Impact of Schedule IV controlled substance classification on carisoprodol utilization in the United States: An interrupted time series analysis.

BACKGROUND: In January 2012, the Drug Enforcement Agency (DEA) classified carisoprodol as a Schedule IV controlled substance at the US federal level. We aimed to examine the effect of this policy on the use of carisoprodol in a commercially-insured population. METHODS: This interrupted time series study included individuals with musculoskeletal disorders in the IBM MarketScan Commercial Database between December 2009 and February 2014. We used comparative segmented linear regression to assess changes in the proportions of patients who filled/newly filled carisoprodol each month. RESULTS: A total of 13.3 million patients were included. 29 states with no scheduling prior to the DEA classification had lower baseline prevalence of carisoprodol use compared to 17 states that had scheduled carisoprodol individually before 2010 (11.0 vs. 21.1 patients with fills per 1000 patients). The federal scheduling was associated with an immediate decline (-1.12 per 1000 patients, p < 0.01) and decreasing trend in prevalence (-0.07 per 1000 patients per month, p = 0.02). This effect was not modified by existing state-level scheduling status. During the first, second, third, and fourth 6-month periods after federal scheduling, the relative difference between observed and predicted prevalence was 7.8%, 10.5%, 13.4%, and 19.8%. Similar patterns were observed for carisoprodol initiation. Overall, declining use was more pronounced among younger age groups and patients with injury. CONCLUSIONS: Schedule IV controlled substance classification at the federal level was associated with a moderate reduction in the dispensing of carisoprodol regardless of whether scheduling was already present at the state level.

Skeletal muscle relaxants.

Health care providers prescribe skeletal muscle relaxants for a variety of indications. However, the comparative efficacy of these drugs is not well known. Skeletal muscle relaxants consist of both antispasticity and antispasmodic agents, a distinction prescribers often overlook. The antispasticity agents-baclofen, tizanidine, dantrolene, and diazepam-aid in improving muscle hypertonicity and involuntary jerks. Antispasmodic agents, such as cyclobenzaprine, are primarily used to treat musculoskeletal conditions. Much of the evidence from clinical trials regarding skeletal muscle relaxants is limited because of poor methodologic design, insensitive assessment methods, and small numbers of patients. Although trial results seem to support the use of these agents for their respective indications, efficacy data from comparator trials did not particularly favor one skeletal muscle relaxant over another. Therefore, the choice of a skeletal muscle relaxant should be based on its adverse-effect profile, tolerability, and cost.

Sedoanalgesia y relajación neuromuscular en el área de urgencias / Sedation, analgesia and neuromuscular relaxation in the emergency service

Revisión práctica de los principales fármacos analgésicos (opioides y no opioides), hipnóticos y relajantes neuromusculares, de uso habitual, que pueden tener interés para el médico de Urgencias (hospitalarias y no hospitalarias) y dirigido a estos profesionales .Se describen aquellos principios activos con un perfil farmacocinético y farmacodinámico más acorde con el manejo agudo de los pacientes en estas unidades, sin profundizar demasiado en otros aspectos derivados de su aplicación a largo plazo.-Hipnóticos, habitualmente empleados como inductores anestésicos y que se caracterizan por provocar la inconsciencia de forma predecible y con recuperación rápida. Pertenecen a este grupo el tiopental, propofol, etomidato y ketamina.-Benzodiacepinas, dentro de este grupo se revisan los dos fármacos con mayores posibilidades de administración parenteral para el control agudo de la situación. Se trata del diacepam y del midazolam. El espectro de acciones de estas benzodiacepinas varía en función de la dosis y va de la ansiolisis a la hipnosis pasando por la sedación, amnesia y actividad anticonvulsivante.-Opiáceos, son analgésicos potentes que interactúan a través de los receptores opioides ampliamente distribuidos por el organismo. Morfina, meperidina, fentanilo, alfentanilo y tramadol pertecen a este grupo. Los analgésicos no opoides: ketorolaco, metamizol y propacetamol, tienen sus indicaciones y habitualmente se administran en asociación con los anteriores .-Bloqueantes neurmusculares: son inhibidores de la transmisión sináptica en la unión neuromuscular, suprimiendo toda la actividad contráctil de la musculatura estriada. Se clasifican en dos tipos en función del mecanismo de acción: -BM despolarizantes: succinilcolina -BM no despolarizantes: atracurio, vecuronio y rocuronio entre otros .Por último se incluyen una serie de recomendaciones prácticas de sedoanalgesia y relajación neuromuscular, según el estado hemodinámico, patología cardiaca concomitante, función ventilatoria y situación neurológica inicial del paciente en el momento de su llegada al Hospital (AU)

Centrally acting skeletal muscle relaxants and associated drugs.

A review of available studies supports a role for muscle relaxants in the treatment of painful musculoskeletal disorders. The utility of these drugs is limited by sedation and other side effects, as well as by the potential for abuse and dependency. Other drugs can also be used in the treatment of muscle spasm, specifically diazepam, baclofen, dantrolene sodium, and quinine sulfate. The pharmacology of the muscle relaxants and these other agents is discussed and practical suggestions for use are offered.