Tadalafil gehört zur Gruppe der PDE5-Hemmer und wirkt über eine hochselektive Blockade des Enzyms Phosphodiesterase Typ 5. Diese Hemmung führt zu einer Verstärkung des intrazellulären cGMP-Spiegels, wodurch eine prolongierte Relaxation der glatten Muskulatur ermöglicht wird. Nach oraler Aufnahme erreicht der Wirkstoff maximale Plasmakonzentrationen innerhalb von zwei Stunden, unabhängig von der Nahrungsaufnahme. Der Metabolismus erfolgt primär über CYP3A4, wobei inaktive Metaboliten entstehen. Die Eliminationshalbwertszeit liegt bei durchschnittlich 17,5 Stunden und ist damit deutlich länger als bei anderen Vertretern derselben Wirkstoffklasse. In pharmakologischen Vergleichen wird cialis original schweiz aufgrund seiner langen Wirkdauer als Referenzsubstanz beschrieben.

Managed care

Dr Amal Beaini, Clinical Lead
Dr Noufel Aljushaah, Medical Officer
June 2011
• 1996: The first patient successfuly completed the compressed opiate detoxification programme.
• 2000: Our peer reviewed paper gets published in • 2004: Extended services become available for those patients with concomitant addictions or underlying mental health problems.
• 2006: Channel 4 series “Going Cold Turkey” broadcast • 2007: Naltrexone Implant Service launched.
 2001: Published cohort study of 501 patients showed that 51% were opiate-free at 12 months.
 2011: Almost 8000 patients have successfully  To date: we have managed to obtain information on 50% of our service users at 12 post discharge; of them 59% on average have remained opiate-  Since the addition of the implants to Detox 5 in 2007 we have seen a positive impact on our Detox 5 service users booked vs admitted
 It was abundantly clear from the start that the world of implants was going to be confusing, contradictory and at times misleading.
 Our plan was to proceed carefully and  From the outset al implant procedures were evidenced from the manufacturer to the service user.
 A clear audit pathway is available.
 O’Neill implants = 146 (June 2007 to June 2008) Sherman implants = 859 (June 2008 to present) Combination of first implants and repeat  Total implant procedures carried out Our findings: Implant may take up to 2 years plus to  6 month implant may be effective for 3 to  12 month implant may be effective for 6 Figures for the first 12 months
Oral Naltrexone
Repeat implant at
Detox 5
Repeat implant
elsewhere
No further
treatment (OK)
Readmission to
Detox 5
Relapsed
Lost to follow up
Our findings: User friendly  Reliable for 3 months  Dissolves within 6 months  Scar is small  Significant anti-craving  Double pellet implant Single pellet in exceptional cases Figures for the first 12 months
Oral Naltrexone
Repeat implant at
Detox 5
Repeat implant
elsewhere
Readmission to
Detox 5
Relapsed
Refunded
Lost to follow up
Naltrexone comparison – oral v implant: It is very difficult to compare the two 10 years of tablets v 3 years of implants Latterly we have seen an increase in:  the number of people we are able to fol ow up the numbers of people who are opiate-free at 3, 6  service user satisfaction, particularly in relation to

Source: http://www.gplabslimited.com/_webedit/uploaded-files/All%20Files/Detox%205%20Naltrexone.pdf