scholarly journals Monotherapy or Polytherapy for Epilepsy?

1998 ◽  
Vol 25 (S4) ◽  
pp. S3-S8 ◽  
Author(s):  
Alan Guberman
Keyword(s):  
Side Effects ◽  
Seizure Control ◽  
Lower Cost ◽  
Mechanisms Of Action ◽  
New Drugs ◽  
First Line ◽  
New Antiepileptic Drugs ◽  
Epilepsy Treatment ◽  
Multiple Drugs ◽  
The Ideal

ABSTRACT:Monotherapy has been promoted as the ideal in epilepsy treatment because of reduced side effects, absence of drug interactions, better compliance, lower cost and, in many cases, improved seizure control compared to polytherapy. The question of monotherapy vs. polytherapy has assumed increasing importance with the availability of multiple new antiepileptic drugs (AEDs), initially tested as add-on agents. The new drugs clobazam, lamotrigine, vigabatrin, gabapentin and topiramate, have also been shown to be effective as monotherapy. These data bring up the possibility of using them as first-line agents. However, a high percentage of patients with resistant epilepsy are treated with polytherapy, which probably benefits only a minority of them. The availability of multiple drugs with different mechanisms of action favours the possibility of "rational polytherapy", taking advantage of possible synergism, a yet unproven concept. This article reviews the theoretical advantages of monotherapy and monotherapy with traditional and newer AEDs.

scholarly journals Review of properties and mechanisms of action of hepatoprotective drugs

2020 ◽  
pp. 36-44
Author(s):  
Е.В. Кардаш ◽  
Е.М. Григорьева ◽  
А.Г. Емельянова ◽  
С.А. Тарасов
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Side Effects ◽  
Randomized Clinical Trials ◽  
Evidence Base ◽  
Mechanisms Of Action ◽  
New Drugs ◽  
Simultaneous Administration ◽  
Essential Phospholipids ◽  
Meta Analyses

В медицинской практике достаточно часто возникает необходимость в одновременном приеме нескольких лекарственных средств. Иногда это оказывается невозможным в силу наличия у препаратов гепатотоксических свойств, поэтому актуальными задачами фармакологии являются как поиск и разработка новых препаратов, так и оптимизация уже существующих с целью уменьшения побочных эффектов при их приеме. В настоящем обзоре были проанализированы данные о фармакологических препаратах класса гепатопротекторов, разобраны механизмы их действия и потенциал поиска новых препаратов. В заключение отмечено, что в настоящее время в клинической практике наибольшей популярностью пользуются препараты, содержащие эссенциальные фосфолипиды и препараты, улучшающие рециркуляцию и выведение желчных кислот. Существуют теоретические обоснования механизмов действия этих препаратов и перспектива накопления доказательной базы для них в виде рандомизированных клинических исследований и мета-анализов. Medical practice quite often requires simultaneous administration of several drugs. Sometimes it is impossible due to their hepatotoxicity; therefore, urgent tasks of pharmacology include searching for and developing new drugs as well as optimizing already existing products in order to reduce side effects during their administration. This review focused on pharmacological drugs of the hepatoprotector class and their mechanisms of action and evaluated the prospects of searching for new medicines. In conclusion, drugs containing essential phospholipids and those improving recirculation and removal of bile acids are currently the most popular agents in clinical practice. Mechanisms of action of these drugs are theoretically justified and there is a prospect for building an evidence base for them by randomized clinical trials and meta-analyses.

Do New Antiepileptic Drugs with Novel Mechanisms of Action Suggest Reconsideration of Rational Polypharmacy?

US Neurology ◽  
2010 ◽  
Vol 06 (01) ◽  
pp. 70 ◽  
Author(s):  
Barry E Gidal ◽  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Mechanisms Of Action ◽  
Rational Approach ◽  
Effective Control ◽  
Partial Seizures ◽  
New Antiepileptic Drugs ◽  
Number Of Patients ◽  
Seizure Models ◽  
Pharmacologic Effect

Although effective control of epilepsy can be achieved by a single antiepileptic drug (AED), the condition persists in a significant number of patients despite increasing dosages with monotherapy and polytherapy. Treatment with combinations of older AEDs has been known to cause undesirable drug–drug interactions and side effects. However, there has been renewed interest in polytherapy with the advent of newer AEDs with novel mechanisms of actions that are less likely to cause adverse effects in patients. Animal seizure models are useful for determining whether AEDs will be effective in generalised or partial seizures prior to clinical studies and isobolgraphic analysis may allow for a more systematic, rational approach to predicting whether a given combination of drugs will result in a greater or lesser pharmacologic effect. Since one treatment strategy does not suit all patients, studies should focus on the tolerability and safety of specific combinations of AEDs in order to provide guidance to physicians. In summary, pharmacokinetic interactions must be taken into account in studies in humans and animals with measurement of toxicity as well as efficacy.

Clinical Use and Efficacy of Levetiracetam for Absence Epilepsies

2018 ◽  
Vol 34 (2) ◽  
pp. 94-98 ◽  
Author(s):  
Danielle Nolan ◽  
Shannon G. Lester ◽  
Stephanie M. Rau ◽  
Reneé A. Shellhaas
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Low Dose ◽  
Seizure Control ◽  
Absence Epilepsy ◽  
Routine Clinical Practice ◽  
Clinical Use ◽  
Epilepsy Treatment ◽  
Neurology Clinic ◽  
New Onset

Background: Levetiracetam is prescribed for a broad spectrum of seizure types but does not have a specific indication for absence epilepsy. We hypothesized that levetiracetam is commonly prescribed for children with absence epilepsies and evaluated the efficacy of this medication for absence epilepsy treatment in clinical practice. We also hypothesized that electroencephalographic (EEG) findings could help predict levetiracetam efficacy. Methods: We reviewed the charts of all patients treated for new-onset absence epilepsies at our pediatric neurology clinic between January 2011 and January 2016. Among 158 children diagnosed with absence epilepsies, 72 were treated with levetiracetam. Results: Levetiracetam was discontinued in 74% (n = 53/72) because of incomplete seizure control (59%, n = 35/72) and/or intolerable side effects (41%, n = 24/72) after a median 8.5 months (interquartile range 2, 17 months). Among patients for whom levetiracetam was effective, 44% (n = 8/18) had polyspikes on their initial EEG, versus 27% (n = 14/52) of patients for whom levetiracetam was discontinued ( P = .17). The maximal prescribed dose was lower for children in whom levetiracetam was effective (29 ± 13 mg/kg/d) than those for whom levetiracetam failed (42 ± 20 mg/kg/d; P = .005). Conclusion: In routine clinical practice, levetiracetam is often chosen for patients with absence seizures. However, only about one-quarter of children with absence epilepsy in this study became seizure free with levetiracetam. When effective, levetiracetam can control absence epilepsy at a relatively low dose. Lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.

New Trends On Biological Activities And Clinical Studies Of Quinolinic Analogues: A Review

2021 ◽  
Vol 22 ◽  
Author(s):  
Sandra Elizabeth Barbosa da Silva ◽  
José Arion da Silva Moura ◽  
Tiago Rafael de Sousa Nunes ◽  
Ivan da Rocha Pitta ◽  
Marina Galdino da Rocha Pitta
Keyword(s):  
Side Effects ◽  
Clinical Studies ◽  
Biological Activities ◽  
Mechanisms Of Action ◽  
Antimalarial Drugs ◽  
New Drugs ◽  
Phase Iii ◽  
Synthetic Compounds ◽  
Preclinical And Clinical Studies ◽  
Natural And Synthetic

: The quinolinic ring, present in several molecules, has a great diversity of biological activities. Therefore, this ring is in the structure composition of several candidates of drugs in preclinical and clinical studies, thus, it is necessary the grouping of these results to facilitate the design of new drugs. For this reason, some of the activities were selected for this review, such as: antimalarial, antimicrobial, anticancer, anti-inflammatory, antidiabetic, anti-rheumatic and antiviral. All publications of scientific articles chosen are dated between 2000 and 2020. In addition to presenting the structures of some natural and synthetic compounds with their activities, we list the clinical studies of phases III and IV of antimalarial drugs containing the quinoline nucleus and phase III clinical studies of hydroxychloroquine and chloroquine to assess their possible role in COVID-19. Finally, we show some of the mechanisms of action, as well as the side effects of some of the quinolinic derivatives.

Advances in the application of 1,2,4-triazole-containing hybrids as anti-tuberculosis agents

2021 ◽  
Author(s):  
Yingdong Cao ◽  
Hong Lu
Keyword(s):  
Side Effects ◽  
Rational Design ◽  
Communicable Disease ◽  
Mechanisms Of Action ◽  
New Drugs ◽  
Current Status ◽  
Potential Drug ◽  
Antitubercular Agents ◽  
Drug Candidates ◽  
Privileged Structure

Tuberculosis is a deadly communicable disease caused by the bacillus Mycobacterium tuberculosis (MTB), and pulmonary tuberculosis accounts for over 80% of the total cases. The 1,2,4-triazole is a privileged structure in the discovery of new drugs, and its derivatives act on various targets in MTB. In particular, 1,2,4-triazole hybrids can not only exert dual or multiple antitubercular mechanisms of action but also have the potential to enhance efficacy and reduce side effects. The present work aims to summarize the current status of 1,2,4-triazole hybrids as potential antitubercular agents, covering articles published between 2010 and 2020, to aid the further rational design of novel potential drug candidates endowed with higher efficacy, better compliance and fewer side effects.

scholarly journals LETTER TO THE EDITOR: Management of Vemurafenib Induced Severe Arthralgia and Pyrexia in a Patient with BRAF V600E Mutated Melanoma: First Experience with a Switch to Dabrafenib

2015 ◽  
Vol 9 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Lars Alexander Schneider ◽  
Peter Paschka ◽  
Karin Scharffetter-Kochanek ◽  
Verena Haftek ◽  
Nicolai Treiber ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Side Effects ◽  
Concomitant Administration ◽  
New Drugs ◽  
Braf V600e ◽  
Induction Phase ◽  
Advanced Stage ◽  
Braf Inhibitors ◽  
Ideal Situation ◽  
The Ideal

The invention of targeted therapy for BRAF mutated advanced stage melanoma has given the patients the perspective of a possible longer remission of the disease based on taking several pills a day without a further hospital stay. That is the ideal situation. However, the new drugs are not without side effects. Amongst them, fever and acute arthralgia are well known. We report on a patient in which these effects were so severe under vemurafenib that we had to stop the drug twice in the induction phase. Only with concomitant administration of corticosteroids finally a third induction worked. After 6 months on this therapy we switched the patient to dabrafenib and observed that in this case dabrafenib was much better tolerated. This is the second report on such a switch between the two licensed BRAF inhibitors because of side effects so far.

scholarly journals Monotherapy versus Polytherapy in Epilepsy: a Framework for Patient Management

1998 ◽  
Vol 25 (S4) ◽  
pp. S9-S13 ◽  
Author(s):  
J.H. Schneiderman
Keyword(s):  
Decision Making ◽  
Side Effects ◽  
Drug Interactions ◽  
Patient Management ◽  
Seizure Control ◽  
Medical Condition ◽  
Critical Evaluation ◽  
Newly Diagnosed ◽  
New Antiepileptic Drugs ◽  
Complex Drug

ABSTRACT:The long-standing debate between proponents of monotherapy and those of polytherapy for treatment of epilepsy has been rekindled by the recent development of several new antiepileptic drugs. The likelihood of improved seizure control on polytherapy must be weighed against the risk of increased side effects, complex drug interactions and cost. Providing maximal seizure control while avoiding overtreatment is a challenge which requires an ongoing critical evaluation of each patient's management. This review provides a framework for decision-making by considering issues affecting the choice between monotherapy and polytherapy in five clinical situations: 1) newly diagnosed epilepsy; 2) seizures on monotherapy; 3) seizures controlled on polytherapy; 4) not controlled on polytherapy; 5) change in medical condition.

scholarly journals How About the New Antiepileptic Drugs?

1994 ◽  
Vol 21 (S3) ◽  
pp. S17-S20 ◽  
Author(s):  
B.J. Wilder
Keyword(s):  
Antiepileptic Drugs ◽  
The United States ◽  
Mechanisms Of Action ◽  
New Drugs ◽  
Optimal Management ◽  
Controlled Clinical Trials ◽  
New Antiepileptic Drugs ◽  
The Us ◽  
Epileptic Patients ◽  
Clonic Seizures

Abstract:No new antiepileptic drugs (AEDs) were licensed in the United States from 1978 to 1992. In late 1992, felbamate and gabapentin were recommended for approval, and in early 1993, lamotrigine. In July 1993, felbamate was licensed, and gabapentin and lamotrigine may soon follow. Lamotrigine, vigabatrin and clobazam are in use outside the US. Tiagabine, oxcarbazepine, fosphenytoin, topiramate, vigabatrin and zonisamide are in Phase II clinical testing in the US. All of the new AEDs are effective against partial and tonic-clonic seizures. Few controlled clinical trials have been done in patients with absence and myoclonic seizures. Mechanisms of action of the new drugs have not been clearly defined. The new AEDs will provide an opportunity to improve the care of epileptic patients. Even with optimal management with currently available drugs, some 30% of patients remain refractory to medical management.

Ideal body position for epinephrine autoinjector administration

2020 ◽  
Author(s):  
Qing Wang ◽  
Luke Pittman ◽  
Andrew Healey ◽  
James Chang ◽  
T. Ted Song
Keyword(s):  
Body Position ◽  
Vastus Lateralis ◽  
The United States ◽  
Thigh Muscle ◽  
First Line ◽  
Medical Treatment Facility ◽  
First Line Therapy ◽  
Epinephrine Autoinjector ◽  
Ideal Body ◽  
The Ideal

Background: Epinephrine is the first-line therapy for patients with anaphylaxis, and intramuscular (IM) delivery is shownto be superior to subcutaneous (SC) delivery. There currently is no consensus on the ideal body position for epinephrine autoinjector (EAI) administration.Objective: We designed this study to investigate whether SC tissue depth (SCTD) is affected by body position (e.g., standing, sitting, supine), which can potentially impact delivery of EAI into the IM space.Methods: Volunteer adults (ages >/= 18 years) from a military medical treatment facility in the United States were recruitedto participate in this study. SCTD of the vastus lateralis was measured via ultrasound at standing, sitting, and supine bodypositions. Subjects’ age, sex, and body mass index (BMI) were collected. Statistical analysis was performed to compare averageSCTD between body positions, sex, and BMI.Results: An analysis of variance of 51 participants (33 men and 18 women) did not reveal statistically significant differencein SCTD among standing, sitting, and supine body positions. It did show a significantly greater SCTD in women than in men (2.72 +/- 1.36 cm versus 1.10 +/- 0.38 cm; p < 0.001). There was no significant association observed between BMI and SCTD in this study.Conclusion: Body position did not seem to significantly change the distance between skin and thigh muscle in adults. Thiswould suggest that there might not be an ideal body position for EAI administration. Therefore, in case of anaphylaxis, promptadministration of epinephrine is recommended at any position.

Dexamethasone-Chemical Structure and Mechanisms of Action in Prophylaxis of Postoperative Side Effects

2019 ◽  
Vol 70 (3) ◽  
pp. 843-847 ◽  
Author(s):  
Oana Roxana Ciobotaru ◽  
Mary-Nicoleta Lupu ◽  
Laura Rebegea ◽  
Octavian Catalin Ciobotaru ◽  
Oana Monica Duca ◽  
...  
Keyword(s):  
Wound Healing ◽  
Side Effects ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Postoperative Period ◽  
Analgesic Effect ◽  
Chemical Structure ◽  
Mechanisms Of Action ◽  
Good Recovery ◽  
Synthetic Glucocorticoid

Dexamethasone is a synthetic glucocorticoid used for its anti-inflammatory and analgesic effect. In addition to these therapeutic indications, it is also recommended for nausea and vomiting treatment which may occur during the postoperative period, with impact on postoperative evolution, regarding the evolution of wound healing and length of stay (LOS), with a reflection on the costs of hospital admission. Therefore, their prevention is very important for both patients� comfort and a good recovery.

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