Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2015
A Pilot Chemical and Physical Stability Study of Extemporaneously Compounded Levetiracetam Intravenous Solution.
Levetiracetam is a commonly used antiepileptic medication for tumor-related epilepsy. However, the 100 mL intravenous (IV) infusion volume can be burdensome to imminently dying hospice patients. A reduced infusion volume would improve patient tolerability. ⋯ Over the 2-week storage period, there was no significant change in visual appearance or pH for any of the stability samples. The HPLC results confirmed that all stability samples retained 94.2-101.3% of initial drug concentration and no degradation products or leachable material from the packaging materials were observed. We conclude that levetiracetam 1000 mg/25 mL IV solution in sodium chloride 0.9% is physically and chemically stable for up to 14 days under refrigeration in polypropylene syringes, PVC bags, and polyolefin bags.
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J Pain Palliat Care Pharmacother · Jan 2015
ReviewOpioids for the Management of Dyspnea in Cancer Patients: Evidence of the Last 15 Years-A Systematic Review.
The objective of this study was to review the evidence on the use of opioids for treatment of the dyspnea in adult cancer patients. A systematic literature review was conducted in the databases MEDLINE, CINAHL (EBSCO), ScienceDirect, and Cochrane Library of trials testing the effect of opioids in relieving dyspnea in cancer patients. Fourteen trials met the criteria for inclusion in the review. ⋯ Morphine has been the most studied strong opioid showing efficacy in alleviating dyspnea when administered, either orally or subcutaneously, in cancer patients. The potential benefit of the strong opioids in the alleviation of dyspnea in cancer patients is modest and limited to some opioids. More studies are needed to sufficiently support the role of opioids in dyspnea at rest, at exertion, and for breakthrough dyspnea and to clarify the safety issues.
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J Pain Palliat Care Pharmacother · Jan 2015
Case ReportsFentanyl-Induced Neurotoxicity in Children.
Fentanyl-induced neurotoxicity is an uncommon adverse effect of fentanyl and is seldom seen in pediatric palliative care practice. It presents as myriad of nonspecific symptoms such as severe pain, allodynia, insomnia, agitation, hallucinations, behavioral changes, and headache. ⋯ This is a case report of an 11-year-old girl; a case of locally advanced neuroblastoma, progressed on disease-modifying treatment, and referred to pediatric palliative care for best supportive care. She developed features of fentanyl-induced neurotoxicity during upward titration of transdermal fentanyl that was promptly identified and managed in a pediatric palliative care setting.
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J Pain Palliat Care Pharmacother · Jan 2015
Case ReportsTreatment of Refractory Hiccups with Amantadine.
Persistent or intractable hiccups are not uncommon at the end of life, occurring in approximately 4% to 9% of patients, and can cause considerable suffering, including difficulties in eating, drinking, and speaking, insomnia, pain, fatigue, and depression. In palliative practice, the etiology of hiccups is often either unknown or untreatable, and empirical pharmacologic treatment is the norm. ⋯ The role of dopamine in hiccups is somewhat ambiguous and likely not central to their cause or treatment. Amantadine may be a reasonable option for patients with distressing hiccups who cannot tolerate a sedating agent.