative to death, psoriasis may be very unpleasant but does not generally prove fatal. Nevertheless, the patient unhesitatingly requested the procedure. A peritoneal catheter was inserted and dialysis commenced with a 1.5% dialysate solution (Dianeal®; Baxter Travenol Laboratories of Canada Ltd.). The patient was allowed to eat and drink what she pleased. Fairly intensive dialysis was performed for the first few days; subsequently the patient underwent
CMA JOURNAL/MAY 19, 1979/VOL. 120 1209
Indications: OPTIMINE (azatadine maleate) tablets are indicated for the symptomatic relief of respiratory allergic conditions which include acute and chronic allergic rhinitis, pollenosis (hay fever), and vasomotor rhinitis. OPTIMINE is also indicated in the symptomatic relief of such allergic dermatological conditions as acute and chronic urticaria, angioneurotic edema, allergic eczema, contact dermatitis, insect bites, pruritus vulvae and ani, pruritus of nonspecific orig in, drug and serum reactions, dermographism; for anaphylactic reactions, as adjunctive therapy to epinephrine and other standard measures. Contraindications: OPTIMINE (azatadine maleate) is contraindicated in patients with a history of hypersensitivity to any of the components. As with all anticholinergic agents, azatadine maleate is also contiaindicated in patients with glaucoma, prostatic hypertrophy, and in patients predisposed to urinary retention, stenosing peptic ulcer or pyloroduodenal obstruction. It is also contraindicated with concurrent monoamine oxidase inhibitor therapy, tricyclic antidepressants, in elderly debilitated patients suffering from depression and in acute asthmatic attack. Warnings: Until the safety of OPTIMINE in regards to adverse effect on human fetal development has been established, the drug is not recommended for use in pregnant or lactating women. Precautions: Although drowsiness is infrequent, patients taking the drug should be cautioned against engaging in mechanical operations requiring mental alertness. Azatadine maleate may potentiate central nervous system depressants. Therefore, patients should be cautioned against ingestion of alcohol and other central nervous system depressants. Overdosage of antihistamines, particularly in infants and children may produce convulsions and death. Prolonged therapy with antihistamines may cause blood dyscrasias. Adverse Reactions: OPT1MINE is well tolerated and side effects are generally doserelated and transient. Among these are: weakness, nervousness, dry mouth, increased appetite, anorexia, nausea, headache, drowsiness, dysuria and blurring of vision. Although not reported with azatadine maleate, antihistamines cause central nervous system stimulation such as agitation, confusion, visual hallucinations. Dosage and Administration: Each OPTIMINE tablet contains 1 mg of azatadine maleate. Available in bottles containing 100 white, compressed, scored tablets. For most conditions, 1 mg of OPTIMINE - 1 tablet - in the morning and evening is recommended for the majority of patients. In refractory or more severe cases, 2 mg twice daily may be used. For children between the ages of six and twelve, 1Ato 1 tablet of OPTIMINE twice daily is recommended. Full information is published in the Compendium of Pharmaceuticals and Specialties and available on request from Schering Canada Inc.. Pointe Claire, Quebec H9R 1B4.
*R.TM
MEM6ER
IPAABI IPMACI
other supplements. The mind-bending and drug-pushing has gone on long enough. ZOLTAN RONA, MD
Medical Arts Primary Care Center Mississauga, Ont.
Health insurance To the editor: Dr. J.D. Brown (Can Med Assoc 1 120: 524, 1979) may be knowledgeable about his medical practice but seems less so when it comes to medical history or social reality. Prior to state-subsidized medical care the care of the sick poor was frequently paid for by those more generously endowed with wealth and health. This was effected through charitable institutions, religious groups, voluntarism and direct subsidies to the poor by doctors, who often used a sliding scale so that the higher fees paid by the wealthy compensated for the uncollectable debts. Dr. Brown should also be aware that any insurance scheme is simply a method of risk-spreading in which the premiums paid by the healthy contributors are managed by a third party and eventually pay for the care of contributors who become sick. The second point I wish to contest is the moral model of ill-health implied in the final paragraph of Dr. Brown's letter. This ignores the fact that the elderly, irrespective of social class, are over-represented as consumers of health care; they are also frequently of slender means. Should we consign them to charity and handouts? Finally I wish to point out that to be born poor in Canada is likely not only to condemn one to a lifetime of relative poverty1'2 but also to endow one with a heritage of inadequate nutrition, inadequate housing and certainly an increased likelihood of congenital or genetic abnormalities. How unfair can one be in selectively discriminating against certain groups by stating that good health is a personal responsibility without at least adding some riders? P.R.W. KENDALL, MB, BS
SCHERING
2041 Vanness Ave. Vancouver, BC
References 1. MARCHAK MP: Ideological Perspectives on Canada, McGraw-Hill Ryerson, Scarborough, Ont, 1975 2. FORCESE D: The Canadian Class Structure, McGraw-Hill Ryerson, Scarborough, Ont, 1975
Dialysis for psoriasis To the editor: The following is a preliminary report on a case of psoriasis treated by peritoneal dialysis. A 62-year-old woman had suffered from extensive psoriasis for more than 13 years. Her condition was so severe that during the last 5 years she had spent about a third of each year in hospital. During this time she received many of the standard treatments for psoriasis: cold tar preparations and ultraviolet light; topical or systemic steroids; systemic methotrexate, to which she eventually had a severe reaction; and hydroxyurea, which produced an excellent but shortlived remission. During the 12 months prior to this treatment the patient spent 152 days in hospital. Moderately severe angina pectoris complicated the situation. Recent reports have suggested that remissions of psoriasis may occur in patients being treated by peritoneal dialysis1'2 or hemodialysis.3'4 This patient, desperate that something be achieved, was offered peritoneal dialysis in the renal unit of the Royal Inland Hospital, Kamloops, BC. The dangers of the procedure were carefully explained, and it was pointed out that the therapeutic process was still experimental for psoriasis and that, whereas dialysis in renal failure is offered as the alternative to death, psoriasis may be very unpleasant but does not generally prove fatal. Nevertheless, the patient unhesitatingly requested the procedure. A peritoneal catheter was inserted and dialysis commenced with a 1.5% dialysate solution (Dianeal®; Baxter Travenol Laboratories of Canada Ltd.). The patient was allowed to eat and drink what she pleased. Fairly intensive dialysis was performed for the first few days; subsequently the patient underwent
CMA JOURNAL/MAY 19, 1979/VOL. 120 1209
