RESUMO
The purpose of this study was investigate whether replacing or discontinuing drugs that are inhibitors or substrates of cytochrome P450 3A4 (CYP3A4) may improve the clinical course of central serous chorioretinopathy (CSC). A retrospective observational study included 43 patients with active CSC. Twenty seven patients (32 eyes, group 1) were using drugs that act as substrates or inhibitors of CYP3A4. In 25 of these 27 patients, treatments including steroids, calcium channel blockers, anticoagulants, statins, beta-adrenolytics, angiotensin receptor antagonists, antidepressants, muscarinic receptor antagonists, phosphodiesterase type 5 inhibitors, and others were discontinued or replaced with medications not affecting CYP3A4. Sixteen patients (19 eyes, group 2) not using any medication that affects CYP3A4, were given eplerenone, rifampicin, or laser treatment. Main outcomes measures were assessed by functional and anatomical images obtained using multimodal imaging techniques. The average follow-up time was 12 months. In group I after discontinuing or replacing substrates or inhibitors of CYP3A4, improvements were observed in 18 patients (22 eyes). None of the patients that were using drugs affecting CYP3A4 improved with eplerenone therapy, however, all 18 patients improved after discontinuing the drugs. All these drugs had a blocking effect on eplerenone therapy. Best corrected visual acuity (BCVA) improved in 14 eyes, remained unchanged in 5 eyes, and worsened in 3 eyes. In 21 of the 22 eyes, subretinal fluid absorption was observed with optical coherence tomography (OCT). Mean central retinal thickness decreased from 361 µm to 219 µm. One patient (2 eyes) was unable to change treatment (due to neoplasm), one patient (1 eye) did not agree to change or stop treatment, and seven patients (7 eyes) were lost to follow-up. Of the 16 patients (19 eyes) who were treated with eplerenone, rifampicin, or laser, improvements were observed in 14 patients (16 eyes), two patients (2 eyes) were lost to follow-up, and CSC worsened in 1 eye. We concluded that patients with CSC should not take substrates or inhibitors of CYP3A4. These drugs should be replaced with alternatives that act through other metabolic pathways.
Assuntos
Coriorretinopatia Serosa Central/induzido quimicamente , Inibidores do Citocromo P-450 CYP3A/efeitos adversos , Citocromo P-450 CYP3A/metabolismo , Eplerenona/uso terapêutico , Adulto , Coriorretinopatia Serosa Central/enzimologia , Coriorretinopatia Serosa Central/patologia , Olho/efeitos dos fármacos , Olho/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodosRESUMO
BACKGROUND: This article summarizes the outcome from an international consensus meeting, which took place in Vienna on 4 November 2014. SCOPE: The aim of the meeting was to provide the state of the art on the pathophysiology and treatment of acute pain with special emphasis on nimesulide, a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of acute pain and primary dysmenorrhea. Besides the data on the mechanisms of acute inflammatory pain and on the efficacy and safety of nimesulide in patients affected by different forms of acute pain, the clinical experience of attending experts was discussed based on selected case reports. RESULTS: The members of this consensus group recognized that nimesulide is a NSAID highly effective in the treatment of several painful situations with an acute inflammatory component including primary dysmenorrhea. Although safety concerns regarding nimesulide have emerged in recent years, both robust new epidemiological data and clinical experience confirm a positive benefit/risk profile of nimesulide in the treatment of several forms of acute pain. CONCLUSIONS: The members of this international consensus group concluded that nimesulide, when used appropriately, remains a particularly valuable and safe option for the treatment of several conditions characterized by the presence of acute inflammatory pain because of the rapid onset of the analgesic action, and the positive evidence-based benefit/risk profile.
Assuntos
Dor Aguda/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Sulfonamidas/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Comorbidade , Feminino , Humanos , Masculino , Sulfonamidas/efeitos adversos , Sulfonamidas/farmacologiaRESUMO
Pain is one of the most common symptoms in cancer patients, especially in advanced disease. However, pain also accompanies a significant percentage of patients during diagnostic and therapeutic procedures. In some patients pain may be the first symptom of the disease. The causes of pain in cancer patients are often multifactorial including direct and indirect cancer effects, anticancer therapy and co-morbidities. Moreover, pain in cancer patients often has mixed pathophysiology including both nociceptive and neuropathic components, especially in patients with bone metastases. In this article, basic knowledge regarding epidemiology, pathophysiology and clinical features of pain in cancer patients with a primary tumour localised in lung, gastrointestinal tract (stomach, colon and pancreas), breast in women and prostate in men are presented. Pain is a common symptom in cancer patients and its appropriate assessment and treatment may significantly improve in patients' and families' quality of life.
Assuntos
Dor do Câncer/etiologia , Dor do Câncer/patologia , Neoplasias/complicações , Neoplasias/patologia , Animais , Humanos , Qualidade de VidaRESUMO
The authors examined whether ketoprofen administered 60 min before surgical extraction of the lower wisdom teeth provides effective postsurgical analgesia and reduces rescue analgesic intake compared with ketoprofen administered 60 min after surgery or placebo. The 96 patients were placed into three groups: pre-group (ketoprofen 60 min preoperatively); post-group (ketoprofen 60 min postoperatively); and no-group (placebo). Study interventions had a significant effect on pain sensations in the 12 h after surgery. The initial onset of pain was significantly delayed only in the post-group. Pain intensity at the first onset of pain was significantly lower only in the post-group. Patients in the pre- and post-groups required significantly less rescue analgesic than those in the no-group. Ketoprofen administered after third molar surgery provides more effective pain control than ketoprofen administered before the surgery or placebo.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Cetoprofeno/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Pré-Medicação , Extração Dentária , Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/cirurgia , Bloqueio Nervoso , Medição da Dor , Placebos , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
The goal of this study was to evaluate the efficacy of single- and multi-dose (5-day) clindamycin therapy for the prevention of inflammatory complications in patients undergoing lower third molar surgical extraction with bone removal. Patients who qualified for the prospective, randomized, double-masked, placebo-controlled trial were randomly divided into three groups: (1) single dose of oral clindamycin administered preoperatively (single-dose group); (2) clindamycin administered preoperatively with continued therapy for 5 days (5-day group); and (3) a placebo group. The following parameters were evaluated on the first, second and seventh days postsurgery: trismus, facial swelling, body temperature, lymphadenopathy, alveolar osteitis and subjective pain sensations. There were 86 patients (31 in the single-dose group, 28 in the 5-day group and 27 in the placebo group) enrolled in the study. There were no statistically significant differences in postoperative inflammatory complications in patients during the first and second days postsurgery. A statistically significant variation in body temperature was reported on the seventh day. Analysis of the postoperative analgesic intake did not show statistically significant differences between examined groups. Clindamycin applied in a single preoperative dose of 600 mg with or without subsequent 5-day therapy does not demonstrate efficacy in prophylaxis for postoperative inflammatory complications after third molar surgery.
Assuntos
Antibacterianos/administração & dosagem , Clindamicina/administração & dosagem , Mandíbula/cirurgia , Dente Serotino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Extração Dentária , Adulto , Analgésicos/uso terapêutico , Antibioticoprofilaxia , Temperatura Corporal/efeitos dos fármacos , Método Duplo-Cego , Alvéolo Seco/prevenção & controle , Edema/prevenção & controle , Feminino , Seguimentos , Humanos , Linfadenite/prevenção & controle , Masculino , Dor Pós-Operatória/prevenção & controle , Placebos , Estudos Prospectivos , Dente Impactado/cirurgia , Resultado do Tratamento , Trismo/prevenção & controleRESUMO
Physiological and pathological knowledge of blood platelets effectively permit to inhibition their adhesion and aggregation processes. Antiplatelet drugs are very important therapeutic groups in prevention of many cardiovascular system diseases. They characterize with high effectiveness tested in many clinical studies and small amount of side effects. However during the interaction with other simultaneously applied drugs one may observe decrease of therapeutic tolerancy, diminishing of its effectiveness and appearing of adverse effects. In this work we considered clinical results of interactions of some antiplatelet drugs (acetylosalicylic acid, ticlopidin, clopidogrel, heparin).
Assuntos
Inibidores da Agregação Plaquetária/farmacologia , Interações Medicamentosas , Humanos , Adesividade Plaquetária/efeitos dos fármacos , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/efeitos adversosRESUMO
Hepatoprotective, hypolipidemic and hypocholesterolemic effects of the lipid flower pollen extract in subchronically testosterone-androgenized rats were shown. Normalization of AspAT, A1AT and alkaline phosphatase--biochemical indicators of necrotic changes in the hepatic cell--substantially testifies to the hepatoprotective effect of the investigated lipid flower pollen extract on the hepatic cell, and constitutes a premise for further clinical studies.