RESUMO
Opioids are frequently used first line to manage acute pain in a variety of settings; however, the use of nonprescription analgesics for acute pain is recognized by experts as a practical and effective opioid-sparing strategy. Variations in dosages and formulations and a lack of standardization in reporting clinical data hinder the awareness of nonprescription treatments and recommendation of their use before opioids and other prescription options. A fixed-dose combination (FDC) of two common nonprescription analgesics, ibuprofen (IBU) and acetaminophen (APAP), is an appealing alternative to opioids in acute pain settings with a range of potential benefits. This narrative review evaluates the evidence in support of IBU/APAP FDCs containing IBU (≤1200 mg/day) and APAP (≤4000 mg/day), the nonprescription maximum daily doses in Canada and the United States, as alternatives to opioids and as a means to reduce the need for rescue opioid medication in acute pain management. A literature search was performed to identify clinical studies that directly compared IBU/APAP FDCs with opioids or nonopioids and measured the need for opioid rescue therapy in acute pain. Across studies, IBU/APAP FDCs consistently demonstrated pain relief similar to or better than opioid and nonopioid comparators and reliably reduced the use of rescue opioids with fewer adverse events. Based on these data, healthcare clinicians should consider FDC nonprescription analgesics as a potential first-line option for the management of acute pain.
The growing trend of opioid-sparing treatment demands effective nonopioid pain management solutions. A fixed-dose combination (FDC) of ibuprofen and acetaminophen (IBU/APAP) has shown promise as an alternative to opioids in a range of pain management scenarios, but the available data are limited and can be difficult to compare across studies. In this review, the authors performed a comprehensive evaluation of the clinical studies that assessed the use of IBU/APAP FDCs as a means to prevent or decrease the use of opioids for patients with acute pain. In the included studies, IBU/APAP FDCs consistently and safely provided pain relief that could replace or reduce the need for opioids across a range of procedures. This manuscript can serve as a resource for healthcare clinicians when considering the use of IBU/APAP FDC treatments for acute pain management.
Assuntos
Acetaminofen , Dor Aguda , Analgésicos não Narcóticos , Analgésicos Opioides , Combinação de Medicamentos , Ibuprofeno , Humanos , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Ibuprofeno/administração & dosagem , Ibuprofeno/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/efeitos adversos , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Dor Aguda/tratamento farmacológico , Manejo da Dor/métodos , Manejo da Dor/normas , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêuticoRESUMO
LEARNING OBJECTIVES: At the end of the activity, participants will be able to:Summarize important findings and trends involving women and atherosclerotic cardiovascular disease (ASCVD). Characterize the multiple cardiometabolic changes that occur during menopause and the associated ASCVD risk. Discuss the challenges of assessing ASCVD risk and dyslipidemia management in women. Identify women with elevated ASCVD risk and implement guideline-recommended statin therapy.
Assuntos
Aterosclerose , Doenças Cardiovasculares , Dislipidemias , Inibidores de Hidroximetilglutaril-CoA Redutases , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Aterosclerose/prevenção & controle , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/diagnóstico , Dislipidemias/tratamento farmacológico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Fatores de RiscoRESUMO
BACKGROUND: Traditional continuous glucose monitoring (CGM) provides detailed information on glucose patterns and trends to inform daily diabetes management decisions, which is particularly beneficial for patients with a history of hypoglycemia unawareness. However, a high level of patient adherence (≥70%) is required to achieve clinical benefits. The aim of this study was to assess the impact of real-world patient nonadherence and early discontinuation on healthcare resource use. METHODS: A cost calculator was designed to evaluate monthly healthcare resource waste within the first year of traditional CGM initiation by combining estimates of real-world nonadherence and early discontinuation from the literature with the wholesale acquisition costs of the current technology in the United States (for a commercial payer and for Medicare), or its equivalent in Sweden, Germany, or the Netherlands. RESULTS: Based on an early discontinuation rate of 27% and nonadherence rates of 13.9%-31.1% over the 12 months following initiation, the healthcare resource waste associated with nonadherence and early discontinuation was $220,289 and $21,775, respectively, for every 100 patients initiating CGM in the U.S. commercial payer scenario. In the Medicare scenario, the corresponding figures were $72,648 and $5,675, respectively. In both scenarios, nonadherence and early discontinuation accounted for â¼24% of resources being wasted within the first year of CGM initiation. Similar results were observed using the local costs in the other countries analyzed. CONCLUSIONS: The healthcare resource waste associated with traditional CGM nonadherence and early discontinuation warrants deliberate consideration when selecting suitable patients for this technology.