Areas of application

ADHD stands for Attention Deficit Hyperactivity Disorder.

This is one of the most common mental disorders in children and adolescents. It is assumed that about 2 to 6 percent of all children and adolescents suffer from pathological disorders of attention and motor restlessness. Characteristics for ADHD:

• 1. Hyperactivity (excessive urge to move)
  2. Inattention (impaired ability to concentrate)
  3. Impulsivity (rash actions)

However, the individual symptoms can vary in severity and do not always have to occur all at the same time. As varied as the manifestations of ADHD are, so colourful are the names for it. In allusion to the typical urge to move of many ADHD children, it is also popularly called the “fidget syndrome”. The generic term ADHD also describes the manifestation of the disease, in which no hyperactive behaviour is observed, but only attention deficits are present.

However, not every restless or inattentive child immediately suffers from ADHD. Only a doctor or psychotherapist experienced in the diagnosis and treatment of children and adolescents with behavioural problems can determine whether a pathological disorder is really present after a differentiated examination. The following applies in particular: The abnormalities must occur over a longer period of time (at least six months) and in different areas of the child’s life (family, school and leisure time) in order to really speak of ADHD.

If ADHD remains untreated, this can have serious consequences for the child and his or her entire family environment, such as school failure, family problems or an increased risk of addiction. In most cases, intensive care and targeted treatment of the symptoms can enable the affected children and adolescents to achieve largely normal social and academic development. Today, the treatment of ADHD is based on several pillars: Individually combined, after education and counselling of all those affected, psychotherapy, e.g., behavioural therapy of the child, parent and teacher training, and, in individual cases, drug therapy. ¹

¹ German Federal Ministry of Health July 19, 2018, www.bundesgesundheitsministerium.de (accessed: 23.08.2019)

The number of allergy sufferers is constantly increasing, and effective and safe therapy is essential for these patients.

Allergy is an excessive immune response to an antigen that is harmless by itself. The most common form of allergy is hay fever. Since the symptoms of hay fever are manifested within a very short time by reactions of the immunoglobulins E (IgE), it is also called an allergy of the immediate type or a type 1 allergy. It is imperative that hay fever be treated immediately, since in addition to the disturbances in the patient’s state of health and performance, a “floor change” very often occurs, in which the disease shifts from the sections of the upper respiratory tract to deeper sections of the lungs with asthmatic symptoms.

To restore quality of life, symptoms can be controlled with mast cell stabilizers, anti-IgE antibodies, glucocorticoids, or histamine H1 receptor antagonists. Agents of first choice are the newer generation antihistamines (e.g., cetirizine, loratadine) because of the risk-benefit ratio.¹

¹ Stark H. Awake through the allergy season, Pharmazeutische Zeitung online, issue 13/2011.

Alzheimer’s dementia is the most common form of intellectual decline syndromes.

It can be assumed that 2-4% of the population over the age of 65 is affected by Alzheimer’s dementia. The disease is more common in women due to longer life expectancy. The incidence rate is estimated to be about 1% per year. The probability that a person will have severe dementia by the age of 80 must be put at about 20%. More and more citizens in western industrialized nations are reaching the manifestation age of Alzheimer’s disease, the prevalence of which will thus continue to rise. In Austria, the number of people suffering from Alzheimer’s disease is estimated at around 90,000.

Acetylcholinesterase inhibitors (e.g. rivastigmin) and memantine are currently available for the treatment of cognitive and functional deficits of Alzheimer’s dementia. The principle of action of acetylcholinesterase inhibitors is to improve neural availability of acetylcholine, which is reduced in Alzheimer’s dementia, by inhibiting the degrading enzyme cholinesterase or butyrylcholinesterase (cholinergic hypothesis). The efficacy of treatment with acetylcholinesterase inhibitors for mild and moderate forms of AD as “first-line” therapy has been widely demonstrated. Evidence of efficacy has been obtained in randomized, placebo-controlled trials and has also been confirmed in meta-analyses. A particular challenge is patient compliance. Memantine has an antagonistic function on the NMDA receptor and serves to regulate glutamate balance. Currently, memantine is prescribed to patients with moderate to severe AD.¹

¹ Fleischhacker & Hinterhuber. Textbook Psychiatry. Springer Vienna New York 2012, 370-372.

The term tranquilizers (minor tranquilizers) refers to psychotropic drugs that are used to treat states of anxiety and tension (Latin tranquillare = to calm).

They are also referred to as anxiolytics (anxiety relievers). The clinical tranquilizer effect is defined as the anxiety-relieving, calming and emotionally relaxing effects. The real “tranquilizer era” began with the benzodiazepines, which, thanks to their pharmacological advantages, still rank first among tranquillizers today.

Hypnotics are not a sharply defined group of drugs; rather, any drug that produces sleep is called a hypnotic. Benzodiazepines and the newer benzodiazepine receptor agonists/nonbenzodiazepines, such as zolpidem or eszopiclon, are among the most commonly prescribed hypnotics.¹

¹ Riederer & Laux. Fundamentals of neuro-psychopharmacology. SpringerViennaNewYork 2010, 362-374.

Asthma is a chronic inflammatory disease of the airways, characterized by the occurrence of symptoms that vary in time and intensity, such as dyspnea, wheezing, chest tightness, and cough, as well as bronchial hyperreactivity. Due to inflammatory response of the airways, bronchial hyperreactivity and even bronchial obstruction may occur.¹ Asthma is one of the most common chronic diseases, occurring in approximately 10% of the child population and 5% of the adult population, and the trend is increasing.² The goal of pharmacotherapy is to suppress asthmatic inflammation and decrease bronchial hyperreactivity and airway obstruction, as well as to achieve the best possible asthma control. Medications are divided into on-demand therapeutics for rapid symptomatic therapy (inhaled rapid-acting beta-2 sympathomimetics) and long-term therapeutics (inhaled corticosteroids, inhaled long-acting beta-2 sympathomimetics, montelukast). The goal of asthma therapy is to achieve or maintain a controlled asthma status.¹

Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate with a progressive course.

It is the most common disease of the prostate. Enlargement of the prostate is present in every second man between the ages of 50 and 60 and in more than 80 percent of men over the age of 80. Clinical symptoms include prostate enlargement itself, bladder obstruction and lower urinary tract symptoms (delayed urination, prolonged bladder emptying, weakened urinary stream, urinary stuttering, post urinary dribbling, feeling of incomplete emptying and feeling of pressure as well as frequent urination during the day and at night, strong urge to urinate and urge incontinence). The impact of these complaints can greatly affect the quality of life.

Options for treatment include “watchful waiting” (regular monitoring without therapeutic intervention when symptoms are mild), drug therapy with herbal preparations, alpha-blockers or 5-alpha-reductase inhibitors, and surgical procedures.¹

¹ Haberfeld H., Summer Academy Pörtschach 2010 – The lectures of the 3rd session. ÖAZ, 2010, 64: 704-707.

A typical clinical picture of bipolar disorder is the alternation of depressive phases with manic episodes.

While the depressive phase is characterized by a negative mood, listlessness, sleep disturbances and lack of concentration, euphoria, overconfidence, and hyperactivity are classic symptoms of mania.

In Austria, 0.5 to 2% of the population are affected by a severe bipolar disorder (Bipolar I) with the full picture of mania and depression. Another 5-10% suffer from a Bipolar II disorder, in which hypomania and depression are present. Genetic predisposition, biological and psychosocial parameters as well as certain lifestyle habits can influence the onset as well as the course of the disease. From a neuropsychological point of view, in mania and depression there is a change in the transmitter metabolism of serotonin, dopamine, noradrenaline and GABA between the nerve cells as well as within the nerve cells.

For successful therapy, it is necessary to tailor treatment to the individual patient’s disease course. First-line agents for the treatment of the acute manic phase are mood stabilizers such as valproic acid and lithium, or atypical antipsychotics such as olanzapine, risperidone, quetiapine and aripiprazole. For acute therapy of the depressive phase, the combination of an antidepressant with a mood stabilizer is recommended. Drug treatment is supplemented by special psychotherapy and psychoeducation.¹

¹ Simhandl C., DFP literature: Management of bipolar disorder, Österreichische Ärztezeitung, Issue No. 5/10.03.2013, pp. 26-35.

Blood clotting & circulatory disorders, thrombosis prophylaxis.

Patients who have already had a vascular occlusive disease such as myocardial infarction, stroke, or vascular surgery (e.g., bypass) are at high risk for recurrence of vascular events.¹ The options for prevention and treatment have improved.² For secondary prevention of cardiovascular disease, in addition to lifestyle interventions, there are drug treatment methods that can be individually adapted to the patient due to the possible selection from different agents, such as platelet aggregation inhibitors and anticoagulants.

Venous thromboembolism occurs in a significant proportion of patients in typical risk situations (e.g., surgery or trauma). Anticoagulant medications, particularly low-molecular-weight heparins, can reduce venous thrombosis, pulmonary embolism, and death from pulmonary embolism in these specific high-risk situations.³

¹ Antithrombotic Trialists’ (ATT) Collaboration et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet, 2009, 373: 1849-1860.

² Secondary prevention of cardiovascular disease with acetylsalicylic acid: a gap between guideline and practice. Der Arzneimittelbrief, 2013, 47: 13-14.

³ Prabinger I. et al. Guidelines for venous thromboembolism prophylaxis in Austria. Wiener Klinische Wochenschrift, 2007, 119: 739-746.

Breast cancer is the most common cancer among women in Austria, accounting for 29% of all cancer cases.

Annually, there are approximately 5,565 new cases in Austria, and approximately 1,620 women die of breast cancer each year.¹

Treatment options for localized breast cancer include surgery, radiation and drug-based cancer therapy. Approximately two-thirds of all malignant breast tumors grow dependent on female sex hormones, primarily estrogens. In the treatment of these estrogen receptor-positive breast tumors, anti-hormone therapy agents from three different drug classes are predominantly used. These are the so-called selective estrogen receptor modulators (SERMs; e.g., tamoxifen), estrogen synthesis inhibitors (aromatase inhibitors; e.g., anastrozole, letrozole), and selective estrogen receptor downregulators (SERDs; e.g. e.g. fulvestrant).² Like chemotherapy, anti-hormone therapy acts throughout the body and therefore combats even microscopic metastases that cannot yet be detected with currently available options. The advantage over chemotherapy is that healthy cells are not directly attacked, although the withdrawal of the hormone effect still affects them. Overall, antihormones are better tolerated and can be taken for several years.³

The goal of treating patients with metastatic breast carcinoma is to achieve remission with symptom relief and a prolongation of the progression-free period. Monoclonal antibodies (e.g., bevacizumab) in combination with cytostatics (e.g., capecitabine) can lead to an increase in remission rates as well as a prolongation of progression-free survival.⁴

¹ STATISTIK AUSTRIA (ed.). Austrian Cancer Registry, Status: 2021: http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/brust/index.html (accessed February 09, 2021). 
² Fiegl H. Endocrine resistance mechanisms and treatment strategies. Gyn-Aktiv, 2012.
³ German Cancer Society (ed.): https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/brustkrebs/therapie/hormontherapie.html (accessed: 09.02.2021).
⁴ Wörmann B. et al. Onkopedia guideline: breast carcinoma in women. As of 01/2018. Available at: https://www.onkopedia.com/de/onkopedia/guidelines/mammakarzinom-der-frau/@@guideline/html/index.html (accessed: 13.09.2021).

In the healthy body, there is a balance between iron intake and iron loss. Plasma iron levels are regulated by the hepcidin/ferroportin system. Disturbances in the hepcidin/ferroportin regulatory system cause diseases associated with iron deficiency or iron overload.

In certain diseases, excess iron may result from increased absorption (primary iron storage disease) or from repeated blood transfusions (secondary iron storage disease). Too much iron cannot be compensated by active excretion (e.g. via urine). As a result, the transport and storage capacity for iron is exceeded, and free iron is formed in the blood (NTBI). Some of the NTBI can be converted into labile iron. Redox-reactive labile iron can cross cell membranes in an uncontrolled manner without active transport. If labile iron accumulates in the cells, the antioxidant mechanisms of the cells are overwhelmed and reactive oxygen species (ROS) are subsequently formed. These ROS damage macromolecules such as proteins, DNA and lipids, and consequently organelles such as lysosomes and mitochondria. The damage at the molecular and cellular levels can eventually lead to organ dysfunction. Iron overload thus has a toxic effect in that excess iron is present in an unbound form and causes severe oxidative stress.

Diseases such as hereditary hemochromatosis and chronic transfusion-related anemias such as thalassemias show that iron overload can have multiple consequences (e.g., on the heart, liver, or other organs).

Since the organism has no physiological mechanisms to excrete excess iron, the excess iron must be bound by chelating agents. Chelators form a complex with iron that is excreted biliterally. In this way, iron chelators reduce the amount of labile iron into the normal range and subsequently reduce oxidative stress and its subsequent damage to organs. Maintenance of protection against oxidative stress can only be achieved by continuous iron chelation.

Sources: 

Gattermann N et al. Dtsch Arztebl Int 2021; 118: 847-56; DOI: 10.3238/arztebl.m2021.0290
Onkopedia Guidelines. Beta Thalassämie. DGHO Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie e.V. (Accessed: October 2019).

Out of 38,000 new cancer patients annually, one in 8 is diagnosed with colorectal cancer.

At 13%, colorectal cancer is the third most common cancer in men and at 11% the second most common cancer in women.¹ Ninety-five percent of all those affected develop adenocarcinoma, tumours such as lymphomas, sarcomas, neuroendocrine tumours or squamous cell carcinomas, are diagnosed less frequently. Early diagnosis is often difficult due to lack of characteristic symptoms; local symptoms such as pain, cramps, and haematochezia usually occur, accompanied by weight loss, paraneoplasia, or anaemic symptoms. As a result of metastasis, liver failure or the appearance of icterus may also occur.

Before the start of therapy, treatment goals and the therapeutic measures necessary to achieve them are defined individually for each patient. In particular, the stage of the cancer and clinical risk factors such as comorbidity and age influence the choice of drugs and the intensity of treatment. For cancer patients in stages 1 to 3, complete resection of the primary tumour is the central element of curative therapy. Adjuvant drug tumour therapy aims to prevent the manifestation of distant metastases. In addition, it leads to a reduction in the recurrence rate as well as to an increase in the survival rate. Fluoropyrimidines (capecitabine, 5-fluorouracil/folinic acid) and other cytostatic drugs such as irinotecan and oxaliplatin as well as monoclonal antibodies (bevacizumab, cetuximab, panitumumab) are components of drug-based tumour therapy.²

¹ STATISTIK AUSTRIA (ed.). Cancer Incidence and Mortality in Austria 2014: http://www.statistik.at/web_de/dynamic/statistiken/gesundheit/krebserkrankungen/dickdarm_enddarm/publdetail?id=95&listid=95&detail=679 (accessed 08.05.2015).

² Austrian Society for Haematology & Medical Oncology (ed.): http://www.oegho.at/onkopedia-leitlinien/solide-tumore/kolonkarzinom.html (accessed 08.05.2015).

Affective disorders are the most common mental illnesses and are often comorbid with other mental disorders (anxiety disorders, addictions, personality disorders).

Due to the risk of suicide during depressive periods, they are classified as fundamentally life-threatening. However, the impact on the psychosocial integration of the patients as well as the burden on the relatives is often also very high. Unipolar depression alone now ranks first among causes of loss of “healthy life years” worldwide according to the DALY (Disability-Adjusted Life Year) score. Affective disorders cause 7% of the total burden of disease in Europe.

The phase of acute antidepressant therapy, which aims at complete remission, leads directly into maintenance therapy. The mechanism of action of almost all antidepressants on the market today is based on the monoamine deficiency hypothesis of depression formulated in the 1960s. According to this hypothesis, antidepressant drugs correct the postulated cerebral deficit of serotonin and norepinephrine and induce mood elevation via downregulation of the receptors. The efficacy of antidepressants is 60-70%, i.e., about one-third of patients do not respond to initial drug therapy. In these cases, a switch to another agent or the initiation of adjuvant measures is therefore necessary.¹

¹ Fleischhacker & Hinterhuber. Textbook of Psychiatry. Springer Vienna New York 2012, 154-177.

Disorders of blood lipid metabolism are an established risk factor for atherosclerosis, therefore the importance of therapeutic regulation of dyslipidaemia for the prevention of cardio- and cerebrovascular complications is recognized by professional societies worldwide.

In addition to disorders of lipid metabolism, cardiovascular risk is increased by risk factors such as older age, positive family history of premature coronary artery disease, smoking, hypertension, and low HDL cholesterol. Therapeutic lifestyle modification is recommended immediately when the LDL cholesterol target is exceeded. Drug intervention should be given if the required thresholds are exceeded in low- or intermediate-risk individuals after 3 months of lifestyle modification or if the risk is high to very high.¹ For this purpose, there are separate classes of agents depending on the lipid profile, which allow individualized therapy.

¹ Austrian Lipid Consensus 2010. management of dyslipidaemia for prevention of vascular complications. Joint consensus statement of eight Austrian professional societies, May 2010.

Epilepsy is one of the most common neurological disorders, the age-dependent incidence shows a 2 peaked course with a first maximum in childhood and a second in older age (⅓ of epilepsies begin after the age of 60).

Epilepsy is present if at least 2 unprovoked seizures have occurred or if increased epileptogenicity can be assumed as probable after a seizure by a corresponding EEG or MRI finding. In approximately 65% of patients with epilepsy, sustained seizure freedom can be achieved by antiepileptic therapy; in the remaining 35%, therapy-resistant or difficult-to-treat epilepsy develops. The most important treatment goals are, in addition to optimal seizure control (ideally freedom from seizures), good tolerability of the drug therapy, avoidance of chronic side effects, simple handling of the medication for the physician and patient, favourable influence of concomitant diseases frequently associated with epilepsy, and consideration of the needs of special patient groups. In general, therapy should be as individualized as possible, tailored to the needs of each patient.¹

¹ Baumgartner C & Pirker S. Update on the diagnosis and therapy of epilepsy. J Neurol Neurochir Psychiatr 2012, 13 (2): 64-80.

Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse.

This dysfunction should persist for at least 6 months, may have organic (vascular, arterial, venous, mixed, neurogenic, anatomic, endocrine) or psychogenic causes, and may significantly reduce the quality of life and well-being of the individual as well as the life partner. ¹ In the European Male Aging Study (EMAS), 30% of men reported suffering from erectile dysfunction (ED). The condition can occur at any age, but prevalence increases with age to approximately 64% of those over 70 years. Comorbidities (e.g., diabetes mellitus, coronary artery disease, hypertension, or depression) and noxious agents (nicotine, alcohol) but also lifestyle (obesity, lack of physical activity) can cause or exacerbate the manifestation of ED.² Studies show that ED in all age groups not only affects sexual life, but also reduces all quality of life parameters.³ Apart from treatment of the cause or prevention (e.g. diabetes), erectile dysfunction can be treated with medication, e.g. phosphodiesterase-5 inhibitors. ¹

¹ Guidelines for diagnosis and therapy in neurology; 4th revised edition 2008, p. 654 ff, ISBN 978-3-13-132414-6; Georg Thieme Verlag Stuttgart.

² Corona G. et al. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J. Sex. Med, 2010, 7: 1362-1380.

³ McCabe MP. Intimacy and quality of life among sexually dysfunctional men and women. J. Sex Marital Ther., 1997, 23: 276-290.

Gastric cancer (gastric carcinoma) is a malignant tumour of the gland-forming cells of the stomach (adenocarcinoma).

Risk factors include long-term infection with the bacterium Helicobacter pylori (with gastritis or inflammation of the stomach), frequent consumption of cured, heavily salted or smoked foods, smoking, increased alcohol consumption, previous stomach surgery, and hereditary predisposition. The number of new cases varies between 10 and 15 cases per 100,000 population per year. Men are more frequently affected than women. The majority of patients are over 65 years of age. Patients with gastric cancer can be cured by timely diagnosis. Early detection includes gastroscopy with fine tissue examination. Unfortunately, two-thirds of patients are not diagnosed until the disease is in an advanced stage. Typical warning symptoms may include upper abdominal discomfort, loss of appetite, vomiting and nausea, black stools (tarry stools), food intolerance and weight loss.

Therapy depends on the local spread, stage and histological type of the disease. Removal of gastric cancer by surgery is the most important component of therapy. In addition, the therapy can be supported by medication both before and after surgery by means of chemotherapy. Chemotherapy can be given with one or more agents, and in combination with radiotherapy or without.^1,2

¹ Wöll E. Cancer in focus. Gastric cancer. © OeGHO – Austrian Society for Hematology & Medical Oncology 2017. http://www.krebsimfokus.at/ueber-krebs/magenkrebs/im-ueberblick.html (last accessed: 02.05.2017).

² Austrian Cancer Society. Stomach cancer. https://www.krebshilfe.net/information/krebsformen/magenkrebs/ (last accessed: 02.05.2017).

A peptic ulcer describes a pronounced defect of the gastrointestinal mucosa, usually of the stomach or duodenum.

The bacterium Helicobacter pylori appears to play a crucial role in the development of peptic ulcers.¹ The prevalence of Helicobacter pylori infection varies widely both between industrialized and developing countries and within individual societies. The infection induces chronic active gastritis; a possible complication or secondary disease of this is, among others, gastroduodenal ulcer disease.² The aim of therapy is the eradication of Helicobacter pylori via antibacterial substances and the neutralization or inhibition of acid secretion via antisecretory agents such as famotidine or sucralfate.

Other causes of peptic ulcers include disorders in the mucosal defense mechanism, reflux of intestinal contents into the stomach, or delayed gastric emptying, as well as emotional stress, smoking, alcohol, and the use of nonsteroidal anti-inflammatory drugs or corticosteroids.¹

Numerous studies show that nonsteroidal anti-inflammatory drugs lead to gastroduodenal ulcers with increased incidence of bleeding in a dose-dependent manner. Risk factors for upper gastrointestinal bleeding, in addition to age (over 60 or 65 years), include male sex, previous gastrointestinal bleeding or history of gastroduodenal ulcers, oral anticoagulation, and use of corticosteroids. Prospective randomized, double-blind trials have demonstrated that the risk of such bleeding can be significantly reduced by taking proton pump inhibitors.2

¹ Sweetman SC (ed.), Martindale. The Complete Drug Reference: http://www.medicinescomplete.com/ (accessed: 11/20/2013).

² Fischbach et al: S3 guideline “Helicobacter pylori and gastroduodenal ulcer disease” of the German Society for Digestive and Metabolic Diseases (DGVS). Z Gastroenerol 2009, 47: 68-102.

A common but not precisely defined disorder associated with upper abdominal discomfort or pain is dyspepsia. In some cases, the symptoms can be attributed to a specific disease (such as peptic ulcers, gastroesophageal reflux disease, gastric cancer, chronic pancreatitis, or gallstones), but in many patients no systemic disease can be identified. In such cases, the condition is also referred to as functional dyspepsia. Avoidance of alcohol, caffeine, smoking, and foods that aggravate symptoms should be recommended as an initial therapeutic approach, as well as a reduction in portion sizes to aid digestion. Furthermore, medications to suppress stomach acid, such as antacids or antisecretory agents, are often prescribed.¹

Disturbed digestive processes also often lead to flatulence. The increased gases are then present in the gastrointestinal tract as an inert, fine-bubbled foam. This makes normal absorption of the gases through the intestinal wall difficult or even completely impossible. In such cases, the active substance simeticon, for example, can use its special surface effect to cause the foam-like bubbles to disintegrate immediately after taking a simeticon preparation. The gases thus released can now escape naturally.²

¹ Sweetman SC (ed.), Martindale. The Complete Drug Reference: http://www.medicinescomplete.com/ (accessed: 11/20/2013).

² SmPC Antiflat® chewable tablets Gerot Lannach, Date of information: June 2013.

Proton pump inhibitors, such as pantoprazole, omeprazole, suppress the secretion of gastric acid by irreversibly inhibiting the proton pump in the gastric vestibular cells.

Proton pump inhibitors are used in situations where inhibition of gastric acid secretion is beneficial, such as gastroesophageal reflux disease.¹ This is a common condition in industrialized countries of the Western world. 10% of the population suffer from daily or weekly reflux symptoms.

Medications may exacerbate symptoms, including calcium antagonists, nitro medications, theophyllines (exacerbation of reflux-related asthma), anticholinergics, psychotropic drugs, oral contraceptives, peppermint oil-containing preparations, and others.

It is known from numerous studies that reflux symptoms decrease dramatically within a few days under effective therapy. Due to the superior effect of acid inhibition via proton pump inhibitors compared to other forms of therapy, primary therapy should be carried out with a proton pump inhibitor, whereby the therapy result also provides diagnostic information. In the majority of cases, a long-term therapy concept is required. In this context, long-term treatment can usually be carried out as “on demand” therapy with acid secretion inhibitors. The efficacy of such a therapeutic concept is well established, especially for proton pump inhibitors.²

¹ Sweetman SC (ed.), Martindale. The Complete Drug Reference: http://www.medicinescomplete.com/ (accessed: 11/20/2013).

² Koop et al. Gastroesophageal reflux disease-results of an evidence-based consensus conference of the German Society for Digestive and Metabolic Diseases. Z Gastroenterol 2005, 43: 163-164.

Gout is the most common and most important of the crystal arthropathies. In our latitudes, it is the most common inflammatory joint disease of all.

As a result of hyperuricemia, urate crystal-induced inflammation of the joints or soft tissues occurs. The prevalence of gout shows considerable regional and ethnic differences, is on the rise, and currently ranges from 3 to 4% in western countries, with men being affected twice as often. According to studies, the prevalence of hyperuricemia reaches values as high as 21% regardless of gender, which is partly due to the increase in obesity. A positive family history is found in 30%. hyperuricemia has now emerged as a cardiovascular risk factor.¹ The most common uricostatic drug and the first-line agent for hyperuricemia requiring treatment is allopurinol. It inhibits uric acid formation and thus promotes the excretion of soluble precursors such as xanthine and hypoxanthine.² The active substance allopurinol has been on the WHO’s list of essential medicines since 1977.³

¹ Arzt & Praxis (ed.) Gout and Hyperuricemia: http://www.arztundpraxis.at/index.php?id=262&tx_ttnews%5Btt_news%5D=2756&cHash=00acd37bdff83bbdd195fa5f174d8852 (accessed: 11/4/2013).

² Arzneimittelverlags-GmbH Berlin (ed.). Assessment Allopurinol: http://www.arznei-telegramm.de/db/01wkstxt.php3?&knr=&art=beide&nummer=Allopurinol&ord=uaw (accessed: 11/4/2013).

³ WHO (ed.). WHO Model Lists of Essential Medicines: Allopurinol; 18th list: http://www.who.int/medicines/publications/essentialmedicines/18th_EML.pdf (accessed: 4.11.2013).

With increasing age, the prevalence of heart failure also rises – already more than 10 % of people over 70 are affected.

Approximately 1-2% of the adult population in the industrialized world suffers from heart failure, or 70,000 to 140,000 people in Austria. Hospitalizations due to heart failure are not uncommon in Austria, with over 24,000 hospitalizations per year. Increasing life expectancy, rising survival rates after myocardial infarction, and risk factors such as arterial hypertension and diabetes mellitus have led to an increase in the incidence and prevalence of heart failure in recent decades.

Heart failure is a severe disease of the heart in which the heart is unable to supply sufficient blood to the body and organs, resulting in a lack of oxygen and nutrients. Typical symptoms of heart failure include shortness of breath, ankle edema, fatigue, and decreased exercise capacity caused by a structural or functional abnormality of the heart.1 In more than 50% of cases, chronic heart failure is due to arterial hypertension or coronary artery disease. Heart failure patients can be classified into four different stages (NYHA stages) according to their physical capacity (without physical limitation to discomfort during all physical activities) according to the New York Heart Association.

Drug therapy is the primary treatment for chronic heart failure patients; angiotensin converting enzyme inhibitors (e.g. Enapril®) or angiotensin receptor blockers (e.g. Candeblo®, Valsax®), beta blockers (e.g. Nebilan®) and aldosterone antagonists (e.g. Eplezot®) are administered. The patient is titrated up to the desired target dose depending on blood pressure, heart rate, renal function and individual tolerance. Diuretics (e.g. HCT G.L.) are recommended for symptom relief, but physical activity and lifestyle modification (e.g. reduction of alcohol consumption, smoking cessation and normalization of body weight) are also advised. Thanks to improved treatment methods, 5-year survival rates have increased significantly with adherence to medically prescribed therapy.2

1 Mörtl D. DFP literature review: heart failure. ÖAZ, no. 8, 25.4.2016.

2 BVA – Versicherungsanstalt öffentlich Bediensteter (ed.). Information for physicians on heart failure. www.bva.at/herzinsuffizienz (accessed: 11.08.2016).

Parathyroid glands (Latin: glandulae parathyreoideae) are four lentil-sized hormone-producing glands located at the back of the thyroid gland (Latin: glandula thyreoidea).

The parathyroid glands produce parathyroid hormone (abbreviated as PTH), which is a key hormone in regulating calcium balance. The most important disease of the parathyroid gland is hyperfunction, also called hyperparathyroidism. The causes of parathyroid hyperfunction can be varied. Diagnosis requires, among other things, certain laboratory tests, such as the determination of calcium, phosphate, and parathyroid hormone levels in the blood.¹

In primary and secondary hyperparathyroidism, the parathyroid glands produce too much parathyroid hormone. “Primary” means that the hyperparathyroidism is not caused by any other disease. A common cause is a benign tissue neoplasm (adenoma) of the parathyroid gland; malignant tumors are less common. “Secondary” means that hyperparathyroidism is caused by another disease, such as kidney disease. In this form, the parathyroid glands respond to an existing deficiency of calcium with increased production of parathyroid hormone. Both primary and secondary hyperparathyroidism can result in calcium loss from the bones, leading to bone pain, fractures, problems with the blood and heart vessels, kidney stones, mental illness, and coma.^1,2

The therapeutic goal is to normalize blood calcium, phosphate, and parathyroid hormone levels. This is achieved by treatment of the underlying disease, surgical removal of the parathyroid glands, vitamin D or calcium supplementation, a low-phosphate diet, or by taking drugs such as calcimimetics (these control the level of parathyroid hormone).^1,2

¹ Federal Ministry of Social Affairs, Health, Long-Term Care and Consumer Protection (BMSGPK) (ed.): https://www.gesundheit.gv.at/krankheiten/stoffwechsel/ueberfunktion-nebenschilddruesen (accessed: July 23, 2020).

² Package leaflet Cinglan®, Date of information: 08/2019.

Hypertension is considered the leading risk factor for cardio- and cerebrovascular morbidity and mortality worldwide.

It is estimated that 2/3 of all strokes and 47% of ischemic heart disease (deficient blood flow to the heart) are due to elevated blood pressure and could be prevented by adequate treatment. Arterial hypertension is responsible for 14% of premature deaths and 6% of disability. According to epidemiological studies, approximately ¼ of the adult population worldwide is hypertensive. Cardiovascular risk increases as blood pressure rises, with systolic blood pressure rising steadily until about 80 years of age, while diastolic blood pressure rises until 50 years of age, and then declines.¹ Numerous classes of agents with different targets are available to achieve target blood pressure in order to achieve therapeutic goals in each patient individually.

¹ Weber , T. et al. Austrian blood pressure consensus 2019. Wien Klin Wochenschr 2019;131[Suppl 6]:S489-S590.
² Mügge A. Stable angina. Leading symptoms, diagnosis and therapy. Ars Medici, 2009, 12: 491-6.

Chemotherapy not only destroys cancer cells, but can also affect different types of blood cells. Therefore, depending on the therapeutic regimen used and individual risk factors, chemotherapy can trigger febrile neutropenia.

This involves a decrease in a certain type of white blood cell (neutrophil leukocytes), which are part of the immune system. In febrile neutropenia, there are too few neutrophil leukocytes for the immune system. Symptoms of infection may be absent, but fever occurs in most severe infections. The diagnosis is made on the basis of a differential blood count. Febrile neutropenia and associated infections are a significant factor in illness and mortality after chemotherapy. It may lead to dose reduction of chemotherapy and/or cycle delays. The use of granulocyte colony-stimulating factor (G-CSF) is recommended as a strategy in guidelines for reducing the incidence and duration of febrile neutropenia in certain malignancies.

Sources:

Oncology Guideline Program. S3 guideline Supportive therapy in oncology patients. Long version 1.0 – November 2016, AWMF register number: 032/054OL.

Onkopedia Guideline. Prophylaxis of infectious complications by granulocyte colony-stimulating factors (G-CSF, pegfilgrastim, biosimilars). August 2014.

Antibiotics have a strong inhibitory effect on the metabolic processes of bacteria and thus prevent the bacteria from multiplying or surviving.

Antibiotics have been used for decades to treat and prevent infectious diseases and infections. The use of antimicrobials has greatly contributed to the improvement of health. Antibiotics are indispensable in modern medicine, and procedures such as transplants, chemotherapy for cancer, and orthopaedic surgery could not be performed without their use. However, their widespread use is also accompanied by an increasing incidence of resistant microorganisms. Efforts are being made throughout Europe to reduce the development of resistance through the judicious use of antibiotics (i.e., prevention of resistance through appropriate selection of active ingredients depending on the pathogen and spectrum of activity, as well as administration of an adequate dose over a sufficient period of time). Efforts are directed toward the avoidance of antibiotics in the treatment of viral infections and of excessively prophylactic antibiotic applications (e.g., in surgical procedures), as well as proper use of antibiotics by patients.¹

¹ Federal Ministry of Health (ed.), Resistance Report Austria AURES 2018: https://www.ages.at/download/0/0/f1fed55f3f4bbce389ee6e9f8fd9bfe5ff1fcfb2/fileadmin/AGES2015/Themen/Arzneimittel_Medizinprodukte_Dateien/AURES/AURES_2018.pdf (accessed: 09.02.2021). 

Leukaemia is a collective term for a number of malignant diseases of the blood, all of which are found in the bone marrow, the place where blood cells are produced.

A degeneration of white blood cells (leukós = white, haïma = blood) occurs, which over a short (acute leukaemia) or longer period of time (chronic leukaemia) leads to a disruption in the production of normal blood cells. Uncontrolled cell growth of immature blood cells results in a reduced number of mature blood cells in the blood. Among the slower forms of leukaemia is chronic myeloid leukaemia (CML).¹ CML is a rare disease with 1.5 new cases per 100,000 population per year. Men are affected slightly more often than women. CML occurs in all age groups, most commonly between 55 and 60 years.² In the group of leukaemia, the proportion of patients with CML is 20%. Specific screening is difficult. Chemical agents (e.g. benzene) as well as drugs in the context of chemotherapy or immunosuppressants are considered risk factors. The onset of the disease is insidious and asymptomatic to asymptomatic (e.g., initially general symptoms such as fatigue, decreased performance, night sweats, weight loss, fever, later enlargement of the spleen).³ Drug therapy for CML is guideline-concordant with protein kinase inhibitors such as imatinib, nilotinib, or dasatinib.²

¹ Cancer in focus. Leukemia in general. © OeGHO – Austrian Society for Hematology & Medical Oncology 2017. http://www.krebsimfokus.at/ueber-krebs/leukaemien/im-ueberblick.html (accessed: 02.05.2017).

² Hochhaus A et al. Onkopedia guidelines. Chronic myeloid leukemia (CML). OeGHO. As of January 2013. https://www.onkopedia.com/de/onkopedia/guidelines/chronische-myeloische-leukaemie-cml/@@guideline/html/index.html (accessed: May 02, 2017).

³ Petzer A. Cancer in focus. Chronic myeloid leukemia (CML). © OeGHO – Austrian Society for Hematology & Medical Oncology 2017. http://www.krebsimfokus.at/ueber-krebs/leukaemien/chronische-myeloische-leukaemie-cml/im-ueberblick.html (accessed: 02.05.2017).

Lung carcinomas are malignant tumours that originate primarily in the lungs from surface cells in the airways. In the diagnosis, a differentiation is made between small cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC) for further treatment. About 80% of all lung cancer cases can be classified as non-small cell lung carcinomas and about 17-20% are small cell carcinomas.¹

Every year, about 3000 men and 2000 women are diagnosed with lung cancer in Austria. Lung carcinoma is thus the third most common malignant cancer in women and the second most common malignant cancer in men in German-speaking countries. In terms of mortality, the relevance of lung cancer is even higher, as about a quarter of all cancer deaths are attributable to lung cancer.¹

Therapy options, depending on the tumour stage, are surgical interventions, radiation therapies and systemic therapies, these are often combined as a multimodal concept. In recent years, the use of new therapeutic approaches and individualised therapy has significantly improved the prognosis of many patients. Treatment options include cytostatics (substances that inhibit cell growth or cell division), angiogenesis inhibitors (substances that suppress the formation of new blood vessels), immune checkpoint inhibitors (drugs that interfere with the immune system) or kinase inhibitors (substances that bind to certain enzymes and inhibit their function), as well as supportive measures.¹

¹ DGHO Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie e.V.. (Ed.). Lung cancer, non-small cell (NSCLC). Onkopedia guideline. (Status July 2021). https://www.onkopedia.com/de/onkopedia/guidelines/lungenkarzinom-nicht-kleinzellig-nsclc/@@guideline/html/index.html (accessed 30.07.2021).

Malignant pleural mesothelioma is a malignant tumour that in most cases (>80%) originates in the pleura, but can also originate in the peritoneum or pericardium. With a new case rate of about 20 cases per million population, this type of cancer is rare, and pleural mesothelioma most often affects men. Up to 90 % of the diseases are due to exposure to asbestos: Mesotheliomas are classified as signal tumours of occupational asbestos exposure and are considered an occupational disease. The number of cases of the disease is still rising despite the long-standing ban on asbestos processing in many industrialised countries, as a latency period of 50 years on average is assumed.¹

Treatment of this rare tumour disease is carried out in specialised centres. Surgical interventions, radiotherapies, chemotherapies, as well as pain therapy approaches are used with the aim of prolonging life and improving quality of life.¹

¹ Neumann V. et al. Malignant pleural mesothelioma: incidence, aetiology, diagnosis, therapy and occupational medicine. Dtsch Arztebl Int 2013; 110: 319 – 326.

Migraine is a common, underdiagnosed, undertreated, chronic recurrent disease that can significantly impact the quality of life of those affected.

In a WHO Global Burden of Disease study, migraine currently ranks 7th out of 289 diseases worldwide. Migraine occurs with a prevalence of 10 to 15% in adults and 3 to 10% in children. Women between 25 and 55 are up to three times more likely to be affected than men.¹

Characteristic of the neuronal disease is the severe, usually unilateral pulsating-pounding headache. Acute attacks are often accompanied by loss of appetite, nausea, vomiting, photophobia, phonophobia, and osmophobia.² Pathophysiologically, neurogenic inflammation develops in the area of the dural vessels, triggered by activation of the trigeminovascular system.

In migraine treatment, a distinction is made between acute therapy and migraine prophylaxis, with drug and non-drug treatment methods being used in each case.¹ The aim of prophylaxis is to reduce the number of migraine days by up to 50%. The beta-blockers propranolol and metoprolol, the calcium antagonist flunarizine, and the antiepileptic drugs topiramate and valproic acid are considered the first-choice substances for this purpose. Even at lower doses than in their original indication, they reduce the sensitivity of cells of the cortex to form a “cortical spreading depression”.²

¹ Wöber C., DFP literature: diagnosis and therapy of migraine. CliniCum neuropsy, issue 02/2014, pp.30-36.

² German Society of Neurology, Guidelines for diagnosis and therapy in neurology. Headache and other pain: therapy of migraine. (Status: March, 2013)

Multiple sclerosis (MS) is a chronic, as yet incurable disease that manifests itself differently in each individual affected.

The central nervous system, or CNS for short, comprises the area of the brain as well as the spinal cord and is responsible for cognitive functions such as thinking and speaking, but also for the control of physical activities and the processing and transmission of signals and information.

Nerve fibres are responsible for the correct and fast transmission and, similar to an electric cable, they are surrounded by a protective or insulating layer – the so-called myelin.

In MS, cells of the body’s immune system attack this myelin. Parts of the sheathing of the nerve fibres are repaired, resulting in scars or hardening that no longer allow proper signal transmission. This manifests itself in symptoms ranging from tingling to movement disorders – depending on which part of the CNS is affected.

Long-term therapies are used to treat MS, which differ in terms of administration, mode of action and, of course, side effects. What they all have in common, however, is that long-term therapies can only develop their optimal effect if they are taken on a permanent and regular basis.

The wide range of therapies offers the opportunity to tailor the treatment perfectly to your needs. But which therapy is best for you? Which long-term therapy best fits your life situation? How can you best integrate the therapy into your life or daily routine so that you can comply with it regularly?

You will make this important decision about therapy together with your doctor, because therapy success is teamwork.

In psychiatry, people with addiction represent one of the largest patient groups in percentage terms.

For people with substance problems, authoritarian prescriptions to change or abstain from consumption often do not achieve sustainable change,¹ because the patient remains what he or she is, addicted.² In terms of high-risk drug use, poly-drug use (use of several substance groups) involving opioids plays the central role in Austria. Currently, there are between 31,000 and 37,000 people in Austria with high-risk opioid use, mostly in combination with other illicit drugs, alcohol and psychopharmaceuticals. 9,300 to 14,800 are predominantly injecting users.³

Substitution therapy is the treatment of choice for opioid dependence and an extension to abstinence-oriented forms of treatment. The treatment goals are freedom from symptoms, a good quality of life in the family, partnership and parenthood, the ability to work and learn, success in education and career, as well as the prevention of complications and “risk reduction”,² which can be individually achieved by the patient in the context of substitution treatment in close cooperation with the treating physician with the available active substances.

¹ Kurz M. Addiction – diagnosis and therapy. Psychopraxis, 2011, 5-6: 21-24.

² Haltmayer H. et al. Consensus statement “Substitution-assisted treatment of opioid addicts.” Addiction Medicine Forsch. Prax., 2009, 11: 281-297.

³ Austrian Federal Institute of Public Health. Report on the drug situation 2020. Gesundheit Österreich GmbH Vienna, 2020. https://www.sozialministerium.at/Themen/Gesundheit/Drogen-und-Sucht/Suchtmittel-NPS-Drogenausgangsstoffe/Berichte-und-Statistiken/Berichte-zur-Drogensituation-in-%C3%96sterreich.html (accessed: 03.2021).

In industrialized countries, osteoporosis is one of the most common diseases of the musculoskeletal system.

According to the Austrian Osteoporosis Report, about 740,000 people over the age of 50 are affected in Austria, 617,000 are women. About 16,500 people suffer a hip fracture every year. Preventing osteoporotic fractures means preventing personal suffering and saving costs. Bisphosphonates, along with calcium and vitamin D supplementation, physical training and fall prevention, are the standard first-line therapy for osteoporosis. They have demonstrated antifracture efficacy and are those agents that have proven most effective in the treatment of postmenopausal osteoporosis.¹

¹ Preisinger E. et al. Management of osteoporosis. ÖAZ, 2012, 20: 24-35.

Overactive or hyperactive bladder (formerly: irritable bladder) is a functional disorder of bladder function without organ pathological findings.

It is a symptom complex that significantly affects the quality of life of patients.

The symptoms are composed of urinary retention symptoms, imperative urge to urinate, i.e. urge to urinate suddenly without warning and with the risk of urine leakage, pollakiuria (8 or more urinations within 24 hours), nocturia (urinating once or several times during night sleep) and urge incontinence (involuntary urine leakage associated with imperative urge to urinate).^1,2 Urinary incontinence can have a variety of causes, including disorders of the urinary bladder, urethra, bladder sphincter, pelvic floor muscles, nerves supplying these organs, or an enlarged prostate gland in men.³ An overactive bladder can have a significant impact on sexual function, sleep, and mental health.¹

Although the incidence of overactive bladder is similar in women and men, there are gender differences in individual symptoms and impact on quality of life. In men, overactive bladder often occurs in association with benign prostate enlargement.¹ In Austria, urinary incontinence affects approximately 850,000 women and men (i.e., about one in ten of the population). In women, this condition occurs much more frequently.⁴ From the age of 60, almost one in five people has symptoms of an overactive bladder.² If behavioural measures such as micturition or toilet training do not lead to sufficient therapeutic success, various agents (e.g., so-called antimuscarinics or beta-receptor agonists) are available for symptomatic treatment prior to the use of invasive therapy.²

¹ Eapen RS & Radomski SB. Research and Reports in Urology 2016, 8: 71-76.

² Madersbacher S & Wolfesberger J. The overactive urinary bladder. J Urol Urogynaecol 2017, 24: 135-141.

³ Austrian Society of Urology and Andrology. Patient information urinary incontinence. https://www.uro.at/patienten-informationen/patienten-ratgeber/47-harninkontinenz.html (accessed: August 27, 2019).

⁴ Professional Association of Austrian Urologists. For women. Urinary incontinence. http://www.urologisch.at/harnverlust.php (accessed: August 27, 2019).

Pain can occur acutely, i.e. for a limited period of time, or chronically, over a longer period of time.

Chronic pain is one of the most common symptoms of all. According to figures from the “Austrian Pain Alliance”, 1.5 million people are affected in Austria alone. Half of these patients are impaired in their working lives by their chronic pain, and 11% are even unable to work due to their condition.¹

Pain is classified not only according to its duration, but also according to its underlying triggering mechanisms into so-called nociceptive, neuropathic, mixed and dysfunctional pain.^2,3 Therefore, the type of pain must be known for a drug-based pain therapy in order to be able to individually adapt a mechanism-oriented pain therapy to the patient.

Nociceptive pain is caused by acute tissue damage in the context of inflammatory, degenerative and malignant diseases or in the context of an acute injury. Depending on the localization, somatic pain (caused by diseases of the musculoskeletal system, skin, subcutaneous tissue and mucous membrane) can be distinguished from visceral pain (so-called “visceral pain” affecting internal organs, e.g. colic). Nociceptive pain is mediated by pain receptors (nociceptors) and tends to have a consistent character (e.g., stabbing, dull, or drilling). Neuropathic pain occurs after damage or disease to the nervous system (often referred to as “nerve pain”) and is often described as burning, tingling, stabbing, shooting in, radiating, “electrifying.” Neuropathic pain is subject to a different mechanism than nociceptive pain and, accordingly, requires different analgesics. Mixed pain has both nociceptive and neuropathic components.

These types of pain can vary in intensity from mild to severe and can occur in the context of different diseases (e.g. tumour diseases or non-malignant diseases). Therefore, especially in the context of chronic pain therapy, an exact diagnosis of both the mechanism and the intensity of pain is essential for the correct choice of analgesic.

¹ Rudolf Likar. Opioids in chronic pain. Ärztemagazin 11, 2017: 16- 19.

² Sabine Sator-Katzenschlager. Pain therapy update 2015. physician & practice volume 69, 2015: 89-94.

³ Gabriele Grögl. Type of pain determines type of drug. Physicians Crown Pain17, 2017: 14-16.

Skin diseases

Scabies (“Scabies”).

Symptoms:
This contagious skin disease is characterized by severe itching (especially at night under warm bed covers) and multilayered clinical manifestations (red, itchy “spots and whimpers,” some scaly-crusty) in typical locations (e.g., interfinger spaces, wrists, groin region, elbows, area around nipples, genital area, palms and soles of feet in young children).

Occurrence and transmission:
Scabies occurs worldwide and affects individuals of all ages. It is estimated that approximately 300 million people worldwide are infected with the scabies mite, but there are no frequency figures for individual countries. These vary according to climate, population density, living conditions and hygienic conditions. In German-speaking countries, a sharp increase in scabies cases has been registered in recent years.^1,2,3

Scabies is more likely to occur in populations living together in close quarters, where direct skin-to-skin contact for a minimum of several minutes is common (e.g., members of a family or shared apartment, sexual partners, nursery schools, care facilities for the disabled and elderly, hospitals, prisons, homeless asylums, etc.).⁴ Indirect transmission may occur via shared bedding or clothing.⁵ Typically, infection does not occur with brief contacts, such as handshakes or via inanimate objects.¹

Pathogen:
Scabies is a parasitic skin disease and is caused by the scabies mite Sarcoptes scabiei. Female scabies mites grow to 0.3-0.5 mm in size (just visible as a dot to the human eye), while male mites grow to 0.21-0.29 mm. Female scabies mites can penetrate the skin after fertilization. In the stratum corneum, the uppermost layer of the epidermis, female scabies mites dig tunnel-shaped tunnels in which they lay eggs and excrete fecal pads, moving forward about 0.5-5 mm per day.⁴ Larvae hatch from the eggs after 2-3 days and swarm out to the skin surface, where they develop into so-called nymphs that mature into sexually active mites after about 2-3 weeks.¹ This leads to the unpleasant symptoms of scabies already described.

Treatment:
Medicinal scabies therapy can be performed externally by means of topical drugs in the form of creams, or, in certain cases, systemically with tablets.  Combination therapy of topical and systemic medicines is also possible. Your doctor will select the therapy individually for you based on your symptoms according to the current therapy recommendations for your age group and will check the success of the therapy.^5,6

In addition, follow general hygiene measures for cleaning your body, clothing, bedding, towels, and other items with prolonged physical contact (e.g., stuffed animals, blood pressure cuff, etc.), and keep fingernails short and clean.^5,7

Tropical diseases

Strongyloidiasis (Anguillulosis)

Strongyloidiasis is an infection with Strongyloides stercoralis (threadworm infection). This disease is endemic in the tropics and subtropics, including rural areas of the United States, in locations where unprotected skin comes into contact with contaminated soil (e.g., by walking barefoot) or unsanitary conditions exist.

Acute symptoms of strongyloidiasis can affect the skin (itchy, erythematous rash), lungs (cough), and gastrointestinal tract (abdominal pain, diarrhea, anorexia), depending on where the larvae or adult worms are located in the body of the infected person. Due to autoinfection, a chronic course lasting for years is also possible. Both acute and chronic courses may be asymptomatic. However, a hyperinfection syndrome with severe to fatal symptoms may occur.

Therapy is with so-called anthelmintics (agents against worm infections).⁸

Filariasis

Lymphatic filariasis is a mosquito-borne tropical disease, is endemic to Southeast Asia, Pacific, tropical Africa, Caribbean and is 90% caused by Wuchereria bancrofti. The pathogens pass through their life cycles partly in mosquitoes and partly in the human host, where they localize in the lymphatic system. This leads to acute symptoms such as swelling of the lymph nodes and fever. Chronic progression may result in blockage of the lymphatic system and subsequent elephantiasis due to lymphedema.⁹

Preventive mosquito protection measures should be used. In endemic areas, chemoprophylaxis is given with antifilarial substances, which include ivermectin.¹⁰

¹ Das Land Steiermark. Jahresbericht zum Steirischen Seuchenplan 2018, 16. Ausgabe. Im Auftrag der Steiermärkischen Landesregierung Abteilung 8: Gesundheit, Pflege und Wissenschaft. Hrsg. Hofrat Dr. Odo Feenstra. Graz, March 2019. Franz F Reinthaler unter Mitarbeit von Gebhard Feierl und Marianne Wassermann-Neuhold.
² Kämmerer E. Medizinreport: Skabies. Erfahrungen aus der Praxis. Deutsches Ärzteblatt Jg 115, Heft 15, 13.04.2018.
³ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
⁴ Robert Koch Institut. RKI-Ratgeber Skabies (Krätze). https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Skabies.html (accessed: 10.01.2022)
⁵ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
⁶ Oberösterreich. Skabies – Ärzteinformationsblatt Beilage 4 – Status: March 2021
⁷ Package leaflet Ivergelan^®–Tablets.
⁸ Pearson RD. MSD Manual. Ausgabe für medizinische Fachkreise. Strongyloidiasis (Fadenwurminfektion). March 2019. https://www.msdmanuals.com/de/profi/infektionskrankheiten/nematoden-rundw%FCrmer/strongyloidiasis (accessed: 10.01.2022)
⁹ Centers for Disease Control and Prevention. Lymphatic Filariasis https://www.cdc.gov/dpdx/lymphaticfilariasis/index.html (accessed: 10.01.2022)
¹⁰ SmPC Ivergelan^®-Tablets

Currently, around 16,000 people in Austria suffer from Parkinson’s disease.

Although Parkinson’s is not a widespread disease, such as stroke, the incidence of the disease is expected to triple by 2030. The incidence of the disease increases with age: about 2% of people over 60 years show Parkinson’s syndrome, and over 80 years around 3%.¹

Pramipexole is used for the symptomatic treatment of idiopathic Parkinson’s disease, alone (without levodopa) or in combination with levodopa, i.e., throughout the course of the disease up to the advanced stage, when the effect of levodopa decreases or becomes irregular, and fluctuations in therapeutic effect occur (so-called end-of-dose or on-off phenomena).²

A multicentre randomized placebo-controlled trial in PD patients showed that with initial treatment with pramipexole, compared with levodopa, dyskinesias and wearing-off effects were significantly less.³

Pramipexole is also associated with antidepressant efficacy. This has also been supported by studies.⁴

¹ Medical University of Innsbruck. Public Relations and Communication. Parkinson’s disease: early diagnosis can delay disease progression: https://www.i-med.ac.at/pr/presse/2012/38.html (accessed: Nov. 5, 2013).

² SmPC Calmolan® tablets, Gerot Lannach. Date of information: September 2013.

³ Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Arch Neurol. 2004; 61(7): 1044-53.

⁴ AWMF guideline: http://www.awmf.org/uploads/tx_szleitlinien/030-010l_S2k_Parkinson_Syndreome_Diagnostik_Therapie_2012-09.pdf (accessed: Nov. 5, 2013).

Prostate cancer is the most common cancer among Austrian men with an incidence of 24%.

In 2011, 4,722 men developed prostate cancer and 1,146 died. In 2010 one in 10 cancer deaths in men was due to prostate cancer. The risk of developing prostate cancer before the age of 75 is approximately 8.3%.¹ Depending on the tumor stage, different treatment options can be considered, ranging from regular check-ups by the physician without further treatment, to radiation therapy, drug treatment, and removal of the prostate, to a combination of these options. For drug therapy, LHRH analogues, GNRH blockers or antiandrogens can be considered. The goals of therapy and the measures required to achieve them depend on the stage of the disease and are therefore sensibly coordinated individually between the physician and the patient.²

¹ STATISTIK AUSTRIA, Cancer – Prostate (Date: 31.10.2013).

² Guideline program oncology of the AWMF, Deutsche Krebsgesellschaft e.V. and Deutsche Krebshilfe e.V., Interdisciplinary guideline of quality S3 for early detection, diagnosis and therapy of the different stages of prostate carcinoma, version 2.0 – 1st update 2011.

Pulmonary hypertension (PH), is a chronic progressive disease characterized by an increase in pressure in the pulmonary circulation.

According to the cause, PH is divided into 5 subgroups according to the Nice Classification. Pulmonary hypertension is a relatively common complication of pulmonary and cardiac diseases, e.g., COPD or heart failure. Another subgroup pulmonary arterial hypertension (PAH) subsumes pathological changes in the pulmonary arterial circulation due to specific causes, e.g., heredity, in certain underlying diseases (e.g., connective tissue diseases, HIV infection, portal hypertension, congenital systemic pulmonary shunts, or the worm disease schistosomiasis) or without a known cause. PAH is a very rare disease: in Europe, approximately 5-10 new cases of PAH per 1 million population are diagnosed annually. The overall PAH disease rate is reported to be 15-60 per million population. The risk of developing PAH is known to be higher for women.

PH is often diagnosed only at an advanced stage. In the majority of patients, the symptom of dyspnoea is prominent. Other symptoms are often nonspecific and include fatigue, physical weakness, dry cough, angina, dizziness, and syncope. When PH is suspected, patients should be referred to specialized centers where specific investigations are performed for the diagnosis of PH. In these specialized centers, an interdisciplinary network of cardiologists/pneumologists, specialized clinical nurses, radiologists, and psychologists is further established for the comprehensive treatment of PH. Various drugs are available for the therapy of PAH: Endothelin receptor antagonists, PDE-5 inhibitors (e.g., Pulmolan®), a soluble guanylate cyclase stimulator, prostacyclins, and a selective IP receptor agonist.¹

¹ Diestelmaier K & Lang I. Pulmonary hypertension – state of the art of modern therapies. DFP Literature Clinicum 4/2017,p14-8.

The Chernobyl nuclear accident has led to a sharp increase in radiation-induced thyroid cancer in children and adolescents in the heavily contaminated areas of Ukraine, Belarus and Russia.

The cause is radioactive iodine, which is released in large quantities during severe reactor accidents. After absorption into the body, it is stored in the thyroid gland, where it leads to high local radiation exposure.

The stable iodine in potassium iodide tablets temporarily saturates the thyroid gland with iodine (“iodine blockade”). The inhaled radioactive iodine is therefore no longer absorbed by the thyroid gland, but is rapidly excreted by the body. In this way, high radiation doses to the thyroid gland can be avoided and the incidence of radiation-induced thyroid cancer can be reduced to a minimum.¹

¹ Federal Ministry of Health (ed.): https://www.sozialministerium.at/Themen/Gesundheit/Strahlenschutz/Kaliumiodid-Tabletten.html (accessed: 18.11.2013).

Renal cell cancer (RCC) is a disease of older people, the median age is 68 years for men and 71 years for women.¹
According to Statistics Austria, 1.370 people (897 men and 473 women) were newly diagnosed with malignant invasive RCC in 2018. This is more than 1.7 times as many as in the early 1980s.² RCC is among the top 10 cancers³ and is the third most common urologic tumor.⁴ Few patients show the classic symptoms (blood in the urine, flank pain, a palpable lump in the upper abdomen, or changes in blood counts that then lead to the diagnosis of RCC). Most renal tumors today are discovered incidentally during ultrasound examinations or computed tomography, which are often performed for entirely different reasons.⁴

Confirmed risk factors for RCC according to current evidence are smoking, obesity, and elevated blood pressure. Familial clustering may occur. The most effective preventive measures are abstinence from smoking and normalization of body weight.^1,5

Treatment is either surgical or medicinal depending on the type of RCC, its prognosis, spread (metastasis) if any, and patient-specific factors. For system therapy of metastatic RCC, so-called immune checkpoint inhibitors, VEGF inhibitors, tyrosine kinase inhibitors, mTOR inhibitors and multi-kinase inhibitors are used.¹

¹ Oncology Guideline Program. Consultation version S3 guideline Diagnostics, therapy and follow-up of renal cell carcinoma. Long version 3.01 (consultation version)– August 2021 AWMF-Registernummer: 043/017OL
² Statistik Austria. Kidney (C64) – Cancer incidence (new cases per year), Austria since 1983.
³ Statistik Austria. Austrian Cancer Registry (status: Dec. 17, 2020) and cause-of-death statistics. Cancer incidence and mortality (diagnosis period 2013-2017).
⁴ Austrian Society of Urology and Andrology. Patient information. Renal cell carcinoma. https://www.uro.at/patienten-informationen/patienten-ratgeber/52-das-nierenzellkarzinom.html (Accessed on 21.12.2021)
⁵ Urologist portal.de. Renal cell carcinoma (Dr. Arne Tiemann, 31.08.2020) https://www.urologenportal.de/patienten/patienteninfo/patientenratgeber/nierenzellkarzinom.html (Accessed on 21.12.2021)

The prognosis of schizophrenia patients has been significantly improved through the treatment of schizophrenia with medication.

Antipsychotics help to shorten hospital stays considerably and can be the basis for social integration. There is often a misconception among the public that antipsychotics are only used to anesthetize patients or make them compliant. However, if one considers that the symptoms of the disease are mainly due to an imbalance of neurotransmitters and that with the help of antipsychotics this neurotransmitter imbalance is compensated, the necessity of psychopharmacological therapy becomes understandable. Drug therapy is particularly successful in acute treatment when the goal is to improve the positive symptoms and, in some cases, the negative symptoms as well. In approximately 85% of all patients treated with antipsychotics, the symptoms of a first episode improve substantially or subside completely within one year. Therapy with antipsychotics leads to improvement or disappearance of schizophrenic symptoms in many patients. Long-term treatment with antipsychotics reduces the relapse rate from about 80% to 20% in the first year. Antipsychotics help restore functioning and facilitate return to social life.¹

¹ Austrian Schizophrenia Society. What is schizophrenia – treatment – medication: http://www.schizophrenie.or.at/was-ist-schizophrenie/behandlung/medikation-46.html (accessed: 6.11.2013).

Trichomoniasis is the most common sexually transmitted disease worldwide, with 5 million new cases per year worldwide.

Young people, both men and women, are particularly affected. The infection is often asymptomatic. Usually men and half of the women do not experience any symptoms. If symptoms do occur, they manifest themselves as itching, with burning during urination and sweet-smelling, foul-smelling discharge. If left untreated, infection can lead to sterility in both women and men.¹ Metronidazole is considered the drug of choice for trichomoniasis. Partner therapy is strongly indicated even in the absence of symptoms.²

Vulvovaginal candidiasis: Vaginal yeast colonization depends on the glucose supply in the vagina, which varies cyclically under the influence of sex steroids. Therefore, vaginal colonization by yeasts is rare in girls in the hormonal resting phase and in longer postmenopausal women. The incidence is 10 to 20% in healthy nonpregnant premenopausal women, up to 30% in untreated pregnant women at term, 5 (to 10) % in healthy postmenopausal women, and at least 30% in all nonpregnant women with immune deficiencies. About 80% of detected yeast fungi are Candida albicans. Colonization usually occurs through the woman’s own orointestinal tract or that of her partner, who may also be colonized with the same yeast strain in semen. Acute vaginal candidiasis can be treated locally or systemically.³

¹ Federal Office of Public Health, Switzerland: http://www.bag.admin.ch/themen/medizin/00682/00684/11693/index.html (accessed: 6.11.2013).

² Austrian Society of Gynaecology and Obstetrics (OEGGG): http://www.oeggg.at/fileadmin/user_upload/downloads/Leitlinien/Leitlinien_ESIDOG_Auswahl.pdf (accessed: 6.11.2013).

³ AWMF guideline: https://www.awmf.org/uploads/tx_szleitlinien/015-072l_S2k_Vulvovaginalkandidose_2020-10_01.pdf (accessed: 6.11.2013).

Genital warts (condyloma acuminate) are among the most widespread sexually acquired diseases.

The peak incidence of the disease is between the ages of 20 and 40. Worldwide, the number of new cases is continuously increasing. Therapy of choice for singular condylomas is podophyllotoxin. Seven randomized controlled trials have shown that the use of podophyllotoxin significantly reduces the number and infestation area of condylomas and significantly increases the complete healing rate.¹

Local glucocorticoid therapy for skin diseases:

Prednisolone in topical application: The anti-inflammatory and antiproliferative effects of corticosteroids can treat a variety of dermatologic conditions.² Skin conditions that respond to topical glucocorticoid therapy include: acute, subacute, and chronic eczema of various types (contact, seborrheic, anal, and perigenital), dermatitis, pruritus, erythema exsudativum multiforme, first-degree scalds and burns, or sunburn.³

Calcineurin inhibitors provide an alternative treatment for atopic eczema. However, if neither contraindications nor side effects are present, modern topical steroids remain the agents of choice.²

Psoriasis vulgaris:

The prevalence of psoriasis in Western industrialized nations is 1.5 – 2%. Approximately 80% have psoriasis vulgaris. In more than 90% of the patients it comes to a chronic course. Since the 1970s, photochemotherapy in the form of combined application of photosensitizing psoralens with subsequent whole or partial body irradiation using UVA light has been scientifically established. Application is oral as systemic PUVA therapy or local in the form of bath or cream PUVA.⁴

Scabies (“Scabies”):

Symptoms:
This contagious skin disease is characterized by severe itching (especially at night under warm bed covers) and multilayered clinical manifestations (red, itchy “spots and whimpers,” some scaly-crusty) at typical sites (e.g., interfinger spaces, wrists, groin region, elbows, area around nipples, genital area, palms and soles of feet in young children).

Occurrence and transmission
Scabies occurs worldwide and affects individuals of all ages. It is estimated that approximately 300 million people worldwide are infected with the scabies mite, but there are no frequency figures for individual countries. These vary according to climate, population density, living conditions and hygienic conditions. In German-speaking countries, a sharp increase in scabies cases has been recorded in recent years.^5,6,7

Scabies is more likely to occur in populations living together in close quarters, where direct skin-to-skin contact for a minimum of several minutes is common (e.g., members of a family or shared apartment, sexual partners, nursery schools, care facilities for the disabled and elderly, hospitals, prisons, homeless asylums, etc.).8 Indirect transmission may occur via shared bedding or clothing.⁹ Typically, infection does not occur from brief contacts such as handshakes or via inanimate objects.⁵

Pathogen
Scabies is a parasitic skin disease and is caused by the scabies mite Sarcoptes scabiei. Female scabies mites grow to 0.3-0.5 mm in size (just visible as a dot to the human eye), while male mites grow to 0.21-0.29 mm. Female scabies mites can penetrate the skin after fertilization. In the stratum corneum, the uppermost layer of the epidermis, female scabies mites dig tunnel-shaped tunnels in which they lay eggs and excrete fecal pads, moving forward about 0.5-5 mm per day.⁸ The eggs hatch into larvae after 2-3 days, which swarm out to the surface of the skin and develop into so-called nymphs, which mature into sexually active mites after about 2-3 weeks.⁵ This leads to the unpleasant symptoms of scabies already described.

Treatment
Medicinal scabies therapy can be performed externally by means of topical medicines in the form of creams, or, in certain cases, systemically with tablets. Combination therapy of topical and systemic medicines is also possible. Your physician will select the therapy individually for you on the basis of your symptoms according to the current therapy recommendations for your age group and will check the success of the therapy.^9,10

In addition, follow general hygiene measures to clean your body, clothes, bedding, towels, and other items with prolonged body contact (e.g., stuffed animals, blood pressure cuff, etc.), and keep fingernails short and clean.^9,11

¹ AWMF guideline: http://www.awmf.org/uploads/tx_szleitlinien/081-008_S1_Anale_Feigwarzen_08-2008_07-2012.pdf (accessed: 6.11.2013).
² Weber M & Lautenschlager S. Dermatological therapy: use of topical steroids. Switzerland. Med. forum 2006; 6: 341-348.
³ SmPC Kühlpredinon-Salbe, Gerot Lannach. Date of Information: January 2012.
⁴ AWMF guideline: http://www.awmf.org/uploads/tx_szleitlinien/013-001l_S3_Psoriasis_vulgaris_Therapie_01.pdf (accessed: 6.11.2013).
⁵ Das Land Steiermark. Jahresbericht zum Steirischen Seuchenplan 2018, 16. Ausgabe. Im Auftrag der Steiermärkischen Landesregierung Abteilung 8: Gesundheit, Pflege und Wissenschaft. Hrsg. Hofrat Dr. Odo Feenstra. Graz, March 2019. Franz F Reinthaler unter Mitarbeit von Gebhard Feierl und Marianne Wassermann-Neuhold.
⁶ Kämmerer E. Medizinreport: Skabies. Erfahrungen aus der Praxis. Deutsches Ärzteblatt Jg 115, Heft 15, 13.04.2018.
⁷ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
⁸ Robert Koch Institut. RKI-Ratgeber Skabies (Krätze). https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Skabies.html (accessed: 10.01.2022)
⁹ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
¹⁰ Oberösterreich. Skabies – Ärzteinformationsblatt Beilage 4 – Status of Information: March 2021
¹¹ Package leaflet Ivergelan^®-Tabletten.

The syndrome of spasticity causes an involuntary, pathological increase in muscle tension and occurs after manifold spinal and supraspinal damage to descending motor pathways in the central nervous system. Spasms (spasms) of skeletal muscles can be observed, for example, in static and functional disorders of the spine or in various neurological diseases such as multiple sclerosis, chronic myelopathy, degenerative spinal cord disease, insult or cerebral palsy. Spastic muscles have the property of reacting to even minor stretching with pronounced shortening, severely limiting the patient’s mobility and quality of life. The shortening of the muscle (muscle contractures) can lead to poor posture of the extremities and alter muscles, joints, tendons and ligaments, often resulting in further stiffening of the musculature.¹

Treatment should be primarily by means of physiotherapeutic measures to activate remaining motor functions and reduce complications, such as muscle shortening or movement disorders caused by muscle contractions. In addition, drug therapy for spasticity can reduce increased muscle tone and spasms and, according to the current guidelines, should be used when spasticity relevant to everyday life (with impairment of passive and/or active functions) cannot be adequately controlled despite adequate physical and therapeutic measures.^1,2 The active ingredient tizanidine (e.g., Tizagelan^®) is the most commonly prescribed agent from the group of oral, centrally acting muscle relaxants.³ The DGN S2K guideline on the diagnosis and treatment of multiple sclerosis also recommends tizanidine as the first-choice drug therapy for multiple sclerosis patients with functionally impairing spasticity.⁴ The treatment goals must be formulated individually for each spasticity patient depending on the severity of the spastic syndrome and existing muscle paralysis.¹

¹ Schwarz M. Spastik. In: Praxisbuch neurologische Pharmakotherapie. Springer Berlin Heidelberg, 2018. https://doi.org/10.1007/978-3-662-55838-6_7.
² Platz T. et al., Therapie des spastischen Syndroms, S2k-Leitlinie, 2018, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (accessed: 27.01.2022).
³ DPMÖ, M03B0 (Muskelrelaxantien, zentral), MAT 11/2021 (in Einheiten).
⁴ Hemmer B. et al., Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie, 2021, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien (accessed: 03.01.2022).

The human body requires the supply of energy, essential nutrients and other health-promoting substances with food.

Energy and nutrient requirements vary from person to person and from day to day and depend on many endogenous and exogenous influences. The insufficient or incorrect supply of essential micronutrients through food is increasing, but is rare in Central Europe. Deficiencies are strongly declining. However, they can certainly be found in corresponding risk groups, e.g. with increased requirements in phases of strong growth and in pregnancy, with disease states and old age, with consumption of one-sided diets or with genetically determined metabolic disorders.¹

Once the biochemical mechanisms of action were elucidated, the development of deficiency symptoms was understood and the vitamin amounts required to prevent these deficiency symptoms were learned. These findings form the basis for current nutrient recommendations. Since it has now been recognized that certain vitamins have a preventive effect in the context of the development of degenerative diseases (cancer, cardiovascular diseases, dementia, etc.), such aspects have been additionally taken into account for some vitamins in the current intake recommendations, resulting in some higher recommendations than was previously the case.²

¹ Vitamins, trace elements and minerals. Georg Thieme Verlag, Stuttgart, 2002.

² Handbook of Vitamins. Urban & Fischer Verlag, Munich, 2008.

Nausea and vomiting as a result of chemotherapy.

Nausea and vomiting are common side effects of chemotherapy and represent a serious burden for many patients during treatment. Cytostatic drugs can trigger these complaints to varying degrees: Some agents are highly emetogenic with a frequency of over 90% (such as cisplatin) compared to low emetogenic agents that induce vomiting only about 10 to 30% of the time (e.g., capecitabine).

It is of importance to administer effective antiemetic prophylaxis from the onset of chemotherapy. With the agents available today, it should be possible to control acute vomiting. One such agent is ondansetron.¹

Ondansetron is a potent, highly selective 5-HT3 antagonist. Chemotherapeutic agents and radiation therapy can cause release of 5HT in the small intestine, thereby inducing emesis by stimulating vagal afferents via 5HT3 receptors. The effect of ondansetron in the treatment of nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy is likely due to antagonism at 5HT3 receptors on neurons located in the peripheral and central nervous systems.²

¹ Sweetman SC (ed.), Martindale. The Complete Drug Reference: http://www.medicinescomplete.com/ (accessed: 11/20/2013).

² SmPC Ondansan 4/8 mg film-coated tablets Gerot Lannach, Date of Information: November 2013.