Drugs online research references
Acta Anaesthesiol Scand. 1997 Jan;41(1 Pt 2):187-90.
Pharmacological approaches other than opioids in chronic non-cancer pain management.
Merskey H.
London Psychiatric Hospital, Ontario, Canada.
Many pains are controlled by non-addictive procedures ranging from exercise to a variety of analgesic medications. Some pains are controlled by analgesic drugs, but at the cost of intolerable side effects. This is true both for non-steroidal anti-inflammatory drugs and opioids. The worst pains are most often controlled by opioids, but problems of tolerance and addiction limit these successes. This contribution provides a statement on non-addictive, non-opioid drugs which help to control pain. Just as these vary in their success, so they vary also in the strength of the scientific evidence which supports their use. The groups of drugs to be considered can be evaluated in three respects; evidence of analgesic effect in controlled trials; evidence of side-effects compared with control substances and with standard experience; evidence of usefulness in clinical practice. The latter which is the most important for practice often has the least scientific proof. Six main classes of drugs are recognized which provide analgesic effects, other than opioids. 1) Non-steroidal anti-inflammatory drugs are widely accepted as analgesics on the basis of animal studies, numerous controlled investigations and clinical practice. Acetaminophene may not be anti-inflammatory, but is recognized as an effective analgesic which in many other respects resembles the above. 2) Muscle relaxants, e.g. cyclobenzaprine or baclofen have varied actions, but often provide some relief of pain. 3) Antidepressants may be analgesic if they relieve depression which is giving rise to pain. This applies to all anti-depressants. Some antidepressants have been shown to be analgesic in the absence of depression. The best accredited of these is amitriptyline. Antidepressants too have significant side effects. A serotoninergic hypothesis is insufficient to explain the actions of antidepressants in relieving pain in the absence of depression. 4) Phenothiazine neuroleptics (and possibly some others) may be analgesic. Drugs reported to be analgesic include chlorpromazine, fluphenazine, perphenazine, trifluoperazine, methotrimeprazine (levomepromazine) among others. Haloperidol has also been utilized. Well controlled evidence exists with the use of methotrimeprazine (levomepromazine) used as an injection. The analgesic effect of oral neuroleptics is less well established and mostly depends upon clinical observation, withdrawal and re-challenge. 5) Anticonvulsants. 6) Other drugs. Non-steroidal anti-inflammatory drugs and some muscle relaxants, e.g. cyclobenzaprine are best used in the short term. The gastrointestinal side effects of non-steroidal anti-inflammatory drugs have been quite troublesome and over 2% of patients followed over five years are at risk of developing peptic ulceration from such medication. Cyclobenzaprine is best used in short term treatment, but may be used intermittently for chronic pain. Antidepressants, neuroleptics, anticonvulsants and some other drugs can be used long term. Topical analgesic agents may also be used.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9061105&dopt=Abstract
J Clin Pharmacol. 1977 Nov-Dec;17(11-12):719-27.
Plasma levels and bioavailability of cyclobenzaprine in human subjects.
Hucker HB, Stauffer SC, Albert KS, Lei BW.
Cyclobenzaprine was extensively metabolized in man, less than 1% of the dose being excreted unchanged in the urine. Comparison of areas under plasma level curves (AUC) after oral and intravenous doses suggests that the drug may be partly metabolized in the lumen or during its first passage through the gut wall and/or liver. Average plasma levels of the drug increased with increasing dosage, but the AUC increased less rapidly with increasing dose, possibly because of dose-dependent absorption.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=925191&dopt=Abstract
J Pharm Sci. 1976 Jun;65(6):815-21.
Identification of 10, 11-epoxide and other cyclobenzaprine metabolites isolated from rat urine.
Belvedere G, Pantarotto C, Rovei V, Frigerio A.
Cyclobenzaprine (40 mg/kg ip) was administered to rats, and six urinary metabolites of this drug were identified. They were the 10, 11-epoxide, the N -oxide, the desmethyl derivative, the hydroxylated and desmethylhydroxylated compounds, and the N-oxide hydroxylated at the 10- or 11-position. Mass spectrometric analysis confirmed their structures.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=932964&dopt=Abstract
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