Dysequilibrium in calcium and phosphate metabolism with development of secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD) stage III and IV. Dietary phosphate restrictions and calcium based oral phosphate binders have not been effective in all subjects with SHPT, and soft tissue and vascular calcifications with an increased risk of cardiovascular death related are known consequences. Treatment with the calcimimetic Cinacalcet (Cc) has contributed to a better calcium and phosphate control in patients given hemodialysis treatment. In this retrospective study we present our experience with Cc given to ten (one year) or five (two years) patients with CKD stage III and IV and SHPT not suitable for surgery. With conventional therapy target levels of intact parathyroid hormon (iPTH) are seldomly reached the reason why an iPTH value < 300 ng/l was considered acceptable. Levels of iPTH decreased significantly after 3 months of Cc treatment and remained at the lower level. Plasma ionized-Ca (Ca) concentrations decreased initially but remained above 1.00 mmol/l in all but one patient. Phophate (P) levels increased to 1.41 ± 0.09 mmol/l (mean ± SE) leaving the Ca × P product unchanged. While patients with high iPTH needed high Cc doses up to 90 mg/day, some of the patients required very low doses 4.5–20 mg/day in order to achieve a decrease in iPTH levels. Only one patient reported gastric pain needing dose reduction and other adverse effects were not found. No changes in QT-time were observed. We experienced that Cc treatment was promising to control SHPT and stabilized the Ca-P balance in patients with CKD stage III and IV. Dosing may be challenging and laboratory values should be controlled often (monthly) as these patients may have variable response to Cc treatment. Due to the minimal knowledge about its effect on morbidity and mortality in the predialytic population further controlled studies are needed to confirm its efficacy and safety.
{"title":"Experience with Cinacalcet for Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease Stage III and IV","authors":"T. Forslund, A. Koistinen, M. Miettinen","doi":"10.4137/CMT.S2983","DOIUrl":"https://doi.org/10.4137/CMT.S2983","url":null,"abstract":"Dysequilibrium in calcium and phosphate metabolism with development of secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD) stage III and IV. Dietary phosphate restrictions and calcium based oral phosphate binders have not been effective in all subjects with SHPT, and soft tissue and vascular calcifications with an increased risk of cardiovascular death related are known consequences. Treatment with the calcimimetic Cinacalcet (Cc) has contributed to a better calcium and phosphate control in patients given hemodialysis treatment. In this retrospective study we present our experience with Cc given to ten (one year) or five (two years) patients with CKD stage III and IV and SHPT not suitable for surgery. With conventional therapy target levels of intact parathyroid hormon (iPTH) are seldomly reached the reason why an iPTH value < 300 ng/l was considered acceptable. Levels of iPTH decreased significantly after 3 months of Cc treatment and remained at the lower level. Plasma ionized-Ca (Ca) concentrations decreased initially but remained above 1.00 mmol/l in all but one patient. Phophate (P) levels increased to 1.41 ± 0.09 mmol/l (mean ± SE) leaving the Ca × P product unchanged. While patients with high iPTH needed high Cc doses up to 90 mg/day, some of the patients required very low doses 4.5–20 mg/day in order to achieve a decrease in iPTH levels. Only one patient reported gastric pain needing dose reduction and other adverse effects were not found. No changes in QT-time were observed. We experienced that Cc treatment was promising to control SHPT and stabilized the Ca-P balance in patients with CKD stage III and IV. Dosing may be challenging and laboratory values should be controlled often (monthly) as these patients may have variable response to Cc treatment. Due to the minimal knowledge about its effect on morbidity and mortality in the predialytic population further controlled studies are needed to confirm its efficacy and safety.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"34 1","pages":"801-808"},"PeriodicalIF":0.0,"publicationDate":"2009-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84986137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Migraine is a neurovascular disease, which pathogenesis is still unclear. It causes a severe headache and a substantial financial loss due to absenteeism, therefore, its effective treatment is particularly valuable. Triptans, selective 5HT1B and D receptor agonists, are effective treatment choices of acute migraine attacks. Migraine patients, who bear special conditions such as hypertension, hepatic or renal impairment, constitute a special subgroup of patients whose treatment with triptans has to be individually arranged. The review of Kalanuria and Peterlin, regarding the metabolism and efficacy of zolmitriptan in the abortive treatment of migraine, highlights many details of the use of zolmitriptan in migraine patients.
{"title":"Triptans in the Treatment of Migraine","authors":"B. Guldiken","doi":"10.4137/CMT.S2927","DOIUrl":"https://doi.org/10.4137/CMT.S2927","url":null,"abstract":"Migraine is a neurovascular disease, which pathogenesis is still unclear. It causes a severe headache and a substantial financial loss due to absenteeism, therefore, its effective treatment is particularly valuable. Triptans, selective 5HT1B and D receptor agonists, are effective treatment choices of acute migraine attacks. Migraine patients, who bear special conditions such as hypertension, hepatic or renal impairment, constitute a special subgroup of patients whose treatment with triptans has to be individually arranged. The review of Kalanuria and Peterlin, regarding the metabolism and efficacy of zolmitriptan in the abortive treatment of migraine, highlights many details of the use of zolmitriptan in migraine patients.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"12 1","pages":"711-713"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89416702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B1 or Tositumomab was the first B-cell specific antibody to be discovered and it targets the CD20 antigen. The potential therapeutic importance of this discovery in targeting CD20, however remained unrealised until the mid 1990's when Tositumomab was radiolabelled and the 131 I Tositumomab radioimmunotherapy (RIT) regimen (Bexxar™) developed. The 131 I Tositumomab regimen is completed within one to two weeks and consists of a tracer dose of the radioimmunoconjugate followed by the therapeutic dose 7 to 14 days later. Each infusion of 131 I-tositumomab is preceded by an infusion of a pre-dose of 450 mg "cold" or unlabeled tositumomab. 131 I Tositumomab has demonstrated remarkable clinical activity in patients with relapsed follicular lymphoma with high response rates and durable remission even in patients with disease that is refractory to chemotherapy and rituximab antibody therapy. Recent new data has provided new insights into the potential mechanisms of the antibody and targeted radiation effects and these as well as the safety and efficacy of this novel therapy in follicular lymphoma are reviewed.
B1或Tositumomab是第一个被发现的针对CD20抗原的b细胞特异性抗体。然而，这一发现在靶向CD20方面的潜在治疗重要性直到20世纪90年代中期才被认识到，当时Tositumomab被放射性标记，131 I Tositumomab放射免疫治疗(RIT)方案(Bexxar™)被开发出来。131 I Tositumomab方案在一至两周内完成，包括放射免疫偶联物的示踪剂，然后在7至14天后给予治疗剂量。每次输注131 i -托西单抗之前，先输注预剂量450 mg“冷”或未标记的托西单抗。131 I Tositumomab在复发性滤泡性淋巴瘤患者中表现出显著的临床活性，即使在化疗和利妥昔单抗抗体治疗难治性的患者中也具有高反应率和持久缓解。最近的新数据为抗体和靶向辐射效应的潜在机制提供了新的见解，并对这种新疗法在滤泡性淋巴瘤中的安全性和有效性进行了综述。
{"title":"Safety and Efficacy of I(131) Tositumomab in the Treatment of non-Hodgkin’s Lymphoma","authors":"T. Illidge, A. Ivanov, Yong Du","doi":"10.4137/CMT.S2124","DOIUrl":"https://doi.org/10.4137/CMT.S2124","url":null,"abstract":"B1 or Tositumomab was the first B-cell specific antibody to be discovered and it targets the CD20 antigen. The potential therapeutic importance of this discovery in targeting CD20, however remained unrealised until the mid 1990's when Tositumomab was radiolabelled and the 131 I Tositumomab radioimmunotherapy (RIT) regimen (Bexxar™) developed. The 131 I Tositumomab regimen is completed within one to two weeks and consists of a tracer dose of the radioimmunoconjugate followed by the therapeutic dose 7 to 14 days later. Each infusion of 131 I-tositumomab is preceded by an infusion of a pre-dose of 450 mg \"cold\" or unlabeled tositumomab. 131 I Tositumomab has demonstrated remarkable clinical activity in patients with relapsed follicular lymphoma with high response rates and durable remission even in patients with disease that is refractory to chemotherapy and rituximab antibody therapy. Recent new data has provided new insights into the potential mechanisms of the antibody and targeted radiation effects and these as well as the safety and efficacy of this novel therapy in follicular lymphoma are reviewed.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"2009 1","pages":"621-631"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87760258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle E McCarthy, D. Jorenby, Haruka Minami, V. Yeh
Bupropion SR is approved for the treatment of tobacco dependence in adult smokers. Bupropion SR is an atypical antidepressant that has been shown to double the likelihood of quitting smoking (to roughly 19%-24% six months into a quit attempt), perhaps by acting on dopaminergic and noradrenergic systems and by acting as an antagonist of nicotine acetylcholine receptors. Head-to-head comparisons of bupropion SR and other stop-smoking treatments suggest that bupropion SR is as or more efficacious than nicotine replacement therapies, equally efficacious as nortriptyline, and less efficacious than varenicline. The evidence available regarding the effectiveness of bupropion SR in real-world settings suggests that abstinence rates are similar to those seen in controlled clinical trials. Bupropion SR appears to be safe and efficacious for both men and women and for people with comorbid medical or mental health conditions. Evidence collected to date supports the use of bupropion SR as a safe, tolerable pharmacotherapy for smoking cessation among adult smokers without a predisposition to seizures, but also suggests that benefits in terms of abstinence last only as long as treatment continues. This review focuses on recent evidence regarding bupropion SR effects and highlights important questions regarding the duration of effects, relative efficacy, effectiveness in clinical use, mechanisms of action, and utilization of bupropion SR that remain unanswered.
{"title":"Treatment Options in Smoking Cessation: What Place for Bupropion Sustained-Release?","authors":"Danielle E McCarthy, D. Jorenby, Haruka Minami, V. Yeh","doi":"10.4137/CMT.S2044","DOIUrl":"https://doi.org/10.4137/CMT.S2044","url":null,"abstract":"Bupropion SR is approved for the treatment of tobacco dependence in adult smokers. Bupropion SR is an atypical antidepressant that has been shown to double the likelihood of quitting smoking (to roughly 19%-24% six months into a quit attempt), perhaps by acting on dopaminergic and noradrenergic systems and by acting as an antagonist of nicotine acetylcholine receptors. Head-to-head comparisons of bupropion SR and other stop-smoking treatments suggest that bupropion SR is as or more efficacious than nicotine replacement therapies, equally efficacious as nortriptyline, and less efficacious than varenicline. The evidence available regarding the effectiveness of bupropion SR in real-world settings suggests that abstinence rates are similar to those seen in controlled clinical trials. Bupropion SR appears to be safe and efficacious for both men and women and for people with comorbid medical or mental health conditions. Evidence collected to date supports the use of bupropion SR as a safe, tolerable pharmacotherapy for smoking cessation among adult smokers without a predisposition to seizures, but also suggests that benefits in terms of abstinence last only as long as treatment continues. This review focuses on recent evidence regarding bupropion SR effects and highlights important questions regarding the duration of effects, relative efficacy, effectiveness in clinical use, mechanisms of action, and utilization of bupropion SR that remain unanswered.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"39 1","pages":"683-696"},"PeriodicalIF":0.0,"publicationDate":"2009-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76744705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huntington's disease (HD) is a heredodegenerative neurological disorder with chorea and other hyperkinetic movement disorders being part of the disease spectrum. These along with cognitive and neurobehavioral manifestations contribute significantly to patient's disability. Several classes of drugs have been used to treat the various symptoms of HD. These include typical and atypical neuroleptics along with dopamine depletors for treatment of chorea and antidepressants, GABA agonists, antiepileptic medications, cholinesterase inhibitors, antiglutamatergic drugs and botulinum toxin for treatment of other manifestations. Tetrabenazine (TBZ), a dopamine depleting medication was recently approved by the US FDA for treatment of chorea in HD. The purpose of this article is to briefly review information regarding HD and current treatments for chorea and specifically focus on TBZ and review the literature related to its use in HD chorea.
{"title":"Tetrabenazine in Huntington’s Disease Chorea","authors":"Shilpa Chitnis, C. A. Karunapuzha","doi":"10.4137/CMT.S2134","DOIUrl":"https://doi.org/10.4137/CMT.S2134","url":null,"abstract":"Huntington's disease (HD) is a heredodegenerative neurological disorder with chorea and other hyperkinetic movement disorders being part of the disease spectrum. These along with cognitive and neurobehavioral manifestations contribute significantly to patient's disability. Several classes of drugs have been used to treat the various symptoms of HD. These include typical and atypical neuroleptics along with dopamine depletors for treatment of chorea and antidepressants, GABA agonists, antiepileptic medications, cholinesterase inhibitors, antiglutamatergic drugs and botulinum toxin for treatment of other manifestations. Tetrabenazine (TBZ), a dopamine depleting medication was recently approved by the US FDA for treatment of chorea in HD. The purpose of this article is to briefly review information regarding HD and current treatments for chorea and specifically focus on TBZ and review the literature related to its use in HD chorea.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"44 1","pages":"669-681"},"PeriodicalIF":0.0,"publicationDate":"2009-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79263766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Leyh, S. Zipperich, R. Winzer, P. Drechsel, J. Bogner, A. Trein, L. Schneider, H. Klinker, P. Langmann
The protease inhibitor Lopinavir (LPV) combined with low dose ritonavir (r) in the formulation of a soft gelatine capsule (SGC) has been widely used in antiretroviral therapy and has been shown to produce safe therapeutic plasma levels. In June 2006, the LPV/r combination was approved as a tablet (TBL) in Germany and since then has replaced the capsule form. The purpose of this study was to analyze and compare pharmacokinetics of Lopinavir both in the new meltrex tablet formulation and the LPV/r soft gelatine capsule during long-term treatment of HIV. Methods: Included in this study were all patients followed at multiple study centers between January 2003 and August 2007 for whom LPV plasma levels were archived during therapeutic drug monitoring. A total of 4010 LPV plasma levels from 721 patients met these inclusion criteria. From these, those patients for whom complete data sets were missing were excluded from the study. Complete data sets were defined as those data that included information regarding cumulative daily dose, the patient's anti-retroviral drug regimen, and the time of measurement after drug intake. A total of 571 LPV plasma levels from 138 patients met the full criteria for inclusion in this retrospective study. Additionally, a small prospective study of LPV plasma levels in 6 patients with 24 data points was conducted in order to increase the reliability of this report. Results: At 3 h after dosing, plasma levels of LPV were significantly higher in patients who had received the meltrex tablet (Mdn = 10030 ng/ml, min = 3323, max = 17280) compared to those who had received the soft gelatine capsule (Mdn = 7964 ng/ml, min = 120, max = 17900). This difference was statistically significant (p 0.05). There were no statistically significant differences between the LPV plasma levels of the tablet and the capsule at 6, 9 and 12 h after dosing. Additionally, there were no differences between the trough levels of LPV in the two formulations. However, great variances of plasma levels were detected at time 12 h after dosing for both treatment groups (s(capsule) = 3213 ng/ml, s(tablet) = 2273 ng/ml). Conclusion: The LPV/r tablet formulation is able to produce equivalent to significantly higher plasma levels of LPV when compared with the SGC formulation at time 3 h after drug intake. In addition, the known sex difference in the pharmacokinetic profile of the tablet formulation was verified in this study.
蛋白酶抑制剂洛匹那韦(Lopinavir, LPV)与低剂量利托那韦(ritonavir, r)联合制成的软明胶胶囊(SGC)已被广泛用于抗逆转录病毒治疗，并已被证明可产生安全的治疗血浆水平。2006年6月，LPV/r组合在德国被批准为片剂(TBL)，从此取代了胶囊形式。本研究的目的是分析和比较洛匹那韦在新型美曲斯片剂和LPV/r软明胶胶囊中长期治疗HIV的药代动力学。方法:本研究纳入了2003年1月至2007年8月在多个研究中心随访的所有患者，这些患者在治疗药物监测期间记录了LPV血浆水平。来自721名患者的4010个LPV血浆水平符合这些纳入标准。从中，那些缺少完整数据集的患者被排除在研究之外。完整的数据集被定义为包括累积每日剂量、患者抗逆转录病毒药物治疗方案和药物摄入后测量时间等信息的数据。138例患者的571例LPV血浆水平符合本回顾性研究的全部标准。此外，为了提高本报告的可靠性，对6例患者的LPV血浆水平进行了一项小型前瞻性研究，共有24个数据点。结果:在给药后3小时，接受美曲斯片剂(Mdn = 10030 ng/ml, min = 3323, max = 17280)的患者血浆LPV水平明显高于接受软明胶胶囊(Mdn = 7964 ng/ml, min = 120, max = 17900)的患者。差异有统计学意义(p 0.05)。给药后6、9、12 h，片剂与胶囊的血浆LPV水平差异无统计学意义。此外，两种制剂中LPV的低谷水平没有差异。然而，在给药后12小时，两组血浆水平差异很大(s(胶囊)= 3213 ng/ml, s(片剂)= 2273 ng/ml)。结论:与SGC制剂相比，LPV/r片剂制剂在服药后3 h的血浆LPV水平显著高于SGC制剂。此外，已知的片剂配方药代动力学特征的性别差异在本研究中得到了验证。
{"title":"Pharmacokinetics of Lopinavir in the LPV/R-Meltrex Formulation Compared to the LPV/R-Soft Gelatine Capsule in HIV Infected Patients","authors":"M. Leyh, S. Zipperich, R. Winzer, P. Drechsel, J. Bogner, A. Trein, L. Schneider, H. Klinker, P. Langmann","doi":"10.4137/CMT.S2098","DOIUrl":"https://doi.org/10.4137/CMT.S2098","url":null,"abstract":"The protease inhibitor Lopinavir (LPV) combined with low dose ritonavir (r) in the formulation of a soft gelatine capsule (SGC) has been widely used in antiretroviral therapy and has been shown to produce safe therapeutic plasma levels. In June 2006, the LPV/r combination was approved as a tablet (TBL) in Germany and since then has replaced the capsule form. The purpose of this study was to analyze and compare pharmacokinetics of Lopinavir both in the new meltrex tablet formulation and the LPV/r soft gelatine capsule during long-term treatment of HIV. Methods: Included in this study were all patients followed at multiple study centers between January 2003 and August 2007 for whom LPV plasma levels were archived during therapeutic drug monitoring. A total of 4010 LPV plasma levels from 721 patients met these inclusion criteria. From these, those patients for whom complete data sets were missing were excluded from the study. Complete data sets were defined as those data that included information regarding cumulative daily dose, the patient's anti-retroviral drug regimen, and the time of measurement after drug intake. A total of 571 LPV plasma levels from 138 patients met the full criteria for inclusion in this retrospective study. Additionally, a small prospective study of LPV plasma levels in 6 patients with 24 data points was conducted in order to increase the reliability of this report. Results: At 3 h after dosing, plasma levels of LPV were significantly higher in patients who had received the meltrex tablet (Mdn = 10030 ng/ml, min = 3323, max = 17280) compared to those who had received the soft gelatine capsule (Mdn = 7964 ng/ml, min = 120, max = 17900). This difference was statistically significant (p 0.05). There were no statistically significant differences between the LPV plasma levels of the tablet and the capsule at 6, 9 and 12 h after dosing. Additionally, there were no differences between the trough levels of LPV in the two formulations. However, great variances of plasma levels were detected at time 12 h after dosing for both treatment groups (s(capsule) = 3213 ng/ml, s(tablet) = 2273 ng/ml). Conclusion: The LPV/r tablet formulation is able to produce equivalent to significantly higher plasma levels of LPV when compared with the SGC formulation at time 3 h after drug intake. In addition, the known sex difference in the pharmacokinetic profile of the tablet formulation was verified in this study.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"4 1","pages":"697-702"},"PeriodicalIF":0.0,"publicationDate":"2009-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87245585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdominal pain is one of the most common reasons why people seek medical care, and is often due to spasm of intra-abdominal visceral organs. Hyoscine butylbromide (HBB) is a quaternary ammonium compound which blocks the action of acetylcholine at parasympathetic sites (both muscarinic and nicotinic receptors) in smooth muscle, and in secretory glands. It causes decreased motility of the gastrointestinal tract and the urogenital tracts, and is useful in the treatment of spasms in these regions. Side effects are common, but tend to be minor and self limiting. Evidence exists to support its use in the management of non-specific colicky abdominal pain (in adults and children); irritable bowel syndrome; labor and delivery; dysmenorrhea; as an adjunct in the therapy of late stage cancer patients with inoperable bowel malignancies; and to facilitate improved resolution in certain imaging techniques. It may also be useful in certain procedures, such as colonoscopy and sigmoidoscopy, and may be useful in the management of renal colic (although NSAIDs seem clinically superior). The role of HBB in the management of esophageal food obstruction is unclear at this time; further studies need to be done.
{"title":"Pharmacotherapy Update: Hyoscine Butylbromide in the Treatment of Abdominal Spasms:","authors":"L. Samuels","doi":"10.4137/CMT.S1134","DOIUrl":"https://doi.org/10.4137/CMT.S1134","url":null,"abstract":"Abdominal pain is one of the most common reasons why people seek medical care, and is often due to spasm of intra-abdominal visceral organs. Hyoscine butylbromide (HBB) is a quaternary ammonium compound which blocks the action of acetylcholine at parasympathetic sites (both muscarinic and nicotinic receptors) in smooth muscle, and in secretory glands. It causes decreased motility of the gastrointestinal tract and the urogenital tracts, and is useful in the treatment of spasms in these regions. Side effects are common, but tend to be minor and self limiting. Evidence exists to support its use in the management of non-specific colicky abdominal pain (in adults and children); irritable bowel syndrome; labor and delivery; dysmenorrhea; as an adjunct in the therapy of late stage cancer patients with inoperable bowel malignancies; and to facilitate improved resolution in certain imaging techniques. It may also be useful in certain procedures, such as colonoscopy and sigmoidoscopy, and may be useful in the management of renal colic (although NSAIDs seem clinically superior). The role of HBB in the management of esophageal food obstruction is unclear at this time; further studies need to be done.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"89 1","pages":"647-655"},"PeriodicalIF":0.0,"publicationDate":"2009-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74889087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bipolar disorder is a common and serious illness usually requiring long term medication. We critically review the available evidence surrounding the increasing use of quetiapine, a second generation antipsychotic, in both the acute and maintenance phases of bipolar disorder. Large scale, randomized controlled data supports the use of quetiapine in both acute mania and acute bipolar depression, as a safe and effective treatment and probably best used in combination with a traditional ‘mood stabiliser’ such as lithium or divalproex. Also, quetiapine monotherapy has been shown to be effective in bipolar depression. Two recently published studies also confirm that quetiapine in combination with either lithium or divalproex ‘adds value’ to the maintenance treatment of bipolar disorder in terms of delaying relapse compared to either lithium or divalproex alone. Quetiapine is generally well tolerated, although further work on long term weight gain and emergent diabetes would be helpful.
{"title":"pharmacotherapy Update: Quetiapine use in Bipolar Disorder—What does the evidence tell us?","authors":"Mark Taylor, Kirsty Mackay, P. Shajahan","doi":"10.4137/CMT.S1136","DOIUrl":"https://doi.org/10.4137/CMT.S1136","url":null,"abstract":"Bipolar disorder is a common and serious illness usually requiring long term medication. We critically review the available evidence surrounding the increasing use of quetiapine, a second generation antipsychotic, in both the acute and maintenance phases of bipolar disorder. Large scale, randomized controlled data supports the use of quetiapine in both acute mania and acute bipolar depression, as a safe and effective treatment and probably best used in combination with a traditional ‘mood stabiliser’ such as lithium or divalproex. Also, quetiapine monotherapy has been shown to be effective in bipolar depression. Two recently published studies also confirm that quetiapine in combination with either lithium or divalproex ‘adds value’ to the maintenance treatment of bipolar disorder in terms of delaying relapse compared to either lithium or divalproex alone. Quetiapine is generally well tolerated, although further work on long term weight gain and emergent diabetes would be helpful.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"71 2 1","pages":"657-667"},"PeriodicalIF":0.0,"publicationDate":"2009-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83565753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article will review newer therapies for the treatment of essential tremor as well as cover potential therapies still in development. Drug pharmacology, specific dosing for ET and adverse effects will be reviewed. Finally, a rationale approach to treatment of ET will be discussed.
{"title":"Emerging Therapies for the Treatment of Essential Tremor","authors":"H. Shill","doi":"10.4137/CMT.S2196","DOIUrl":"https://doi.org/10.4137/CMT.S2196","url":null,"abstract":"This article will review newer therapies for the treatment of essential tremor as well as cover potential therapies still in development. Drug pharmacology, specific dosing for ET and adverse effects will be reviewed. Finally, a rationale approach to treatment of ET will be discussed.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"36 1","pages":"613-620"},"PeriodicalIF":0.0,"publicationDate":"2009-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87436776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lapatinib is an oral dual tyrosine kinase inhibitor against epidermal growth factor receptor (EGFR) and HER-2/neu (HER2). The success of trastuzumab in breast cancer prompted investigations of lapatinib in breast cancer, which revealed that lapatinib has effectiveness similar to that of trastuzumab. Clinical trials showed that lapatinib is effective for patients with HER2-positive breast cancer. Furthermore, lapatinib may be effective in patients with central nervous system metastasis that developed after trastuzumab therapy. Lapatinib may have synergistic effects with trastuzumab or hormonal therapy. There are encouraging preliminary data on the efficacy of lapatinib in patients with inflammatory breast cancer. Ongoing trials may give us exciting data on lapatinib as adjuvant therapy. HER2 positivity is a strong predictor of response to lapatinib, but the predictive value of EGFR positivity is less clear. While cardiac toxic effects have been observed with lapatinib, their incidence and severity are less significant than with trastuzumab. Current data indicate that lapatinib is a promising agent with unique potential benefits in the treatment of metastatic breast cancer.
{"title":"Lapatinib in the Treatment of Breast Cancer","authors":"H. Yamauchi, T. Lafortune, N. Ueno","doi":"10.4137/CMT.S52","DOIUrl":"https://doi.org/10.4137/CMT.S52","url":null,"abstract":"Lapatinib is an oral dual tyrosine kinase inhibitor against epidermal growth factor receptor (EGFR) and HER-2/neu (HER2). The success of trastuzumab in breast cancer prompted investigations of lapatinib in breast cancer, which revealed that lapatinib has effectiveness similar to that of trastuzumab. Clinical trials showed that lapatinib is effective for patients with HER2-positive breast cancer. Furthermore, lapatinib may be effective in patients with central nervous system metastasis that developed after trastuzumab therapy. Lapatinib may have synergistic effects with trastuzumab or hormonal therapy. There are encouraging preliminary data on the efficacy of lapatinib in patients with inflammatory breast cancer. Ongoing trials may give us exciting data on lapatinib as adjuvant therapy. HER2 positivity is a strong predictor of response to lapatinib, but the predictive value of EGFR positivity is less clear. While cardiac toxic effects have been observed with lapatinib, their incidence and severity are less significant than with trastuzumab. Current data indicate that lapatinib is a promising agent with unique potential benefits in the treatment of metastatic breast cancer.","PeriodicalId":10428,"journal":{"name":"Clinical Medicine and Therapeutics","volume":"105 1","pages":"513-526"},"PeriodicalIF":0.0,"publicationDate":"2009-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79417798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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