Drugs of today
-
Extensive basic science research has identified the potential therapeutic benefits of active compounds extracted from the Cannabis sativa L. plant (the cannabinoids). It is recognized that a significant proportion of patients suffering with the debilitating symptoms of pain and spasticity in multiple sclerosis or other conditions smoke cannabis despite the legal implications and stigma associated with this controlled substance. ⋯ Sativex has proved to be well tolerated and successfully self-administered and self-titrated in both healthy volunteers and patient cohorts. Clinical assessment of this combined cannabinoid medicine has demonstrated efficacy in patients with intractable pain (chronic neuropathic pain, pain due to brachial plexus nerve injury, allodynic peripheral neuropathic pain and advanced cancer pain), rheumatoid arthritis and multiple sclerosis (bladder problems, spasticity and central pain), with no significant intoxication-like symptoms, tolerance or withdrawal syndrome.
-
Ziconotide has been introduced as a new nonopioid treatment for chronic pain. Structurally, it is a peptide, the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. N-type voltage-sensitive calcium channels play a role in the transmission of nociceptive stimuli and also are involved in the release of neurotransmitters important in pain transmission. ⋯ When tested in clinical trials, ziconotide has been shown to have synergistic or additive value to the effect of morphine. Ziconotide, formerly known also as SNX- 111, represents a new class of agents, the N-type calcium channel blockers. These may represent another option for patients with refractory pain and refractory pain syndromes.
-
In the nearly 130 years since Trousseau first described migratory thrombophlebitis in cancer patients, thromboembolism has become a well-established presenting sign and complication of cancer. The coagulation system is activated in cancer and is further amplified by treatment with chemotherapy, radiation or surgery. Hypercoagulation is documented in virtually all cancer types, albeit at different rates, and is the second leading cause of death in cancer patients. ⋯ By binding rapidly and strongly to antithrombin, its sole physiologic target in plasma, fondaparinux catalyzes specifically the inhibition of factor Xa, which results in effective and linear dose-dependent inhibition of thrombin generation. Additionally, efficient inhibition of factor Xa activity impairs the activation of tissue factor/factor VIIa complex leading to downregulation of procoagulant state, pro-angiogenesis, and proinflammatory factors induced by tissue factor/factor VIIa. Furthermore, a number of orally active direct antithrombin and anti-factor Xa are in advanced clinical development for various thromboembolic disorders.
-
Current treatment options for patients with Alzheimer's disease are limited to providing symptomatic relief, with no effects on the underlying pathophysiology. However, a greater understanding of the importance of beta-amyloid peptides (Abeta) in the pathogenesis of this disease has led to the investigation of a number of potential antiamyloid therapies, of which tramiprosate (Neurochem Inc.) is in the most advanced stage of development. Tramiprosate is a glycosaminoglycan (GAG) mimetic designed to interfere with the actions of Abeta early in the cascade of amyloidogenic events. ⋯ Promising findings for the efficacy of tramiprosate, indicated by improvement or stabilization of cognitive function, have been shown in phase II clinical trials and open-label extensions of these studies. Furthermore, tramiprosate appears to be well tolerated with no reports of safety concerns. This article reviews the unique mode of action of tramiprosate and summarizes the available clinical information on the effects of tramiprosate in patients with Alzheimer's disease.
-
Current strategies for managing herpes zoster show variable efficacy and do not prevent its appearance. Varicella-zoster virus vaccine, or "zoster vaccine" is a more potent form of the varicella-zoster virus vaccine currently approved for use in the prevention of varicella in children. Zoster vaccine decreases the incidence of herpes zoster and burden of illness in adults aged 60 years and older and appears more efficacious in patients aged 60-69 than in those over 70 years. ⋯ The duration of postherpetic neuralgia is also significantly reduced. Zoster vaccine has a favorable safety profile; most treatment-related adverse events are related to the site of injection. This review summarizes the current data on the clinical efficacy and safety of zoster vaccine in adults aged 60 years and older.