Efficacy and safety of nonsteroidal antiinflammatory drugs for cancer pain: a meta-analysis.

1994 ◽  
Vol 12 (12) ◽  
pp. 2756-2765 ◽  
Author(s):  
E Eisenberg ◽  
C S Berkey ◽  
D B Carr ◽  
F Mosteller ◽  
T C Chalmers
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Cancer Pain ◽  
Multiple Dose ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Efficacy And Safety ◽  
Antiinflammatory Drugs ◽  
Pain Scores ◽  
Multiple Doses ◽  
Dose Effects

PURPOSE To assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of cancer pain by meta-analyses of the published randomized control trials (RCTs). PATIENTS AND METHODS Twenty-five studies met inclusion criteria for analysis. Of these, 13 tested a single-dose effect, nine multiple-dose effects, and three both single- and multiple-dose effects of 16 different NSAIDs in a total of 1,545 patients. Baseline pain intensity (when provided) of moderate or higher was indicated in 81% of patients. RESULTS Single-dose NSAID studies found greater analgesic efficacy than placebo, with rough equivalence to 5 to 10 mg of intramuscular morphine. Pain scores differed insignificantly for aspirin versus three other NSAIDs. Analgesic responses to low- and high-dose NSAIDs suggested a dose-response relationship, but this was not statistically significant. Recommended and supramaximal single doses of three NSAIDs produced comparable changes in pain scores, which indicates a ceiling analgesic effect. Common side effects included upper gastrointestinal symptoms, dizziness, and drowsiness. The incidence of side effects showed a trend to increase with dose, without a ceiling effect, and to increase with multiple doses. Single or multiple doses of weak opioids (WO) alone or in combination (WO/C) with nonopioid analgesics did not produce greater analgesia than NSAIDs alone. Single doses of WO/C analgesics produced more side effects than NSAIDs alone, although both side effect incidence and patient dropout rates were equal when multiple doses were administered. CONCLUSION These findings question whether the traditional World Health Organization (WHO) second analgesic step (addition of a weak opioid when pain is inadequately treated by a nonopioid analgesic alone) is warranted. A lack of comparable studies precluded testing the hypothesis that NSAIDs are particularly effective for malignant bone pain.

Albendazole: a review of anthelmintic efficacy and safety in humans

Parasitology ◽  
2000 ◽  
Vol 121 (S1) ◽  
pp. S113-S132 ◽  
Author(s):  
J. HORTON
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Strongyloides Stercoralis ◽  
Efficacy And Safety ◽  
Adverse Experiences ◽  
Ancylostoma Duodenale ◽  
Gastrointestinal Side Effects ◽  
Spectrum Activity ◽  
Cure Rates ◽  
General Community

This comprehensive review briefly describes the history and pharmacology of albendazole as an anthelminthic drug and presents detailed summaries of the efficacy and safety of albendazole's use as an anthelminthic in humans. Cure rates and % egg reduction rates are presented from studies published through March 1998 both for the recommended single dose of 400mg for hookworm (separately for Necator americanus and Ancylostoma duodenale when possible), Ascaris lumbricoides, Trichuris trichiura, and Enterobius vermicularis and, in separate tables, for doses other than a single dose of 400mg. Overall cure rates are also presented separately for studies involving only children 2–15 years. Similar tables are also provided for the recommended dose of 400mg per day for 3 days in Strongyloides stercoralis, Taenia spp. and Hymenolepis nana infections and separately for other dose regimens. The remarkable safety record involving more than several hundred million patient exposures over a 20 year period is also documented, both with data on adverse experiences occurring in clinical trials and with those in the published literature and/or spontaneously reported to the company. The incidence of side effects reported in the published literature is very low, with only gastrointestinal side effects occurring with an overall frequency of just >1%. Albendazole's unique broad-spectrum activity is exemplified in the overall cure rates calculated from studies employing the recommended doses for hookworm (78% in 68 studies: 92% for A. duodenale in 23 studies and 75% for N. americanus in 30 studies), A. lumbricoides (95% in 64 studies), T. trichiura (48% in 57 studies), E. vermicularis (98% in 27 studies), S. stercoralis (62% in 19 studies), H. nana (68% in 11 studies), and Taenia spp. (85% in 7 studies). The facts that albendazole is safe and easy to administer, both in treatment of individuals and in treatment of whole communities where it has been given by paramedical and nonmedical personnel, have enabled its use to improve general community health, including the improved nutrition and development of children.

Aspirin Synergistically Potentiates Isoflurane Minimum Alveolar Concentration Reduction Produced by Morphine in the Rat 

1998 ◽  
Vol 89 (6) ◽  
pp. 1489-1494 ◽  
Author(s):  
Ignacio A. Gomez de Segura ◽  
Ana B. Criado ◽  
Martin Santos ◽  
Francisco J. Tendillo
Keyword(s):  
Side Effects ◽  
Minimum Alveolar Concentration ◽  
Synergistic Effects ◽  
Objective Measure ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Before And After ◽  
Male Wistar Rats ◽  
Clinically Significant ◽  
Analgesic Potency

Background The combination of opioids and nonsteroidal antiinflammatory drugs is more analgesic than the summed effect of each drug administered separately. This synergism has been used to obtain analgesia in the postoperative period at doses at which side effects are minimal. The aim of this study is to evaluate the analgesic interaction between aspirin and morphine in the rat during isoflurane anesthesia. The reduction in minimum alveolar concentration of isoflurane (MAC(ISO)) was used as an objective measure of the analgesic potency of individual drugs and their use in combination. Methods Thirty-seven male Wistar rats were anesthetized with isoflurane in oxygen, and the MAC(ISO) was determined before and after the intravenous administration of aspirin and morphine. Rats were administered morphine alone (1, 3, and 10 mg/kg) or morphine (1 and 3 mg/kg) and aspirin (30 mg/kg). The MAC(ISO) was determined from alveolar gas samples at the time of tail clamp. The duration of MAC(ISO) reduction was recorded. Results Aspirin did not have an effect on MAC(ISO), (average, 1.35+/-0.1%), whereas the combination of morphine (1 and 3 mg/kg) and aspirin (30 mg/kg) produced a reduction in the dose of morphine needed to produce the same degree of MAC(ISO) reduction. Actual MAC(ISO+drug) data were as follows: 1 mg/kg morphine, 1.17+/-0.14%; 3 mg/kg morphine, 0.98+/-0.15%; 1 mg/kg morphine plus aspirin, 0.90+/-0.04%; 10 mg/kg morphine, 0.63+/-0.13%; and 3 mg/kg morphine plus aspirin, 0.64+/-0.06%. Conclusions The synergistic effects of aspirin and morphine allow a clinically significant reduction in the requirements of isoflurane and isoflurane plus morphine, and these drug combinations may decrease the side effects associated with the use of single higher, equianalgesic doses of these drugs.

scholarly journals Computer search for molecular mechanisms of ulcerogenic action of nonsteroidal antiinflammatory drugs

2014 ◽  
Vol 60 (1) ◽  
pp. 7-16 ◽  
Author(s):  
S.M. Ivanov ◽  
A.A. Lagunin ◽  
A.V. Zakharov ◽  
D.A. Filimonov ◽  
V.V. Poroikov
Keyword(s):  
Side Effects ◽  
Molecular Mechanisms ◽  
Structural Formula ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Mechanisms Of Action ◽  
Computer Search ◽  
Peptic Ulcers ◽  
Antiinflammatory Drugs ◽  
Material Resources ◽  
Data Signal

“Peptic ulcers” is the most frequent side effect of non-steroidal anti-inflammatory drugs (NSAIDs). Experimental data indicate that pathogenesis of peptic ulcers cannot be explained only by the inhibition of cyclooxygenases. The knowledge about other molecular mechanisms of action of drugs related with development of peptic ulcers could be useful for design of new safe NSAIDs. However, considerable time and material resources are needed for corresponding experimental research. For simplification of experimental search, we have developed an approach for in silico identification of probable molecular mechanisms of action of drugs related with its side effects. We have created the set of NSAIDs containing 85 substances with data about structures and side effects. The computer program PASS (Prediction of Activity Spectra for Substances) predicting more than 3000 molecular mechanisms of action based on structural formula of substances was used to estimate unknown molecular mechanisms of action for these set of NSAIDs. Statistically significant relationships between predicted molecular mechanisms of action and development of peptic ulcers have been established. We have discovered twenty-six molecular mechanisms of action (two known previously and twenty-four new) which probably related with development of peptic ulcers. By analyzing of Gene Ontology data, signal and metabolic pathways, publications in Medline, we formulated hypotheses about the role of ten molecular mechanisms of action in pathogenesis of peptic ulcer.

scholarly journals Fentanyl-sparing Effect of Acetaminophen as a Mixture of Fentanyl in Intravenous Parent-/Nurse-controlled Analgesia after Pediatric Ureteroneocystostomy

2010 ◽  
Vol 113 (3) ◽  
pp. 672-677 ◽  
Author(s):  
Jeong-Yeon Hong ◽  
Won Oak Kim ◽  
Bon Nyeo Koo ◽  
Jin Sun Cho ◽  
Eun H. Suk ◽  
...  
Keyword(s):  
Side Effects ◽  
Infusion Rate ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Pediatric Pain ◽  
Pain Scores ◽  
Blinded Study ◽  
Sparing Effect ◽  
Double Blinded ◽  
Fentanyl Group

Background Although acetaminophen has been used widely and is well tolerated in children, its efficacy and safety have not been clarified when combined with an opioid in intravenous parent-/nurse-controlled postoperative analgesia. Methods Sixty-three children (aged 6-24 months) who had undergone elective ureteroneocystostomies were enrolled in this prospective, randomized, double-blinded study. After the surgery, an analgesic pump was programmed to deliver fentanyl at a basal infusion rate of 0.25 microg.kg(-1).h(-1) and 0.25 microg/kg bolus after a loading dose of 0.5 microg/kg(-1). In the fentanyl-acetaminophen group, acetaminophen was coadministered as a solution mixture at a basal infusion rate of 1.5 mg.kg(-1).h(-1) and 1.5 mg/kg bolus after a loading dose of 15 mg/kg, whereas saline was administered to the fentanyl group. Results Postoperative pain scores were similar between the two groups. The total dose (micrograms per kilogram per day, mean+/-SD) of fentanyl at postoperative days 1 (8.3+/-3.7 vs. 18.1+/-4.6, P=0.021) and 2 (7.0+/-2.4 vs. 16.6, P=0.042) was significantly less in the fentanyl-acetaminophen group compared with that in the fentanyl group. The incidences of vomiting (16.1 vs. 56.3%, P=0.011) and sedation (9.7 vs. 46.9%, P=0.019) were significantly lower in the fentanyl-acetaminophen group than those in the fentanyl group. Conclusions Acetaminophen has significant fentanyl-sparing effects and reduces side effects when combined with fentanyl in intravenous parent-/nurse-controlled analgesia for postoperative pediatric pain management.

Epidural Nonsteroidal Antiinflammatory Drugs for Cancer Pain

1998 ◽  
Vol 86 (1) ◽  
pp. 117-118 ◽  
Author(s):  
Gabriela R. Lauretti ◽  
Marlene P. Reis ◽  
Anita L. Mattos ◽  
Josenilia M. A. Gomes ◽  
Ana-Paula M. Oliveira ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs

Antibiotic Prophylaxis In Prostate Biopsy: A Comparative Study Between Single Dose & Multiple Doses Of Ciprofloxacin

2020 ◽  
Vol 16 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Md Sirajul Islam ◽  
Ma Awal ◽  
Sm Mahbub Alam
Keyword(s):  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
Multiple Dose ◽  
Dose Group ◽  
Statistical Significance ◽  
College Hospital ◽  
Medical College ◽  
Multiple Doses ◽  
Quasi Experimental

Objective: To compare the effect of single dose and multiple doses of ciprofloxacin as prophylaxis for prostate biopsy. Method and material: This was a prospective quasi-experimental study carried in the department of Urology, Dhaka Medical College Hospital over seventy patients undergoing prostate biopsy. Half of the patients received single dose of ciprofloxacin and the rest half received three doses of the same drug as antibiotic prophylaxis. Result: Two patients from single dose group and one patient from multiple dose group developed urinary tract infection without any statistical significance Conclusion: Single dose of ciprofloxacin has equal clinical and bacteriological efficacy as that of multiple doses of the same drug for prophylaxis in prostate biopsy. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.5-10

Anakinra in a Cohort of Children with Chronic Nonbacterial Osteomyelitis

2017 ◽  
Vol 44 (8) ◽  
pp. 1231-1238 ◽  
Author(s):  
Manuela Pardeo ◽  
Denise Pires Marafon ◽  
Virginia Messia ◽  
Maria Carmen Garganese ◽  
Fabrizio De Benedetti ◽  
...  
Keyword(s):  
Bone Scintigraphy ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Practical Significance ◽  
Bone Lesions ◽  
Efficacy And Safety ◽  
C Reactive Protein ◽  
Antiinflammatory Drugs ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Chronic Nonbacterial Osteomyelitis

Objective.To report efficacy and safety in patients with chronic nonbacterial osteomyelitis (CNO) unresponsive to nonsteroidal antiinflammatory drugs (NSAID) and bisphosphonates and/or glucocorticoids treated with anakinra.Methods.Nine patients (6 females) with refractory CNO were treated with anakinra for at least 6 months. We recorded, at baseline and after 6 months of treatment, clinical and laboratory features, and number and distribution of bone lesions detected by 99mTc-MDP bone scintigraphy. Disease activity was evaluated using a physician’s global assessment (PGA).Results.At baseline, 9/9 patients had mild to severe PGA. After 6 months of treatment, in 5 patients the PGA score was graded from none to minimal. At baseline, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated in 8 out of 9 patients. After 6 months, 5/9 patients had normalized CRP and ESR and in all except 1, CRP and ESR decreased. Before starting anakinra, a total of 77 bone lesions were detected by bone scintigraphy. After 6 months of treatment of the 77 lesions, 42 had resolved and 35 were stable. In 7/9 patients, 20 new lesions appeared during treatment; 2 of these 7 patients were symptomatic. At the last followup visit (median 1.7 yrs, range 0.8–2.8), 6/9 patients maintained a PGA graded as none to minimal.Conclusion.Anakinra is a possible therapeutic alternative in patients with refractory CNO. The practical significance of clinically silent bone lesions detected by bone scintigraphy remains to be established.

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