International journal of clinical practice. Supplement
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Int J Clin Pract Suppl · Apr 2003
Review Comparative StudyReview of the analgesic efficacy of ibuprofen.
There is a clear relationship between single doses of ibuprofen over the range 50-400 mg and the peak analgesic effect and the duration of analgesia. The smallest clinically useful dose of ibuprofen is 200 mg. Ibuprofen 400 mg has been shown to be as effective as aspirin 600 or 900 mg/day in models of moderate pain but superior to aspirin or paracetamol in more sensitive models such as dental pain. ⋯ The combination of ibuprofen and hydrocodone is more effective than either drug alone in patients undergoing abdominal and gynaecological surgery. The absorption of ibuprofen acid is influenced by formulation, and certain salts of ibuprofen (lysine, arginine, potassium) and solubilised formulations have an enhanced onset of activity. These differences are clinically important, offering a shorter time to onset of relief of tension headache compared with paracetamol.
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Int J Clin Pract Suppl · Apr 2003
Review Randomized Controlled Trial Comparative Study Clinical TrialForty years of ibuprofen use.
Low-dose ibuprofen is as effective as aspirin and paracetamol for the indications normally treated with over-the-counter (OTC) medications and is associated with the lowest risk of gastrointestinal toxicity of any non-steroidal anti-inflammatory drug. By contrast, even low-dose aspirin is associated with an appreciable risk of gastrointestinal toxicity. Paracetamol is well tolerated and effective in treating mild to moderate pain but there is growing concern about a possible risk of gastrointestinal toxicity and a possible link with asthma in children. ⋯ Significant adverse events were more common with aspirin (10.1%) than ibuprofen (7.0%) (P<0.001) or paracetamol (7.8%). Significant gastrointestinal events were less frequent with ibuprofen (4.0%) than with aspirin (7.1%, P<0.001) or paracetamol (5.3%) (P=0.025). For every 100 patients treated, five more will experience significant adverse events if they are taking aspirin rather than ibuprofen, and four more than if they were taking paracetamol.
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Int J Clin Pract Suppl · Feb 2003
ReviewBuprenorphine and the transdermal system: the ideal match in pain management.
A system for the transdermal administration of the opioid drug buprenorphine has recently been introduced. Buprenorphine has physico-chemical properties, including a low molecular weight and high analgesic potency, that make it an excellent compound for transdermal drug delivery. The new technology (buprenorphine TDS, Transtec) is an advanced system that contains the active drug incorporated into a polymer matrix, which is at the same time the adhesive layer. ⋯ Buprenorphine TDS was developed for the treatment of moderate to severe cancer pain and severe pain which does not respond to non-opioid analgesics. Not only does this transdermal system provide excellent analgesia and a low incidence of adverse events, but its ease of use results in greater compliance. The patch provides excellent adhesion and has a low susceptibility to damage that might lead to toxicity or opioid abuse.
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Int J Clin Pract Suppl · Feb 2003
ReviewBuprenorphine TDS: the clinical development rationale and results.
Buprenorphine, a powerful opioid, is newly available for delivery in a transdermal formulation. The transdermal system's matrix patch provides rate-controlled administration of the drug. Three double-blind, placebo-controlled trials were conducted to evaluate efficacy and tolerability of the buprenorphine transdermal system (buprenorphine TDS, Transtec). ⋯ Systemic adverse effects reported in the drug cohorts included nausea, vomiting and dizziness, and were typical of those reported in other studies of opioids; local adverse events, most commonly erythema and pruritus, were transient and mild to moderate. In an open-label, follow-up trial, in which 239 patients from the original clinical studies participated, 90% of patients reported that their analgesia was satisfactory or even better over a mean duration of 4.7 months; nearly 95% of patients found the patch to be user-friendly. The new buprenorphine TDS appears to be an important new modality for administering analgesia in patients with non-acute pain.
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Int J Clin Pract Suppl · Feb 2003
Case ReportsBuprenorphine TDS: use in daily practice, benefits for patients.
In Germany and many other countries, buprenorphine has been used for a long time for the management of pain in both cancer and non-cancer patients. Although a transdermal delivery system for buprenorphine (Transtec) has recently been introduced, the clinical experience in daily practice with this drug, delivered in a matrix patch, is only now being evaluated. In preliminary data from a survey of 3,255 patients with chronic pain, 26% had cancer pain, while the most common diagnoses of the other respondents included back pain (33%), osteoarthritis (22%), osteoporosis (17%), and neuropathic pain (10%, multiple entries). ⋯ Adverse effects were similar to those seen on other opioids, although their intensity was mild in most cases. Local side effects, including erythema (4% of cases) and pruritus (1%), were transitory. Based on the survey results, transdermal buprenorphine is considered an effective opioid treatment for patients with stable cancer and non-cancer pain; it may prove particularly useful in patients who have experienced side effects taking oral analgesic preparations, as well as in those who are taking extensive co-medications.