DOCSLIB.ORG

Drug Use for Non-Hepatic Associated Conditions in Patients with Liver Cirrhosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Drug Use for Non-Hepatic Associated Conditions in Patients with Liver Cirrhosis Eur J Clin Pharmacol (2003) 59: 71–76 DOI 10.1007/s00228-003-0586-2 PHARMACOEPIDEMIOLOGY AND PRESCRIPTION M. Isabel Lucena Æ Rau´l J. Andrade Æ Gianni Tognoni Ramo´n Hidalgo Æ Felipe Sanchez de la Cuesta Æ the Spanish Collaborative Study Group on Therapeutic Management in Liver Diseases Drug use for non-hepatic associated conditions in patients with liver cirrhosis Received: 1 November 2002 / Accepted: 3 February 2003 / Published online: 9 April 2003 Ó Springer-Verlag 2003 Abstract Aims: To study the prescribing patterns of Keywords Pharmacoepidemiology Æ Drug use Æ Liver practising physicians for the most frequent non-hepatic cirrhosis associated conditions in patients with liver cirrhosis. Methods: A multi-centre prospective observational study carried out in 25 Spanish hospitals. Inpatients admitted to gastrointestinal and liver units with a diagnosis of liver cirrhosis were included in five centrally Introduction assigned index days, between February and June 1999. Information was collected about pharmacological treat- Cirrhosis of the liver is one of the most common ments used on admission and recommended at discharge. chronic diseases that can alter drug disposition and Results: Five hundred and sixty-eight in-patients with a effect [1, 2, 3]. The heterogeneity of the effects of liver diagnosis of liver cirrhosis (44% alcoholic cirrhosis) and disease on different routes of drug metabolism, the an average number of 2.5 co-morbid conditions were variability in the rates of these pathways and the ab- studied: diabetes mellitus (30%), infectious disorders sence of a routinely measurable test of metabolic (24%), cardiovascular disease (20%) and active alco- function of the liver make it difficult to accomplish a holism (15%)—the most common associated conditions. simple rule to individualise drug treatment in cirrhotic Chlormethiazole, amoxicillin–clavulanic acid, paraceta- patients [1, 4]. This is of further concern because mol, gliblenclamide, lorazepam, captopril and tiapride underlying liver dysfunction is one of the most com- were the drugs used most prevalently. The average pre- mon factors that increase the risk of adverse effects in scribed daily dose was <1 defined daily dose per day for medical practice [5]. Unfortunately, scarce or occa- most medication classes hepatically handled except for sionally conflicting data are available on whether the calcium channel blockers. presence of liver disease should influence drug choice Conclusions: The present study expands current knowl- and dosage adjustments for common associated con- edge of prescribing patterns for associated conditions in ditions [6, 7]. Nevertheless, there is general agreement patients with underlying liver cirrhosis. Drug dosing was regarding the hazards to which cirrhotic patients are affected in general by the influence of age and hepatic exposed when taking some drugs, such as non-steroid disease on the disposition of drugs, but knowledge on anti-inflammatory drugs (NSAIDs), or the appropri- drug selection needs further attention. ateness to perform a dosage modification for others (i.e. calcium channel blockers). However, the diverse influence of liver function on drug disposition may M.I. Lucena (&) Æ R.J. Andrade Æ F. Sanchez de la Cuesta lead health-care professionals to inappropriate drug Clinical Pharmacology Service and Liver Unit, selection, to inappropriate dosing of medicines or to Hospital Universitario, School of Medicine, University of Ma´laga, 29071 Ma´laga, Spain some degree of therapeutic nihilism, particularly if E-mail: [email protected] there is only a recommendation that the drug should Tel.: +34-952-131572 be used ‘‘with caution’’. Fax: +34-952-131568 The present study was aimed to assess the G. Tognoni prescribing patterns of practising physicians for the Istituto di Ricerche Pharmacologiche Mario Negri, Milan, Italy most frequently associated conditions (excluding dis- R. Hidalgo orders of the gastrointestinal tract) in hospitalised pa- Centro de Ca´lculo, University of Ma´laga, 29071 Ma´laga, Spain tients with underlying liver cirrhosis. 72 represented 38% (218), and cirrhosis of unknown cause Methods 18% (102). The mean age was 61 years (range 27– 92 years); 30% of the patients was younger than This study was part of a large-scale study carried out in Spain and aimed to describe the prescribing patterns of practising physicians 55 years, while 45% was 65 years or older. The younger for patients with liver cirrhosis and to determine the extent of patients were mainly classified in the diagnostic group of practice variability across participating centres, which represented alcoholic cirrhosis of the liver. Women were older than up to one-quarter of the national health system [8]. men. Of the female sample, 58% was older than A multi-centre prospective observational study was carried out 65 years, while the same age group made up 39% of the in 25 Spanish hospitals with a catchment population of 10.8 million inhabitants. A network was set up under the methodological and male patient population. operational co-ordination of a clinical pharmacology research unit. Ascites was the most prevalent major complication of The methodology followed was described previously [8]. Briefly, all cirrhosis in this population (49%), followed by portal– patients admitted to gastrointestinal and liver units with a diag- systemic encephalopathy (24%) and variceal bleeding nosis of liver cirrhosis on five centrally assigned index days, be- tween February and June 1999, were included. The research (22%). Of the patients, 82% was class B–C according to protocol was approved by the locally appointed ethics committee. Child–Pugh classification. Diabetes mellitus (125 patients), infectious disorders other than spontaneous bacterial peritonitis (110 pa- Data collection tients), active alcoholism (68 patients), chronic respira- tory diseases (49 patients), heart disease (47 patients), In each participating hospital, the physician in charge of the study hypertension (45 patients), pain disorders (37 patients) prospectively collected (with a standardised form) information on and non-liver cancer (16 patients) were the most com- all patients with a diagnosis of liver cirrhosis that were admitted in any of the assigned days. Information consisted of demographic monly associated conditions. One hundred and four variables, present medical condition and pharmacological treat- patients (17%) did not have any associated condition. ments prescribed for non-liver related co-morbid conditions on Fifty-seven patients (10%) died during hospitalisation. admission (refers to drugs that patients were already receiving at Multiple co-morbid conditions were prevalent, as indi- time of hospital admission) and at discharge from hospital. Infor- cated by an average number of 2.5±1.7 diagnoses. The mation was obtained by interviewing patients and from the clinical records. Patients were questioned to identify drugs used for other drugs used for the management of these conditions are medical problems not related to the liver that might not have been shown in Table 1. recorded in the medical record. In addition, family members were Prescribed oral hypoglycaemics accounted for 41% interviewed when patients were not able to collaborate. Medication of the total diabetes prescriptions (47 of 116) on ad- containers, which family members were asked to bring to the hospital, were inspected. A written medication plan was provided mission and 26% at discharge (26 of 99). The most by the patient when available. The name of each drug, daily dose, frequently prescribed sulfonamides at discharge were route and frequency of administration, and diagnosis motivating glibenclamide (69%) followed by gliclazide, glipizide the prescription were recorded. The diagnosis of liver cirrhosis was and chlorpropamide (8% each). usually made before admission to hospital and according to the standardised clinical, ultrasonographic, endoscopic and histologi- A total of 26 benzodiazepine agents were used at cal criteria. The severity of chronic liver disease was assessed using discharge, lorazepam being the most common (50%), the Child–Pugh classification, with score C representing the most followed by oxacepam, bromazepam, clorazepate and advanced disease. Forms were checked for completeness at the co- lormetazepam (8% each). On admission, the rank order ordinating centre before data entry. was lorazepam (34%), clorazepate (10%), diazepam and The prescribed daily dose (PDD) was recorded as a percentage of the defined daily dose (DDD) for the selected main medication oxazepam (7% each) and others (five compounds: lor- classes by dividing the PDD by the DDD [9]. The DDD of a metazepam, bromazepam, bentazepam, alprazolam and substance is established by the Nordic Council on Medicines and flunitrazepam; 3%). Hydroxyzine, a diphenylmethane the World Health Organization (WHO) Drug Utilization Research derivative, was used for the treatment of pruritus related Group and represents the recommended average daily dose of a drug, if used for its main indication in an average adult. Medicines to liver cirrhosis in five patients on admission but only in were classified according to the Anatomical Classification System three patients (3 of 14) at discharge. (ATC) recommended by WHO Europe. Those medications for Overall, 9 patients received drugs for insomnia and 19 which the liver has a great contribution to their metabolism and patients for the management of alcohol deprivation disposition were chosen. The data were analysed using the Statistical
Load more

Recommended publications
  • Uso Adecuado De BZD En Insomnio Y Ansiedad.Pdf
    Vol. 6 Nº 1 · OCTUBRE 2014 BOLETÍN CANARIO DE USO RACIONAL DEL MEDICAMENTO DEL SCS Uso adecuado de BENZODIAZEPINAS en insomnio y ansiedad. SUMARIO PERFIL FARMACOLÓGICO DE LAS BZD (Tabla 1). - INTRODUCCIÓN 1 - PERFIL FARMACOLÓGICO DE LAS BENZODIAZEPINAS 1 No todas las BZD son iguales, ni tienen las mismas indicaciones. - BENZODIAZEPINAS EN EL INSOMNIO 2 Conocer algunos aspectos sobre su perfil farmacológico es esencial para realizar una prescripción adecuada y segura. - BENZODIAZEPINAS EN LA ANSIEDAD 4 - RECOMENDACIONES PARA SUSPENDER 5 Por lo general las BZD se absorben muy bien por vía oral, mientras TRATAMIENTOS CON BZD que la vía intramuscular presenta una absorción lenta e irregular, por - BIBLIOGRAFÍA 7 lo que no suele ser muy recomendada. En situaciones de emergencia (convulsiones) es preferible utilizar la vía endovenosa. INTRODUCCIÓN Inicio de acción y vida media: el inicio de acción es distinto según el principio activo y constituye un criterio fundamental en la selección de Las benzodiazepinas (BZD) son psicofármacos que actúan aumentan- las BZD. Puede ser: de inicio rápido (0,5-1 h), de utilidad en el insomnio do la acción del ácido gammaaminobutírico (GABA), principal neuro- de conciliación y en crisis de ansiedad; de inicio intermedio (1-3 h) o transmisor inhibidor del sistema nervioso central. Tienen indicaciones de inicio lento (> 3 h), preferibles en insomnio de mantenimiento o terapéuticas diversas, y auque su uso más habitual es en el tratamien- despertar precoz y en la ansiedad generalizada. to de la ansiedad e insomnio, también se utilizan en la inducción a la anestesia, en el tratamiento de las crisis comiciales, en el síndrome La vida media de las BZD es otro de los criterios de selección y puede 5 de abstinencia alcohólica, como tratamiento coadyuvante de de dolor ser : corta (< 6 h); intermedia (6-24 h) y larga (> 24 h).
    [Show full text]
  • Analytical Methods for Determination of Benzodiazepines. a Short Review
    Cent. Eur. J. Chem. • 12(10) • 2014 • 994-1007 DOI: 10.2478/s11532-014-0551-1 Central European Journal of Chemistry Analytical methods for determination of benzodiazepines. A short review Review Article Paulina Szatkowska1, Marcin Koba1*, Piotr Kośliński1, Jacek Wandas1, Tomasz Bączek2,3 1Department of Toxicology, Faculty of Pharmacy, Collegium Medicum of Nicolaus Copernicus University, 85-089 Bydgoszcz, Poland 2Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland 3Institute of Health Sciences, Division of Human Anatomy and Physiology, Pomeranian University of Słupsk, 76-200 Słupsk, Poland Received 16 July 2013; Accepted 6 February 2014 Abstract: Benzodiazepines (BDZs) are generally commonly used as anxiolytic and/or hypnotic drugs as a ligand of the GABAA-benzodiazepine receptor. Moreover, some of benzodiazepines are widely used as an anti-depressive and sedative drugs, and also as anti-epileptic drugs and in some cases can be useful as an adjunct treatment in refractory epilepsies or anti-alcoholic therapy. High-performance liquid chromatography (HPLC) methods, thin-layer chromatography (TLC) methods, gas chromatography (GC) methods, capillary electrophoresis (CE) methods and some of spectrophotometric and spectrofluorometric methods were developed and have been extensively applied to the analysis of number of benzodiazepine derivative drugs (BDZs) providing reliable and accurate results. The available chemical methods for the determination of BDZs in biological materials and pharmaceutical formulations are reviewed in this work. Keywords: Analytical methods • Benzodiazepines • Drugs analysis • Pharmaceutical formulations © Versita Sp. z o.o. 1. Introduction and long). For this reason, an application of these drugs became broader allowing their utility to a larger extent, Benzodiazepines have been first introduced into medical and at the same time, problems related to drug abuse practice in the 60s of the last century.
    [Show full text]
  • Pharmaceutical Appendix to the Tariff Schedule 2
    Harmonized Tariff Schedule of the United States (2006) – Supplement 1 (Rev. 1) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2006) – Supplement 1 (Rev. 1) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. Product CAS No. Product CAS No. ABACAVIR 136470-78-5 ACEXAMIC ACID 57-08-9 ABAFUNGIN 129639-79-8 ACICLOVIR 59277-89-3 ABAMECTIN 65195-55-3 ACIFRAN 72420-38-3 ABANOQUIL 90402-40-7 ACIPIMOX 51037-30-0 ABARELIX 183552-38-7 ACITAZANOLAST 114607-46-4 ABCIXIMAB 143653-53-6 ACITEMATE 101197-99-3 ABECARNIL 111841-85-1 ACITRETIN 55079-83-9 ABIRATERONE 154229-19-3 ACIVICIN 42228-92-2 ABITESARTAN 137882-98-5 ACLANTATE 39633-62-0 ABLUKAST 96566-25-5 ACLARUBICIN 57576-44-0 ABUNIDAZOLE 91017-58-2 ACLATONIUM NAPADISILATE 55077-30-0 ACADESINE 2627-69-2 ACODAZOLE 79152-85-5 ACAMPROSATE 77337-76-9 ACONIAZIDE 13410-86-1 ACAPRAZINE 55485-20-6 ACOXATRINE 748-44-7 ACARBOSE 56180-94-0 ACREOZAST 123548-56-1 ACEBROCHOL 514-50-1 ACRIDOREX 47487-22-9 ACEBURIC
    [Show full text]
  • A Review of the Evidence of Use and Harms of Novel Benzodiazepines
    ACMD Advisory Council on the Misuse of Drugs Novel Benzodiazepines A review of the evidence of use and harms of Novel Benzodiazepines April 2020 1 Contents 1. Introduction ................................................................................................................................. 4 2. Legal control of benzodiazepines .......................................................................................... 4 3. Benzodiazepine chemistry and pharmacology .................................................................. 6 4. Benzodiazepine misuse............................................................................................................ 7 Benzodiazepine use with opioids ................................................................................................... 9 Social harms of benzodiazepine use .......................................................................................... 10 Suicide ............................................................................................................................................. 11 5. Prevalence and harm summaries of Novel Benzodiazepines ...................................... 11 1. Flualprazolam ......................................................................................................................... 11 2. Norfludiazepam ....................................................................................................................... 13 3. Flunitrazolam ..........................................................................................................................
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • PHARMACEUTICAL APPENDIX to the HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2008) (Rev
    Harmonized Tariff Schedule of the United States (2008) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2008) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. ABACAVIR 136470-78-5 ACIDUM GADOCOLETICUM 280776-87-6 ABAFUNGIN 129639-79-8 ACIDUM LIDADRONICUM 63132-38-7 ABAMECTIN 65195-55-3 ACIDUM SALCAPROZICUM 183990-46-7 ABANOQUIL 90402-40-7 ACIDUM SALCLOBUZICUM 387825-03-8 ABAPERIDONUM 183849-43-6 ACIFRAN 72420-38-3 ABARELIX 183552-38-7 ACIPIMOX 51037-30-0 ABATACEPTUM 332348-12-6 ACITAZANOLAST 114607-46-4 ABCIXIMAB 143653-53-6 ACITEMATE 101197-99-3 ABECARNIL 111841-85-1 ACITRETIN 55079-83-9 ABETIMUSUM 167362-48-3 ACIVICIN 42228-92-2 ABIRATERONE 154229-19-3 ACLANTATE 39633-62-0 ABITESARTAN 137882-98-5 ACLARUBICIN 57576-44-0 ABLUKAST 96566-25-5 ACLATONIUM NAPADISILATE 55077-30-0 ABRINEURINUM 178535-93-8 ACODAZOLE 79152-85-5 ABUNIDAZOLE 91017-58-2 ACOLBIFENUM 182167-02-8 ACADESINE 2627-69-2 ACONIAZIDE 13410-86-1 ACAMPROSATE
    [Show full text]
  • 1. La Ansiedad En La Consulta Odontológica 2. Prescripción De
    Farmacología Aplicada en Odontología Morera T, Jaureguizar N. OCW UPV/EHU 2016 1. La ansiedad en la consulta odontológica 2. Prescripción de fármacos ansiolíticos 3. Benzodiacepinas A. Características farmacocinéticas B. Efectos adversos C. Interacciones D. El flumazenil como antagonista benzodiacepínico E. Prescripción de benzodiacepinas F. Pautas de utilización de benzodiacepinas 4. Antihistamínicos Farmacología Aplicada en Odontología. Morera T, Jaureguizar N. OCW UPV/EHU 2016 1. La ansiedad en la consulta odontológica Ansiedad: Vivencia de un sentimiento de amenaza, de expectación tensa ante el futuro y alteración del equilibrio psicosomático en ausencia de un peligro real, o por lo menos, desproporcionada en relación con el estímulo desencadenante Cierto grado de “miedo” o ansiedad es normal cuando un paciente acude a la consulta odontológica (tensión muscular, aumento de la frecuencia cardíaca, sufrimiento limitado y temporal durante la inyección del anestésico local…) En cambio, algunos pacientes experimentan un grado de ansiedad mayor, con reacciones inapropiadas al estímulo (aún cuando se realiza una sola sesión), así como alteraciones tanto físicas como psicológicas En ocasiones, estos pacientes requieren tratamiento farmacológico Farmacología Aplicada en Odontología. Morera T, Jaureguizar N. OCW UPV/EHU 2016 1. La ansiedad en la consulta odontológica Sintomatología de la ansiedad Síntomas físicos Síntomas psicológicos Sequedad de boca Sensación de miedo Sudoración Insomnio Nerviosismo Tensión Molestias gastrointestinales Inapetencia Mareos Cansancio ↑Frecuencia cardíaca Dificultad de concentración Falta de aire Aprehensión Farmacología Aplicada en Odontología. Morera T, Jaureguizar N. OCW UPV/EHU 2016 1. La ansiedad en la consulta odontológica Prevalencia internacional de la ansiedad en la consulta odontológica Farmacología Aplicada en Odontología. Morera T, Jaureguizar N.
    [Show full text]
  • Antidepressants Plus Benzodiazepines Lead to Fewer Dropouts and Less Depression Severity at 4 Weeks in Major Depression
    Evid Based Mental Health: first published as 10.1136/ebmh.4.2.45 on 1 May 2001. Downloaded from Review: antidepressants plus benzodiazepines lead to Sources of funding: fewer dropouts and less depression severity at 4 weeks Ministry of Health and Welfare, Japan; Uehara in major depression Memorial Foundation, Japan. Furukawa T,Streiner DL, Young LT. Antidepressant plus benzodiazepine for major depression. Cochrane Database Syst Rev For correspondence: 2000;(4):CD001026 (latest version 29 Aug 2000). Professor T Furukawa, Department of Psychiatry, Nagoya City University, School of QUESTION: In adults with major depression, does combination treatment with Medicine, Mizuho-cho antidepressants and benzodiazepines lead to any benefits in terms of short term Mizuho-ku Aichi, Nagoya, Japan, 467 (<8 wks) or long term (>2 mo) symptomatic recovery or side effects? 8601. Fax +81 52 852 0837. Data sources Combined antidepressant and benzodiazepine treatment v antidepressant alone in adults Studies were identified by searching Medline, EMBASE/ with major depression* Excerpta Medica, International Pharmaceutical Ab- Weighted event rates stracts, Biological Abstracts, LILACS, PsycLIT, the Antidepressant Cochrane Library, and the trial register of the Cochrane Outcomes Combined alone RRR (95% CI) NNT (CI) Depression, Anxiety and Neurosis Group (January 1972 to December 1998); handsearching major mental health Dropped out 22% 33% 37% (19 to 51) 10 (6 to 22) and general medicine journals; scanning the reference Dropped out due lists of identified articles; checking SciSearch; and by to side effects 7% 14% 48% (14 to 68) 15 (10 to 40) personal contacts. Antidepressant Combined alone RBI (CI) NNT (CI) Study selection >50% reduction in Studies were selected if they were randomised controlled depression at 4 trials comparing combined antidepressant-benzodiazepine weeks 52% 37% 38% (15 to 66) 7 (5 to 15) treatment with antidepressants alone in adults with major *Abbreviations defined in glossary; RRR, RBI, NNT, and CI calculated from data in article.
    [Show full text]
  • Review: Antidepressants Plus Benzodiazepines Lead to Fewer
    Evid Based Mental Health: first published as 10.1136/ebmh.4.2.45 on 1 May 2001. Downloaded from Review: antidepressants plus benzodiazepines lead to Sources of funding: fewer dropouts and less depression severity at 4 weeks Ministry of Health and Welfare, Japan; Uehara in major depression Memorial Foundation, Japan. Furukawa T,Streiner DL, Young LT. Antidepressant plus benzodiazepine for major depression. Cochrane Database Syst Rev For correspondence: 2000;(4):CD001026 (latest version 29 Aug 2000). Professor T Furukawa, Department of Psychiatry, Nagoya City University, School of QUESTION: In adults with major depression, does combination treatment with Medicine, Mizuho-cho antidepressants and benzodiazepines lead to any benefits in terms of short term Mizuho-ku Aichi, Nagoya, Japan, 467 (<8 wks) or long term (>2 mo) symptomatic recovery or side effects? 8601. Fax +81 52 852 0837. Data sources Combined antidepressant and benzodiazepine treatment v antidepressant alone in adults Studies were identified by searching Medline, EMBASE/ with major depression* Excerpta Medica, International Pharmaceutical Ab- Weighted event rates stracts, Biological Abstracts, LILACS, PsycLIT, the Antidepressant Cochrane Library, and the trial register of the Cochrane Outcomes Combined alone RRR (95% CI) NNT (CI) Depression, Anxiety and Neurosis Group (January 1972 to December 1998); handsearching major mental health Dropped out 22% 33% 37% (19 to 51) 10 (6 to 22) and general medicine journals; scanning the reference Dropped out due lists of identified articles; checking SciSearch; and by to side effects 7% 14% 48% (14 to 68) 15 (10 to 40) personal contacts. Antidepressant Combined alone RBI (CI) NNT (CI) Study selection >50% reduction in Studies were selected if they were randomised controlled depression at 4 trials comparing combined antidepressant-benzodiazepine weeks 52% 37% 38% (15 to 66) 7 (5 to 15) treatment with antidepressants alone in adults with major *Abbreviations defined in glossary; RRR, RBI, NNT, and CI calculated from data in article.
    [Show full text]
  • Drug/Substance Trade Name(S)
    A B C D E F G H I J K 1 Drug/Substance Trade Name(s) Drug Class Existing Penalty Class Special Notation T1:Doping/Endangerment Level T2: Mismanagement Level Comments Methylenedioxypyrovalerone is a stimulant of the cathinone class which acts as a 3,4-methylenedioxypyprovaleroneMDPV, “bath salts” norepinephrine-dopamine reuptake inhibitor. It was first developed in the 1960s by a team at 1 A Yes A A 2 Boehringer Ingelheim. No 3 Alfentanil Alfenta Narcotic used to control pain and keep patients asleep during surgery. 1 A Yes A No A Aminoxafen, Aminorex is a weight loss stimulant drug. It was withdrawn from the market after it was found Aminorex Aminoxaphen, Apiquel, to cause pulmonary hypertension. 1 A Yes A A 4 McN-742, Menocil No Amphetamine is a potent central nervous system stimulant that is used in the treatment of Amphetamine Speed, Upper 1 A Yes A A 5 attention deficit hyperactivity disorder, narcolepsy, and obesity. No Anileridine is a synthetic analgesic drug and is a member of the piperidine class of analgesic Anileridine Leritine 1 A Yes A A 6 agents developed by Merck & Co. in the 1950s. No Dopamine promoter used to treat loss of muscle movement control caused by Parkinson's Apomorphine Apokyn, Ixense 1 A Yes A A 7 disease. No Recreational drug with euphoriant and stimulant properties. The effects produced by BZP are comparable to those produced by amphetamine. It is often claimed that BZP was originally Benzylpiperazine BZP 1 A Yes A A synthesized as a potential antihelminthic (anti-parasitic) agent for use in farm animals.
    [Show full text]
  • List of Benzodiazepines - Wikipedia, the Free Encyclopedia
    List of benzodiazepines - Wikipedia, the free encyclopedia Log in / create account Article Talk Read Edit Our updated Terms of Use will become effective on May 25, 2012. Find out more. List of benzodiazepines From Wikipedia, the free encyclopedia Main page The below tables contain a list of benzodiazepines that Benzodiazepines Contents are commonly prescribed, with their basic pharmacological Featured content characteristics such as half-life and equivalent doses to other Current events benzodiazepines also listed, along with their trade names and Random article primary uses. The elimination half-life is how long it takes for Donate to Wikipedia half of the drug to be eliminated by the body. "Time to peak" Interaction refers to when maximum levels of the drug in the blood occur Help after a given dose. Benzodiazepines generally share the About Wikipedia same pharmacological properties, such as anxiolytic, Community portal sedative, hypnotic, skeletal muscle relaxant, amnesic and Recent changes anticonvulsant (hypertension in combination with other anti The core structure of benzodiazepines. Contact Wikipedia hypertension medications). Variation in potency of certain "R" labels denote common locations of effects may exist among individual benzodiazepines. Some side chains, which give different Toolbox benzodiazepines produce active metabolites. Active benzodiazepines their unique properties. Print/export metabolites are produced when a person's body metabolizes Benzodiazepine the drug into compounds that share a similar pharmacological
    [Show full text]
  • Marrakesh Agreement Establishing the World Trade Organization
    No. 31874 Multilateral Marrakesh Agreement establishing the World Trade Organ ization (with final act, annexes and protocol). Concluded at Marrakesh on 15 April 1994 Authentic texts: English, French and Spanish. Registered by the Director-General of the World Trade Organization, acting on behalf of the Parties, on 1 June 1995. Multilat ral Accord de Marrakech instituant l©Organisation mondiale du commerce (avec acte final, annexes et protocole). Conclu Marrakech le 15 avril 1994 Textes authentiques : anglais, français et espagnol. Enregistré par le Directeur général de l'Organisation mondiale du com merce, agissant au nom des Parties, le 1er juin 1995. Vol. 1867, 1-31874 4_________United Nations — Treaty Series • Nations Unies — Recueil des Traités 1995 Table of contents Table des matières Indice [Volume 1867] FINAL ACT EMBODYING THE RESULTS OF THE URUGUAY ROUND OF MULTILATERAL TRADE NEGOTIATIONS ACTE FINAL REPRENANT LES RESULTATS DES NEGOCIATIONS COMMERCIALES MULTILATERALES DU CYCLE D©URUGUAY ACTA FINAL EN QUE SE INCORPOR N LOS RESULTADOS DE LA RONDA URUGUAY DE NEGOCIACIONES COMERCIALES MULTILATERALES SIGNATURES - SIGNATURES - FIRMAS MINISTERIAL DECISIONS, DECLARATIONS AND UNDERSTANDING DECISIONS, DECLARATIONS ET MEMORANDUM D©ACCORD MINISTERIELS DECISIONES, DECLARACIONES Y ENTEND MIENTO MINISTERIALES MARRAKESH AGREEMENT ESTABLISHING THE WORLD TRADE ORGANIZATION ACCORD DE MARRAKECH INSTITUANT L©ORGANISATION MONDIALE DU COMMERCE ACUERDO DE MARRAKECH POR EL QUE SE ESTABLECE LA ORGANIZACI N MUND1AL DEL COMERCIO ANNEX 1 ANNEXE 1 ANEXO 1 ANNEX
    [Show full text]