Pharmatherapeutica最新文献

A double-blind, parallel trial of 40 patients with chronic shoulder pain was carried out to compare alleviation of pain and improvement in mobility after treatment with 20 mg piroxicam each morning or 250 mg naproxen twice daily. During the 3-week study, patients also underwent conservative treatment of therapeutic exercise. Piroxicam was better than naproxen at relieving pain at night, but time, rather than a drug effect, seemed responsible for the improvement in shoulder abduction. No difference between the drugs was demonstrated regarding their effect on pain on active movement of the shoulder and external rotation.

An open study was carried out in 60 elderly patients with Parkinson's disease to assess the efficacy and tolerance of long-term treatment with levodopa/benserazide combination therapy. Patients were treated for periods up to 2 years, doses being titrated to the lowest required to bring about adequate relief of symptoms. The mean daily dose ranged from 165 mg on entry to 199 mg in the 43 patients assessed at 24 months. The results showed that treatment provided lasting therapeutic benefits for approximately three-quarters of the study population with a low incidence of side-effects.

A double-blind crossover study was carried out in 20 patients with mild to moderate essential hypertension to assess the efficacy and tolerability of a low fixed-dose combination containing 20 mg penbutolol (a beta-blocking agent) and 3 mg piretanide (a diuretic) in comparison to placebo over a period of 4 weeks. Active drug treatment in the 20 patients studied was preceded by a 1-week period of placebo. The results showed that there was an effective significant reduction in systolic and diastolic blood pressure compared with initial levels in the fixed-dose combination group, when compared to the placebo group, both at rest, during maximal ergometric and isometric work load, and also in the diurnal blood pressure profile over 24 hours. Pulse rate also decreased in the combination group. The biochemical, haematological and urinary parameters showed no clinically relevant changes in either group during the entire study period. Minor side-effects definitely or probably associated with the treatment were observed in both groups but were generally mild and did not interfere with treatment. No patient withdrew prematurely from the trial.

Nineteen chronic schizophrenics were included in an open trial to evaluate the depot neuroleptic, zuclopenthixol decanoate. The treatment period was 24 weeks and clinical evaluations were carried out every 4 weeks including the CGI, the BPRS (completed at Weeks 0, 4, 8, 16, and 24), the Hamilton Depression Scale (completed at Weeks 0, 12, and 24), and a side-effects check list. Patients received 200 mg zuclopenthixol decanoate intramuscularly at intervals dependent on the severity of the illness. Statistically significant reductions were found for most of the symptoms on the BPRS. The reduction was already seen after 4 weeks of treatment. A clear improvement was also recorded on the Hamilton Depression Scale. The frequency of side-effects was low and decreased during the treatment period. The side-effects recorded were mild and, according to the CGI, they did not interfere with the patients' functioning except in 1 case (Week 24). It is concluded that zuclopenthixol decanoate is an effective and well-tolerated drug in the maintenance treatment of chronic schizophrenia.

Sixty out-patients with acute or sub-acute irritable colon were randomly allocated to receive 3 daily doses of 100 mg tiropramide, 150 mg trimebutine maleate or 20 mg octilonium bromide, orally during 5 consecutive days. Before and after treatment, multiple colonic manometry was performed, monitoring tonus, intensity and frequency of sinusoid contraction waves, transitories and vibrations, as well as the voluntary contraction capacity. Before treatment and after 2 and 5 days, the specific symptoms were also monitored, scored and recorded. Significant variations in tonus were not observed with any drug, but while tiropramide left unmodified the voluntary contractile ability, a significant inhibition was observed with trimebutine and, mainly, with octilonium. The overall power of spontaneous colonic contractions did not vary significantly with any drug. However, while with tiropramide a significant redistribution of muscular power was observed so as to increase propulsion waves and to decrease the ineffective transitory and vibrational contractions, with octilonium and trimebutine no clinically relevant redistribution of the power wasted in transient spasms was observed. Based on these observations, tiropramide was considered to be at least as effective an antispasmodic as octilonium and at least as effective a synchronizer as trimebutine, but was different from both reference drugs because it was the only one to act simultanously as both an antispasmodic and a synchronizer. The three drugs produced an improvement in each and all monitored symptoms as well as in the overall symptom intensity. Tiropramide, however, produced an improvement significantly faster, more progressively and to a greater extent than either reference drug.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective study was carried out to examine the effectiveness of gentamicin-impregnated polymethylmethacrylate beads in the prevention of wound sepsis after gastro-intestinal surgery. The beads were laid in the abdominal and perineal incisions (61 wounds) of 55 patients at the end of the operative procedures, and were withdrawn in stages from the fifth post-operative day. This method of administration results in a sustained high antibiotic concentration in the wound with low serum and urine concentrations, thus eliminating the dangers of gentamicin toxicity. Wound infection occurred in only 1 instance, a favourable result when compared to historical controls. It is suggested that further controlled studies of this method of topical prophylactic antibiotic administration are indicated.

A prospective, randomized, double-blind between-patient study was carried out to compare the efficacy and tolerance of atenolol with nifedipine and atenolol with diuretic. Ninety-eight hypertensive patients inadequately controlled after 1-month's treatment with 100 mg atenolol alone once daily received, in addition, either 20 mg nifedipine twice daily or 5 mg amiloride plus 50 mg hydrochlorothiazide once daily for a further 8 weeks. The results of blood pressure measurements in the lying and standing positions showed that the mean reduction in standing blood pressure from atenolol baseline was 28/12 mmHg for atenolol/diuretic and 18/13 mmHg for atenolol/nifedipine. The only significant difference between treatments in blood pressure control was in lying systolic blood pressure favouring atenolol/diuretic and a trend in favour of this combination for standing systolic blood pressure. Both regimens were reasonably well tolerated, although 19 patients withdrew during the course of the trial because of side-effects (2 on atenolol alone, 10 on atenolol/diuretic and 7 on atenolol/nifedipine).

A study was carried out in general practice during the summer months of 1985 to compare the efficacy and tolerance of astemizole suspension with terfenadine suspension in the treatment of paediatric hay fever. The 65 patients who entered the study were all aged between 6 and 12 years and had suffered from hay fever in at least one previous season. Each child was randomly allocated to receive either 5 ml astemizole suspension (1 mg/ml) once daily or 5 ml terfenadine suspension (6 mg/ml) twice daily for a period of 8 weeks on a single-blind basis. Symptom scores assessed by the patient (or parent/guardian) on two visual analogue scales for ocular and nasal symptoms showed no significant difference between the treatment groups, neither did an analysis of visual analogue scores for runny nose, blocked nose, wheeze, sneezing or eye symptoms assessed by the investigator on entry or after 4 and 8 weeks. The global assessments made by the investigator at 4 weeks and the patient at 8 weeks, however, indicated significantly better overall symptom control in the astemizole group. Both treatments were well tolerated, side-effects being few and minor.

A double-blind, randomized crossover trial was carried out in 10 patients with reversible airways obstruction to assess dose-response and duration of action of 0.5 mg ipratropium combined with 1.25 mg, 2.5 mg or 5.0 mg fenoterol compared with 5.0 mg salbutamol given alone. Each solution was nebulized from a volume of 4 ml and administered via a mouth-piece at approximately the same time on each of 4 test days. Measurements were made of FEV1, FVC and PEFR before and at intervals after nebulization. The results showed that each dose of the combination produced greater improvements in the lung function parameters than did salbutamol alone and the degree of response was proportional to the dose of the combination. No significant treatment differences were recorded in systolic or diastolic blood pressure between any of the treatments, but the combined preparations produced significantly higher pulse rates than did salbutamol.

Seventeen non-digitalized congestive heart failure patients were treated with only the fixed-dose combinations of 20 mg furosemide and 50 mg spironolactone or 20 mg furosemide and 100 mg spironolactone, in a daily dose of 1 or 2 capsules, over a 4-week period. The selected patients had a severity rating ranging between Grades III and IV. Ten of these patients had a severe grade of dyspnoea. Assessments were made on the basis of the reduction in cardiac failure score, extent of reduction in oedema, and relief of dyspnoea. Safety variables measured included laboratory, echocardiographic and side-effect monitoring. By the end of the 4-week study period, significant reduction (46% to 51%) in cardiac score and complete relief of dyspnoea with no adverse effects on safety variables were recorded. These results indicate that it is possible to treat patients with congestive heart failure safely with the fixed-dose combination product without the concurrent use of digitalis.