Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Dec 2013
ReviewLiposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain.
The duration of postsurgical pain greatly outlasts the duration of analgesia (typically < 12 h) following single administration of traditional formulations of local anesthetics. Bupivacaine , one of the most widely studied and extensively used local anesthetics, is now available in a liposomal formulation that has shown promise of providing postsurgical analgesia for a duration of up to 72 h when administered as part of a peripheral (e.g., femoral) or neuraxial (e.g., epidural) nerve block. However, it is currently approved for administration in the surgical site. ⋯ The potential to provide postoperative analgesia lasting 3 days with a single administration at the time of surgery holds considerable promise. This modality could have distinct advantages over currently available techniques, such as continuous perineural local anesthetic infusion, as it would preclude the need for a catheter and pump. However, potential risks and benefits of liposome bupivacaine in peripheral and neuraxial nerve blocks must be further elucidated in surgical populations, and US Food and Drug Administration (FDA) approval must be granted for these indications. Until FDA approval is provided, the use of liposome bupivacaine in peripheral and neuraxial nerve blocks must be considered investigational.
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Expert Opin Pharmacother · Dec 2013
ReviewRecent advances in the treatment of life-threatening, invasive fungal infections.
Invasive fungal infections (IFIs) pose significant morbidity and are often life-threatening to many high-risk patients. Timely diagnosis and treatment of these infections with optimal therapy is imperative. ⋯ The goal for the future of biomarkers in IFIs will be to have excellent sensitivity and specificity to ideally identify a particular fungus causing the infection or eliminate its existence to prevent unnecessary costs, resistance and antifungal usage. In addition, further developments of new antifungals are needed and judicious use of the current regimens needs to be optimized through antifungal PD properties and TDM.
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Expert Opin Pharmacother · Nov 2013
ReviewTramadol and acetaminophen combination for chronic non-cancer pain.
There is some evidence to support the use of tramadol in chronic non-cancer pain, especially osteoarthritis pain, but modest analgesic activity is tempered by adverse effects. Combination of a lower dose of tramadol and acetaminophen is postulated to act synergistically, potentially reducing adverse effects without reduction in analgesic efficacy. ⋯ Combination therapy with tramadol and acetaminophen reduces pain outcomes in several types of chronic non-cancer pains. However, the effect is limited and is based on short duration trials and is associated with a significant adverse effect profile. There are few data comparing other pharmacological options and also sparse evidence to confirm benefits of the putative synergism of tramadol with acetaminophen. Nevertheless, other medications used for these chronic pains also have appreciable side effects and the combination may have a role to play. Increasing incidence of tramadol-associated deaths may lead to legislative changes that could alter prescription trends of tramadol-based medication.
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Expert Opin Pharmacother · Oct 2013
CommentOral BG-12 (dimethyl fumarate) for relapsing-remitting multiple sclerosis: a review of DEFINE and CONFIRM. Evaluation of: Gold R, Kappos L, Arnold D, et al. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med 2012;367:1098-107; and Fox RJ, Miller DH, Phillips JT, et al. Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. N Engl J Med 2012;367:1087-97.
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system involving inflammation, chronic demyelination and axonal loss. MS affects more than 2 million people worldwide. ⋯ The combination of robust efficacy, ease of administration and established safety profile is unique to a new therapy in MS. Findings from the pivotal Phase III studies support BG-12 as a potential initial oral treatment for patients with RRMS or as an alternative to other currently available therapies.