Overdosing on immediate-release morphine solution has predictable adverse effects

Epilepsy is one of the most common chronic neurologic disorders that affects individuals of all ages. It is primarily managed with antiepileptic drugs (AEDs), with the goal of maintaining complete seizure control combined with minimal or no adverse effects. Oral administration is the mainstay of AED delivery for patients with chronic epilepsy and consists essentially of immediate-release (IR) and modified-release (delayed-release and extended-release [ER]) dosage formulations. Extended-release formulations (hydrophilic or hydrophobic matrix systems, reservoir systems, and osmotic-release systems) release a drug in a controlled manner during an extended period of time following administration. Extended-release formulations have many advantages compared with IR formulations, including simplification of dosing regimens, reduction in pill burden, and reduction in the peak-to-trough fluctuations in serum drug concentration that may be associated with a decreased risk of adverse effects and of seizures. These advantages have the potential to increase adherence to antiepileptic therapy, improve the quality of life of patients, and reduce health care costs. This article, which is intended as a practical guide for clinicians, reviews the properties of the different ER AED formulations currently available and discusses the advantages of ER over IR formulations. Subsequently, an explanation of the technologic basis of the different oral ER formulations, the critical attributes that differentiate ER products, and their individual strengths and weaknesses is provided. Specific recommendations to practitioners on treating patients with ER formulations are included.

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Clinical Efficacy and Safety of Tapentadol Immediate Release in the Postoperative Setting

Journal of the American Podiatric Medical Association ◽

10.7547/1020139 ◽

2012 ◽

Vol 102 (2) ◽

pp. 139-148 ◽

Cited By ~ 6

Author(s):

Stephen E. Daniels ◽

Michael Golf

Keyword(s):

Postoperative Pain ◽

Adverse Effects ◽

Single Molecule ◽

Negative Impact ◽

Opioid Analgesics ◽

Immediate Release ◽

Tolerability Profile ◽

Gastrointestinal Tolerability ◽

Podiatric Surgery ◽

Postoperative Setting

The appropriate treatment for postoperative pain remains a common dilemma for podiatric surgeons and patients undergoing surgery of the foot and ankle. The treatment of moderate to severe acute pain typically relies heavily on the use of opioid analgesics, such as hydrocodone and oxycodone, which are often associated with adverse effects, including nausea and vomiting. These adverse effects may have a negative impact on postoperative outcomes and reduce patient compliance with analgesic therapy. Tapentadol is a novel, centrally acting analgesic with two mechanisms of action—μ-opioid receptor agonism and norepinephrine reuptake inhibition—in a single molecule. Tapentadol immediate release has been evaluated in a series of clinical trials in patients with postoperative pain after bunionectomy. The results of these studies demonstrate that tapentadol immediate release is associated with an improved gastrointestinal tolerability profile relative to oxycodone immediate release at doses providing comparable analgesia. Therefore, tapentadol immediate release may offer an improved analgesic option for the relief of postoperative pain after podiatric surgery. (J Am Podiatr Med Assoc 102(2): 139–148, 2012)

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Early administration of oral morphine to orthopedic patients after surgery

Journal of Opioid Management ◽

10.5055/jom.2006.0014 ◽

2006 ◽

Vol 2 (2) ◽

pp. 88 ◽

Cited By ~ 10

Author(s):

Ruth Zaslansky, DSc ◽

Elon Eisenberg, MD ◽

Bezalel Peskin, MD ◽

Elliot Sprecher, PhD ◽

Daniel N. Reis, MD ◽

...

Keyword(s):

Postoperative Pain ◽

Adverse Effects ◽

Treatment Guidelines ◽

Pain Treatment ◽

Oral Morphine ◽

Immediate Release ◽

Treatment Method ◽

Pain Scores ◽

Number Of Patients ◽

Average Pain

Current pain treatment guidelines advise against providing analgesics for postoperative pain using intramuscular injections, as this generally provides poor pain relief. However, this route remains the most prevalent treatment method. Intravenous or epidural patient-controlled-analgesia methods reduce pain effectively but are expensive, labor intensive, and available to only a limited number of patients. We propose administering the analgesics using oral analgesics and have developed a simple protocol for treating postoperative pain by use of oral morphine. After a variety of orthopedic surgeries, patients were given “around-the-clock,” oral, immediate-release morphine. Efficacy of the treatment (pain scores and adverse effects) was assessed 24 ± 2 hours after surgery. Data were collected prospectively from 95 patients, who received an average of 61 ± 30 (SD) mg morphine. Average pain scores were 2.4/10 (± 1.4) at rest and 4.0/10 (± 1.4) during movement in bed. Nausea and vomiting, the most common adverse effects, were reported by 22 (23 percent) patients. Naloxone was not administered to any of the patients. Oral morphine given in the early postoperative time to patients after a variety of orthopedic surgeries was effective and safe.

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Opioid titration with sustained-release oxycodone and immediate-release morphine for moderate/severe cancer pain: A pilot assessment of the CoDem protocol

Journal of Opioid Management ◽

10.5055/jom.2014.0189 ◽

2014 ◽

Vol 10 (1) ◽

pp. 29 ◽

Cited By ~ 6

Author(s):

Boaz Gedaliahu Samolsky Dekel, MD, PhD, MA ◽

Marco Tomasi, MD ◽

Alessio Vasarri, MD ◽

Alberto Gori, MD ◽

Marco Adversi, MD ◽

...

Keyword(s):

Adverse Effects ◽

Sustained Release ◽

Cancer Pain ◽

Rating Scale ◽

Pain Treatment ◽

Numerical Rating Scale ◽

Immediate Release ◽

Rescue Dose ◽

Numerical Rating ◽

Strong Opioids

Objectives: Opioid titration is the first challenging stage for rapid control of moderate/severe cancer pain. Evidence shows that sustained-release formulations may be used for opioid titration. We set a pilot assessment of the efficacy and tolerability of our in-house protocol (continuous and on demand opioids [CoDem]) of the association of sustained-release oxycodone and immediate-release morphine as rescue dose for opioid titration/rotation in opioid-naïve (NAOP, n = 13), tolerant to weak (WOP, n = 20), or strong opioids (STOP, n = 44) in-patients with moderate/severe cancer pain.Methods: Observational and retrospective analysis of cancer in-patients treated for ≥7 days with the CoDem protocol.Outcome measures: Pain intensity (patients self-reported pain with numerical rating scale [NRS] under static [NRSs] and dynamic [NRSd] conditions), amount of drug consumption, opioid adverse effects, and patient satisfaction.Efficacy endpoints: In more than 50 percent of the patients and in <72 hours, steady NRSs and NRSd score reduction of at least two points, NRSs ≤ 3 and NRSd ≤4; and mean daily morphine consumption < mean of one rescue dose and t1:t6 ratio of mean oxycodone daily dose < 1:2.Results: Endpoints were reached within 24 hours both within the sample and subgroups. Only NAOP patients reached NRSd ≤ 4 endpoint within 48 hours. Against moderate and transient adverse effects, most patients (84.4 percent) found pain treatment to be good or excellent.Conclusions: The CoDem protocol was shown to be effective and reasonably tolerated for titration for moderate/severe cancer pain relief in both opioid-naïve or opioid-tolerant cancer in-patients. This pilot assessment warrants prospective and comparative studies with larger samples for more generalized results.

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Effects of Quetiapine on Sleep in Nonpsychiatric and Psychiatric Conditions

Annals of Pharmacotherapy ◽

10.1345/aph.1l320 ◽

2009 ◽

Vol 43 (4) ◽

pp. 707-713 ◽

Cited By ~ 34

Author(s):

Jessica N Wine ◽

Christina Sanda ◽

Joshua Caballero

Keyword(s):

Adverse Effects ◽

Sleep Problems ◽

Case Reports ◽

Data Extraction ◽

Immediate Release ◽

Sleep Time ◽

Current Data ◽

Metabolic Complications ◽

Periodic Leg Movements ◽

Beneficial Effects

Objective: To evaluate the use of immediate-release quetiapine for the treatment of insomnia. Data Sources: Pre-MEDLINE and MEDLINE were searched (1966 to October 2008) using the terms quetiapine, sleep, insomnia, and antipsychotics. Study Selection and Data Extraction: All studies and case reports evaluating insomnia as a primary endpoint were reviewed. Data Synthesis: The role of quetiapine for improving sleep in various patient populations is uncertain. Quetiapine has moderately sedative properties, and closes used in treatment of insomnia have ranged from 12.5 to 800 mg. Results of clinical trials and observations in case studies have revealed possible beneficial effects of quetiapine on several subjective and objective sleep parameters. In most studies, significant improvements in sleep were found in areas of total sleep time, sleep efficiency, and subjective sleep scores. However, some of these results may not be clinically significant. Also, quetiapine has been found to have adverse effects such as periodic leg movements, akathisia, and metabolic complications. Additionally, changes in rapid eye movement (REM) and percentage of REM sleep have been noted in different populations and need further study. Despite quetiapine's sedative properties, current data do not appear to support its use as first-line treatment for sleep complications. However, it may be useful for treatment of insomnia in patients with psychiatric disorders (eg, bipolar, schizophrenia) who do not respond to primary or secondary treatments. Conclusions: Further studies are needed to define the placement, dose, and adverse effects of quetiapine for the treatment of sleep problems.

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The Influence of Specimen Thickness in Quantitative Electron Energy Loss Spectroscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s1431927600000441 ◽

1980 ◽

Vol 38 ◽

pp. 112-113

Author(s):

Nestor J. Zaluzec

Keyword(s):

Quantitative Analysis ◽

Adverse Effects ◽

Energy Loss ◽

Electron Energy ◽

Electron Energy Loss Spectroscopy ◽

Materials Science ◽

Light Element ◽

Specimen Thickness ◽

Element Analysis ◽

Electron Energy Loss

The application of electron energy loss spectroscopy (EELS) to light element analysis is rapidly becoming an important aspect of the microcharacterization of solids in materials science, however relatively stringent requirements exist on the specimen thickness under which one can obtain EELS data due to the adverse effects of multiple inelastic scattering.1,2 This study was initiated to determine the limitations on quantitative analysis of EELS data due to specimen thickness.

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