COX-2 Selective Non-Steroidal Anti-Inflammatory Drugs For
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SBARD – Lithium Nsaids
SBARD in Relation to Potentially Dangerous Interaction Between Lithium and Anti- Inflammatory Drugs A number of medication incidents have been reported recently concerning the prescribing and administration of non-steroidal anti-inflammatory drugs S (NSAIDs) to patients on lithium. Situation Co-administration of a NSAID or cyclo-oxygenase (COX)-2 inhibitor, with lithium increases the risk of lithium toxicity In the last 6 months (Oct.11-Mar.12) there have been 3 Datix incident reports concerning the prescription of a NSAID for in-patients stabilised on lithium. B In each case the NSAID was prescribed “as required”, which increases the risk Background of lithium toxicity due to irregular administration with no increase in lithium monitoring frequency. NSAIDs and COX-2 inhibitors reduce the renal excretion of lithium via their A action on renal prostaglandins, resulting in increased plasma lithium levels. The level of increase is unpredictable (from 10-400%), and the onset of effect is Assessment variable (few days to several months). Risks are increased in patients with impaired renal function, renal artery stenosis or heart failure, and who are dehydrated or on a low salt diet. Co-prescription of NSAIDs or COX-2 inhibitors with lithium is not an absolute R contra-indication, but should be undertaken with extreme caution and only Recommendation when clinically essential. The risk of lithium toxicity is increased with “as required” or intermittent dosing (e.g. when used for menorrhagia), when the effects are less predictable – regular dosing -
Meloxicam 15 Mg Orodispersible Tablets Meloxicam 15.0 Mg
PACKAGE LEAFLET: INFORMATION FOR THE USER Meloxicam 15 mg Orodispersible Tablets Meloxicam 15.0 mg Read all of this leaflet carefully before you start taking may occur if you have serious blood loss or burns, surgery or low this medicine. fluid intake; Keep this leaflet. You may need to read it again. if you have ever been diagnosed with high potassium levels in If you have any further questions, please ask your doctor or the blood; pharmacist. Tell your doctor if you think any of these apply to you. This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are Warning the same as yours. Medicines such as these Meloxicam tablets may be If any of the side effects become serious, or if you notice associated with a small increased risk of heart attack or any side effects not listed in this leaflet, please tell your doctor or stroke. Any risk is more likely with high doses and prolonged pharmacist. treatment. Do not exceed the recommended dose or duration of treatment. IN THIS LEAFLET: Discuss your treatment with your doctor or pharmacist if you have heart problems, have previously had a stroke or you think you 1. What Meloxicam orodispersible tablets are and what might be at risk of conditions such as high blood pressure, they are used for diabetes or high cholesterol, or if you are a smoker. 2 . Before you take Meloxicam tablets 3. How to take Meloxicam tablets Taking other medicines When you are taking Meloxicam tablets, do not take any other 4. -
What Are the Acute Treatments for Migraine and How Are They Used?
2. Acute Treatment CQ II-2-1 What are the acute treatments for migraine and how are they used? Recommendation The mainstay of acute treatment for migraine is pharmacotherapy. The drugs used include (1) acetaminophen, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans and (5) antiemetics. Stratified treatment according to the severity of migraine is recommended: use NSAIDs such as aspirin and naproxen for mild to moderate headache, and use triptans for moderate to severe headache, or even mild to moderate headache when NSAIDs were ineffective in the past. It is necessary to give guidance and cautions to patients having acute attacks, and explain the methods of using medications (timing, dose, frequency of use) and medication use during pregnancy and breast-feeding. Grade A Background and Objective The objective of acute treatment is to resolve the migraine attack completely and rapidly and restore the patient’s normal functions. An ideal treatment should have the following characteristics: (1) resolves pain and associated symptoms rapidly; (2) is consistently effective; (3) no recurrence; (4) no need for additional use of medication; (5) no adverse effects; (6) can be administered by the patients themselves; and (7) low cost. Literature was searched to identify acute treatments that satisfy the above conditions. Comments and Evidence The acute treatment drugs for migraine generally include (1) acetaminophens, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans, and (5) antiemetics. For severe migraines including status migrainosus and migraine attacks refractory to treatment, (6) anesthetics, and (7) corticosteroids (dexamethasone) are used (Tables 1 and 2).1)-9) There are two approaches to the selection and sequencing of these medications: “step care” and “stratified care”. -
Use of Aspirin and Nsaids to Prevent Colorectal Cancer
Evidence Synthesis Number 45 Use of Aspirin and NSAIDs to Prevent Colorectal Cancer Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-02-0021 Prepared by: University of Ottawa Evidence-based Practice Center at The University of Ottawa, Ottawa Canada David Moher, PhD Director Investigators Alaa Rostom, MD, MSc, FRCPC Catherine Dube, MD, MSc, FRCPC Gabriela Lewin, MD Alexander Tsertsvadze, MD Msc Nicholas Barrowman, PhD Catherine Code, MD, FRCPC Margaret Sampson, MILS David Moher, PhD AHRQ Publication No. 07-0596-EF-1 March 2007 This report is based on research conducted by the University of Ottawa Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0021). Funding was provided by the Centers for Disease Control and Prevention. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. -
Lumiracoxib: Suspension of UK Licences with Immediate Effect (Non
Primary and Community Care Directorate Pharmacy Division T: 0131-244 2528 F: 0131-244 2375 E: [email protected] abcdefghijklmnopqrstu 19 November 2007 ___ 1. Medical Directors NHS Boards 2. Directors of Public Health 3. Specialists in Pharmaceutical Public Health/Directors of Pharmacy 4. NHS 24 LUMIRACOXIB – SUSPENSION OF UK LICENCES WITH IMMEDIATE EFFECT (NON URGENT ) CASCADE WITHIN 48 HOURS Please see attached for onward transmission a copy of a message from Professor Gordon Duff, Chairman, Commission on Human Medicines about the suspension of UK licences (marketing authorisations) due to the risk of severe liver reactions associated with lumiracoxib. Please could Medical Directors in NHS Boards forward on to :- ● All General Practitioners - please ensure this message is seen by all practice nurses and non principals working in your practice and retain a copy in your ‘locum information pack’. ● Deptutising services Please could all Directors of Public Health forward the message to: ● Chief Executives NHS Boards Specialists in Pharmaceutical Public Health/Directors of Pharmacy will also receive this information through the usual drug alert channels to forward on to community pharmacists. Yours sincerely PAMELA WARRINGTON Deputy Chief Pharmaceutical Officer St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.scotland.gov.uk abcde abc a Ref: EL(07)A/21 LUMIRACOXIB - SUSPENSION OF UK LICENCES WITH IMMEDIATE EFFECT 19 November 2007 Dear Colleague, I am writing to inform you that the UK licences (marketing authorisations) for lumiracoxib have been suspended and stocks are being withdrawn from pharmacies, on the basis of advice from the Commission on Human Medicines (CHM). -
TILCOTIL® Tenoxicam Film Coated Tablets 20 Mg
NEW ZEALAND CONSUMER MEDICINE INFORMATION TILCOTIL® Tenoxicam Film Coated Tablets 20 mg degenerative joint disease bleeding in your stomach, What is in this leaflet (arthrosis) or have had this in the past menstrual cramps (period a tendency to Please read this leaflet carefully pain) spontaneously bleed or before you start taking Tilcotil. following surgery bleed after minor accidents gout (a disease with painful, (haemorrhagic diathesis) This leaflet answers some common swollen joints) severe heart, liver or kidney questions about Tilcotil. failure Tilcotil contains the active ingredient are more than six months It does not contain all the available tenoxicam. It belongs to a group of pregnant (third trimester of information. It does not take the medicines called Non-Steroidal pregnancy). place of talking to your doctor or Anti-Inflammatory Drugs (NSAIDs). pharmacist. Do not take this medicine after Your doctor may have prescribed the expiry date printed on the All medicines have risks and this medicine for another reason. pack or if the packaging is torn or benefits. Your doctor has weighed shows signs of tampering. the risks of you taking Tilcotil Ask your doctor if you have any If it has expired or is damaged, against the benefits they expect it questions about why this return it to your pharmacist for will have for you. medicine has been prescribed for disposal. you. If you have any concerns about Safety and effectiveness of taking this medicine, ask your This medicine is available only with Tilcotil have not been established doctor or pharmacist. a doctor’s prescription. for children and adolescents. -
Efficacy and Safety of Celecoxib
ORIGINAL PAPER Nagoya J. Med. Sci. 77. 81 ~ 93, 2015 EFFICACY AND SAFETY OF CELECOXIB COMPARED WITH PLACEBO AND ETODOLAC FOR ACUTE POSTOPERATIVE PAIN: A MULTICENTER, DOUBLE-BLIND, RANDOMIZED, PARALLEL-GROUP, CONTROLLED TRIAL NAOKI ISHIGURO1, MD, PhD; AKIO HANAOKA2, MS; TOSHIYUKI OKADA2, MS; and MASANORI ITO3, PhD 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan 2Clinical Development 1, Astellas Pharma Inc., Tokyo, Japan 3Global Data Science, Astellas Pharma Global Development Inc., Northbrook, IL, US ABSTRACT Celecoxib is a nonsteroidal anti-inflammatory drug (selective cyclooxygenase-2 inhibitor) that is widely used. The efficacy and safety of celecoxib for treatment of acute postoperative pain were evaluated in Japanese patients. The objective was to assess whether celecoxib showed superiority over placebo treatment and non-inferiority versus etodolac (another selective cyclooxygenase-2 inhibitor) that has been widely used for the management of acute pain. A multicenter, double-blind, randomized, parallel-group, controlled study was performed, in which 616 patients with postoperative pain received celecoxib, etodolac, or placebo. Their impressions of study drug efficacy (overall assessment) and pain intensity were evaluated. Based on each patient’s overall assessment of pain, the efficacy rate was 63.7% in the placebo group, 76.2% in the celecoxib group, and 68.0% in the etodolac group, with these results demonstrating superiority of celecoxib to placebo and noninferiority versus etodolac. The efficacy rate was significantly higher in the celecoxib group than in the etodolac group. There were no adverse events specific to celecoxib, and the safety of celecoxib was similar to that of placebo. Celecoxib was superior to etodolac for controlling acute postoperative pain. -
New Restrictions on Celecoxib (Celebrex) Use and the Withdrawal of Valdecoxib (Bextra)
Early release, published at www.cmaj.ca on April 15, 2005. Subject to revision. HEALTH AND DRUG ALERTS P RACTICE New restrictions on celecoxib (Celebrex) use and the withdrawal of valdecoxib (Bextra) Early release, published at www.cmaj.ca on Apr. 15, 2005. Subject to revision. Reason for posting: Coxibs, v. 0.5%; risk ratio 3.7, 95% CI the class of NSAIDs that selec- 1.0–13.5).2 Amid concerns about Table 1: The degree of inhibition of COX-2 relative tively inhibit cyclooxygenase 2 reports of severe cutaneous reac- to COX-1 for various NSAIDs (COX-2), were designed to re- tions (Stevens–Johnson syn- NSAID type COX-2 selectivity* duce joint pain and inflamma- drome, erythema multiforme, tion without causing the gastric toxic epidermal necrolysis) COX-2 selective inhibitors epithelial adverse effects typical among patients taking valde- Rofecoxib 80 of nonselective NSAIDs. Rofe- coxib,5 the drug was removed Etodolac 23 coxib (Vioxx) was withdrawn from the market. Meloxicam 11 from the market in September Celecoxib 9 2004 over concerns about car- What to do: COX-2 inhibitors Nonselective NSAIDs diovascular adverse effects, and appear to increase the risk of car- Diclofenac 4 key safety trials involving cele- diovascular adverse events in a Sulindac 3 coxib (Celebrex)1 and valdecoxib dose-related fashion, and all pa- Piroxicam 2 (Bextra)2 have recently been tients should be informed of this. Ibuprofen 0.4 published. Health Canada now Calculating the patient’s baseline Naproxen 0.3 recommends new restrictions on risk of cardiovascular disease Indomethacin 0.2 celecoxib use, and valdecoxib (e.g., with Framingham risk cal- Ketorolac 0.003 has been taken off the market.3 culators) may be wise, and cele- Note: COX = cyclooxygenase. -
Acemetacin.Pdf
Methods and Findings in Experimental and Clinical Pharmacology 2010, 32(2): ???-??? THOMSON REUTERS Copyright © 2010 Prous Science, S.A.U. or its licensors. All rights reserved. CCC: 0379-0355/2010 DOI: 10.1358/mf.2010.32.2.1423883 ORIGINAL ARTICLE ACEMETACIN ANTINOCICEPTIVE MECHANISM IS NOT RELATED TO NO OR K+ CHANNEL PATHWAYS. M. Gil-Flores1, M.I. Ortiz2, G. Castañeda-Hernández1 and A.E. Chávez-Piña1 1Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México, D.F., México. 2Área Académica de Medicina del Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, México SUMMARY Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used for the treatment of acute gout and inflammation. However, its use is limited due to side effects. Acemetacin is a prodrug of indomethacin that exhibits better gastric tolerability in preclinical and clinical tri- als. The aim of this study was to examine if the systemic administration of acemetacin involved the sequential participation of nitric oxide (NO) or K+ channel pathways to confer its antinociceptive effect, as compared to indomethacin. The antinociceptive effect of both drugs was studied with the formalin test. Equimolar doses of acemetacin or indomethacin were administered orally. The intraplantar administra- tion of either L-NAME, glibenclamide, apamin or charybdotoxin plus indomethacin or acemetacin was studied using the formalin test and the anti-inflammatory and antihyperalgesic effects were measured. The antinociceptive effect of acemetacin or indomethacin was not sig- nificantly different when pretreatment with L-NAME, glibenclamide, apamin or charybdotoxin was done. The antihyperalgesic and anti- inflammatory effects were also similar for both indomethacin and acemetacin. -
Binding of Nonsteroidal Anti-Inflammatory Drugs to DPPC: Structure and Thermodynamic Aspects
4132 Langmuir 2008, 24, 4132-4139 Binding of Nonsteroidal Anti-inflammatory Drugs to DPPC: Structure and Thermodynamic Aspects Marlene Lu´cio,*,†,⊥ Frank Bringezu,‡,|,⊥ Salette Reis,† Jose´ L. F. C. Lima,† and Gerald Brezesinski§,⊥ REQUIMTE, Faculdade de Farma´cia, UniVersidade do Porto, Rua Anı´bal Cunha, 4099-030 Porto, Portugal, Institute of Medical Physics and Biophysics, UniVersity of Leipzig, Ha¨rtelstrasse 16, D-04103 Leipzig, Germany, and Max-Planck Institute of Colloids and Interfaces, Research Campus Golm, Am Mu¨hlenberg 1, D-14476 Potsdam, Germany ReceiVed NoVember 16, 2007. In Final Form: January 8, 2008 The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the phase transition and phase properties of 1,2-dipalmitoylphosphatidylcholine (DPPC) has been investigated in both 2D (monolayers at the air/water interface) and 3D (multilayers in lipid/water dispersions) model systems. The 2D membrane models have been characterized by means of pressure-area isotherms and grazing incidence X-ray diffraction (GIXD) measurements. Differential scanning calorimetry (DSC) and simultaneous small- and wide-angle X-ray diffraction have been applied to lipid aqueous dispersions. All NSAIDs studied altered the main transition temperature of the gel to liquid-crystalline phase transition, with the arylacetic acid derivatives (acemetacin and indomethacin) showing the largest effects. A comparison of the results reveals distinct structural features of the membrane models after interaction with the NSAID. All drugs induced perturbations in the lipid liquid-crystalline phase, suggesting a major change in the hydration behavior of DPPC. Again, the largest effects on the structural parameters are found for the arylacetic acid derivatives. The results obtained in the different model systems give indications of the role of the membrane/NSAID interactions that might also be important for NSAID gastric injury. -
Spondyloarthritis: NMA on Pain Outcome RR111467
NICE CGTSU Spondyloarthritis: NMA on Pain Outcome RR111467 Spondyloarthritis: NMA on pain outcome CGTSU, Bristol (Edna Keeney and Sofia Dias) The purpose of this analysis was to estimate the comparative effectiveness of the following pharmacological interventions for management of pain associated with axial spondyloarthritis: 1. Indomethacin (Reference) 2. Diclofenac 3. Sulindac 4. Fenoprofen 5. Ketoprofen 6. Flurbiprofen 7. Tenoxicam 8. Piroxicam 9. Celecoxib 200mg 10. Celecoxib 400mg 11. Aceclofenac 12. Naproxen 13. Enteric coated Naproxen 14. Etoricoxib 15. Tolfenamic acid 16. Meloxicam 15mg 17. Placebo 23 studies were included in the analyses. The network diagram is shown in Figure 1. Edna Keeney 1 13/10/2015 NICE CGTSU Spondyloarthritis: NMA on Pain Outcome RR111467 Figure 1. Network Diagram for pain outcome Pain Indomethacin Placebo Diclofenac Meloxicam 15mg Sulindac Tolfenamic acid Fenoprofen Etoricoxib Ketoprofen Enteric coated naproxen Flurbiprofen Naproxen Tenoxicam Piroxicam Aceclofenac Celecoxib 400mg Celecoxib 200mg METHODS In order to take all trial information into consideration, Mixed Treatment Comparison meta-analytic techniques, also termed Network meta-analysis (NMA), were employed. NMA is a generalization of standard pairwise meta-analysis for A versus B trials, to data structures that include, for example, A versus B, B versus C, and A versus C trials.1-3 A basic assumption of NMA methods is that direct and indirect evidence estimate the same parameter, that is, the relative effect between A and B measured directly -
The Effectiveness of Patches Containing Loxoprofen Sodium
22 Japanese Journal of Comprehensive Rehabilitation Science (2013) Original Article The effectiveness of patches containing Loxoprofen Sodium Hydrate (LX-P) in the conservative therapy of muscular back pain – Clinical results using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) Toyoko Asami, MD, PhD,1 Naoya Yamanouchi, MD,1 Akihiko Asami, MD, PhD,2 Hisato Tanaka, MD,3 PhD, Norihiko Nogami, MD, PhD4 1Department of Rehabilitation Medicine, Saga University Hospital, Saga, Japan. 2Saga Social Insurance Hospital, Saga, Japan. 3Tanaka Hospital (Anju Medical Corporation), Saga, Japan. 4Wakakusu Ryoikuen, Tosu, Saga, Japan. ABSTRACT life disability. The rate of effectiveness of LX-P against Asami T, Yamanouchi N, Asami A, Tanaka H, Nogami pain-related disabilities in the fourth week was 62.2%. N. The effectiveness of patches containing Loxoprofen Conclusion: LX-P showed satisfactory analgesic Sodium Hydrate (LX-P) in the conservative therapy of effect and QOL improvement. We believe it is effective muscular back pain - Clinical results using the Japanese for clinical practice. Orthopaedic Association Back Pain Evaluation Keywords: loxoprofen sodium, JOABPEQ, VAS, Questionnaire (JOABPEQ). Jpn J Compr Rehabil Sci QOL, muscular back pain 2013; 4: 22-29. Objectives: We investigated the analgesic effect, Introduction degree of patient satisfaction, and QOL improvement provided by patches containing loxoprofen sodium According to the Ministry of Health, Labour and hydrate (LX-P) using a questionnaire based on the Welfare’s Comprehensive Survey of Living Conditions evaluation criteria of the Japanese Orthopaedic (several surveys conducted in fiscal 2004, 2007, 2010), Association Back Pain Evaluation Questionnaire pain in the locomotive organs, including “lower back (JOABPEQ). pain,” “stiff shoulders,” and “joint pain,” is one of the Methods: In this study of 53 patients (18 men, 35 most common subjective symptoms reported.