Drugs of today
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Intravenous fentanyl citrate has stood the test of time as a valuable formulation for pain management. The desirable physicochemical properties of fentanyl have allowed the development of several alternative formulations for delivery using less invasive routes, for example, transmucosal (intranasal, oral buccal and oral sublingual) and transdermal. These new formulations have been applied to clinical settings in which rapid onset of analgesia is desired, using convenient but noninvasive methods. ⋯ Finally, they are increasingly used by patients with chronic pain of nonmalignant origin, although there is considerable debate about their merit in this group. We searched the databases MEDLINE, PubMed, EMBASE, CINAHL and Cochrane up to October 2011, using search terms "fentanyl AND nasal; intranasal; transmucosal; buccal; sublingual; oral; inhaled; inhalation; transdermal". The characteristics of several formulations of fentanyl are reviewed, detailing their pharmacokinetics, pharmacodynamics and clinical experience with their use for acute pain management.
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Phentermine hydrochloride is a noradrenergic sympathetic amine approved for decades by the U. S. Food and Drug Administration (FDA) at doses as high as 37.5 mg/day for the short-term treatment of obesity. ⋯ The prescribing information of neither agent describes adverse drug interactions with the other. The controlled-release formulation of phentermine and topiramate at low, medium and full doses (with full dose containing 15 mg of phentermine hydrochloride and 92 mg of topiramate) promotes weight reduction, with clinical trial data supporting improvement in adiposopathic consequences leading to metabolic diseases. Reported adverse events with this combination agent are as expected, based upon knowledge of the individual components.
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Tramadol hydrochloride/acetaminophen is a combination drug containing tramadol hydrochloride 37.5 mg and acetaminophen 325 mg. The use of 25% less tramadol in the combination product reduces the incidence of tramadol-related adverse events, while the addition of acetaminophen reduces the onset time of analgesia and improves the degree of analgesia. However, there was no clinically significant difference in the pharmacokinetic parameters of tramadol or acetaminophen when the fixed-dose combination was compared with the individual agents after multiple-dose administration. ⋯ It improves pain relief and provides a faster onset and longer duration of action with fewer adverse events than either component separately. It also reduces the severity of pain, photophobia and phonophobia associated with migraine headache. Tramadol hydrochloride/acetaminophen has been shown to be most effective in patients with mild to moderate pain and has a lower risk of serious adverse events.
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Improving survival, as well as the quality of life and functioning of survivors, is the main objective of cancer therapy, for which a very large number of drugs are currently available or under development as therapeutic candidates. Information on many of these compounds was discussed during the 2011 American Society of Clinical Oncology (ASCO) meeting in Chicago. The number of news presentations discussed during the meeting was incredibly high, with plenary, oral abstract, poster discussion and general poster sessions filling room upon room. The following report provides a quick review of major new research into drug and support therapies for cancer as presented at the meeting.
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Review
Available therapies and current management of fibromyalgia: focusing on pharmacological agents.
Fibromyalgia (FM) is a chronic medical condition characterized by physical, psychiatric and psychological symptoms. Widespread pain, fatigue, sleep disturbances, heightened sensitivity, morning stiffness, decreased volition, depressed mood and a history of early abuse are frequently reported by patients with FM. Treatment of fibromyalgia is multidisciplinary, with an emphasis on active patient participation, medications, cognitive-behavioral therapy and physical modalities. ⋯ Although nonpharmacological modalities are also frequently used, recent research has focused on identifying more effective pharmacological treatments, particularly antidepressants and anticonvulsants. Furthermore, several new pharmacological agents have been now officially approved for the treatment of patients with FM. Thus, the purpose of this review is to help healthcare professionals make informed decisions about the appropriate use of a number of pharmacological treatments for patients with FM.