Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Aug 2004
ReviewTiotropium bromide, a new, once-daily inhaled anticholinergic bronchodilator for chronic-obstructive pulmonary disease.
Tiotropium bromide is a quaternary ammonium compound structurally related to ipratropium and has recently been approved in the US for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic-obstructive pulmonary disease (COPD). It is available in a dry powder form, where 18 microg [corrected] of the drug is inhaled once-daily through a device, the HandiHaler). The potency and long duration of effect of this anticholinergic bronchodilator result primarily from a prolonged blockade of the M1 and M3 muscarinic receptors in the airways and a relatively more rapid dissociation from the M2 receptor (which provides inhibitory feedback). ⋯ Combined results from two studies comparing once-daily tiotropium to twice-daily inhalation of standard doses of salmeterol, indicate a magnitude of the bronchodilator response similar in the two drugs early in the study. However, by 6 months, the bronchodilator effect of tiotropium was somewhat greater than that of the long-acting beta-agonist. Preliminary data suggest that combining tiotropium with long-acting beta-agonists may produce additional bronchodilator action in COPD.
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Food-borne trematode infections, caused by liver flukes (Clonorchis, Fasciola, Opisthorchis), lung flukes (Paragonimus) and intestinal flukes (Echinostoma, Fasciolopsis, heterophyids), are significant public health problems, most notably in Southeast Asia and the Western Pacific. Globally, it is estimated that > 40 million people are infected among the 750 million people who live in endemic areas. The epidemiology of food-borne trematodiasis has changed over the past few decades, and now presents a dual picture. ⋯ The discovery, chemistry, pharmacological properties, safety, therapeutic efficacy and adverse effects of the current drugs of choice, namely praziquantel and triclabendazole, is then discussed. Recent advances on other drugs and contemporary investigations on novel compounds that might become important players in chemotherapy are highlighted. Finally, the need for research and development of new trematocidal drugs that - employed in concert with health education, improved sanitation and enhanced food safety - are key factors for sustainable control of food-borne trematodiasis, is highlighted.
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Aceclofenac (Almirall Prodesfarma SA) is an oral NSAID that is effective in the treatment of painful inflammatory diseases and has been used to treat > 75 million patients worldwide. It has proved as effective as diclofenac, naproxen and piroxicam in patients with osteoarthritis, diclofenac, ketorolac, tenoxicam and indomethacin in patients with rheumatoid arthritis and tenoxicam, naproxen and indomethacin in patients with ankylosing spondylitis. ⋯ Aceclofenac appears to be particularly well-tolerated amongst the NSAIDs, with a lower incidence of gastrointestinal adverse effects. This good tolerability profile results in a reduced withdrawal rate and hence greater compliance with treatment.
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Expert Opin Pharmacother · Jun 2004
ReviewDelaying surgery with chemotherapy for osteosarcoma of the extremities.
Osteosarcoma is the most frequent primary cancer of bone. When treated by surgery alone, it is almost invariably followed by metastatic dissemination and death. ⋯ This article provides a summary overview of current pharmacotherapy in osteosarcoma of the extremities, focussing on the approach of preoperative 'neoadjuvant' chemotherapy and thus, the potential benefits and pitfalls of delaying surgery. Prospective, multi-institutional trials are essential in guaranteeing that as many patients as possible can benefit from modern, efficacious interdisciplinary therapeutic regimens and that further progress can be made.
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Expert Opin Pharmacother · Jun 2004
ReviewPharmacological strategies in relieving neuropathic pain.
The pharmacological treatment of neuropathic pain relies, to a large extent, on drugs belonging to a small number of defined classes. Opioids, tricyclic antidepressants, antiepileptic drugs and membrane stabilisers form the current basis of treatment. ⋯ A number of drugs currently licensed for a different indication have recently had an analgesic effect in neuropathic pain attributed to them. In addition, a number of novel compounds are undergoing investigation and provide hope of dicovering more efficacious treatment options in the future.