Expert opinion on pharmacotherapy
-
Oseltamivir is the ethyl ester prodrug of the antiviral molecule, oseltamivir carboxylate, a potent and selective inhibitor of influenza A and B neuraminidase (NA) (sialidase). It is highly bioavailable in capsule and suspension formulations and, after conversion to the active metabolite in the liver, distributes throughout the body, including the upper and lower respiratory tract. Oseltamivir carboxylate is 3% bound to human plasma proteins and eliminated through the kidneys by a first-order process as unchanged drug by glomerular filtration and tubular secretion by an anionic transporter system. ⋯ Viruses that develop resistance appear to be less virulent in laboratory animals and to replicate less efficiently than parent strains. Although oseltamivir and the M2 ion channel inhibitors, amantadine and rimantadine, have not been directly compared in clinical trials, the greater breadth of spectrum of oseltamivir, its modest side effect profile compared to amantadine and its lesser propensity to engender the emergence of transmissible drug-resistant strains all suggest strongly that oseltamivir is a significant new agent for the prevention and treatment of influenza. A series of controlled trials comparing M2 ion channel inhibitor drugs and the new neuraminidase (NA) inhibitor agents are now needed to test this hypothesis and thereby to further advance the science of antiviral drug use to control influenza.
-
Expert Opin Pharmacother · Oct 2001
Moving towards rational pharmacological management of pain with an improved classification system of pain.
Recognition that untreated pain can have serious deleterious effects has lead to significant resources being devoted towards understanding physiology, controlling nociception and implementing standards that promise to improve treatment of pain. Recently, improved knowledge and the appreciation of the need for a polypharmaceutical approach has lead to an appreciation that the classification of pain syndromes is the best approach towards rationalising treatment approaches. ⋯ In addition, these classification schemes cannot represent newer advances in the understanding of pain and its physiology. Due to the growing variety of treatment approaches, classification of pain syndromes is often the best first step towards understanding a patient's pathophysiological process, initiating appropriate treatment and improving patient outcomes.