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CNS Drugs

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https://www.readbyqxmd.com/read/29230675/clozapine-and-gastrointestinal-hypomotility
#1
REVIEW
Dan Cohen
Gastrointestinal hypomotility (GIH) is an under-reported but highly prevalent and potentially dangerous side effect of clozapine. In a comprehensive meta-analysis of clozapine-treated patients, the prevalence of GIH was 32%. In general, GIH has consistently been reported to have a negative impact on quality of life, and there is no reason to believe this will be different in clozapine-treated patients with therapy-resistant schizophrenia. GIH is dangerous; in a comparative review of lethal side effects of clozapine, the mortality of agranulocytosis was 2...
December 11, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29214384/dispensability-of-annual-laboratory-follow-up-after-more-than-2%C3%A2-years-of-valproic-acid-use-a-systematic-review
#2
REVIEW
Rosanne W Meijboom, Koen P Grootens
BACKGROUND: The necessity of annual laboratory follow-up in patients treated with valproic acid (VPA) is controversial. OBJECTIVE: We investigated the need for annual laboratory follow-up of liver enzymes, electrolytes, and full blood count (FBC) in patients treated with VPA. PATIENTS AND METHODS: A systematic search in Evidence-Based Medicine Reviews (EBMR), MEDLINE, and EMBASE was undertaken in December 2016 to identify all published articles investigating or citing valproic acid, liver function disorders, electrolyte disorders, and FBC deviations...
December 6, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29204953/comparing-safety-and-efficacy-of-third-generation-antiepileptic-drugs-long-term-extension-and-post-marketing-treatment
#3
REVIEW
Charlotte S Kwok, Emily L Johnson, Gregory L Krauss
Four "third-generation" antiepileptic drugs (AEDs) were approved for adjunctive treatment of refractory focal onset seizures during the past 10 years. Long-term efficacy and safety of the drugs were demonstrated in large extension studies and in reports of subgroups of patients not studied in pivotal trials. Reviewing extension study and post-marketing outcome series for the four newer AEDs-lacosamide, perampanel, eslicarbazepine acetate and brivaracetam-can guide clinicians in treating and monitoring patients...
December 4, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29139041/drug-safety-analysis-in-a-real-life-cohort-of-parkinson-s-disease-patients-with-polypharmacy
#4
Saskia Müller-Rebstein, Claudia Trenkwalder, Jens Ebentheuer, Wolfgang H Oertel, Carsten Culmsee, Günter U Höglinger
BACKGROUND: Polypharmacy is common in geriatric Parkinson's disease (PD) patients in advanced disease stages with multiple comorbidities, bearing multiple risks for drug safety in theory. OBJECTIVE: The aim of this study was to empirically identify the most frequent and relevant contraindications and drug interactions actually occurring and compromising drug safety in PD in real life. METHODS: We conducted a prospective observational study in a multimorbid cohort of PD patients with polypharmacy admitted to a specialized hospital...
November 14, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29134566/lisdexamfetamine-a-review-in-binge-eating-disorder
#5
Young-A Heo, Sean T Duggan
Oral lisdexamfetamine dimesylate (Vyvanse(®); lisdexamfetamine), a prodrug of dextroamfetamine, is currently the only drug to be approved in the USA for the treatment of moderate to severe binge eating disorder (BED) in adult patients. Its approval was based on the results of two pivotal short-term (12 weeks) phase III studies, which showed a significantly greater reduction in binge eating days/week at the end of the study with lisdexamfetamine 50-70 mg/day than with placebo. The findings of these studies have been supported and extended by the results of longer-term (≤ 52 weeks) phase III studies, including one with a randomized 26-week withdrawal phase, which showed that lisdexamfetamine markedly reduced the risk of BED relapse relative to placebo...
November 13, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29098660/therapeutic-potential-of-ursolic-acid-to-manage-neurodegenerative-and-psychiatric-diseases
#6
Ana B Ramos-Hryb, Francis L Pazini, Manuella P Kaster, Ana Lúcia S Rodrigues
Ursolic acid is a pentacyclic triterpenoid found in several plants. Despite its initial use as a pharmacologically inactive emulsifier in pharmaceutical, cosmetic and food industries, several biological activities have been reported for this compound so far, including anti-tumoural, anti-diabetic, cardioprotective and hepatoprotective properties. The biological effects of ursolic acid have been evaluated in vitro, in different cell types and against several toxic insults (i.e. 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, amyloid-β peptides, kainic acid and others); in animal models of brain-related disorders (Alzheimer disease, Parkinson disease, depression, traumatic brain injury) and ageing; and in clinical studies with cancer patients and for muscle atrophy...
November 2, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29076058/pharmacotherapy-of-cardiovascular-autonomic-dysfunction-in-parkinson-disease
#7
REVIEW
Cyndya A Shibao, Horacio Kaufmann
Cardiovascular autonomic dysfunctions, including neurogenic orthostatic hypotension, supine hypertension and post-prandial hypotension, are relatively common in patients with Parkinson disease. Recent evidence suggests that early autonomic impairment such as cardiac autonomic denervation and even neurogenic orthostatic hypotension occur prior to the appearance of the typical motor deficits associated with the disease. When neurogenic orthostatic hypotension develops, patients with Parkinson disease have an increased risk of mortality, falls, and trauma-related to falls...
October 26, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29063471/granulocyte-colony-stimulating-factor-g-csf-for-the-treatment-of-spinal-cord-injury
#8
MirHojjat Khorasanizadeh, Mahsa Eskian, Alexander R Vaccaro, Vafa Rahimi-Movaghar
Spinal cord injury (SCI) is a common medical condition with a poor prognosis for recovery and catastrophic effects on a patient's quality of life. Available treatments for SCI are limited, and the evidence suggesting their harmful side effects is more consistent than any suggestion of clinical benefit. Developing novel safe and effective therapeutic options for SCI is crucial. Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine with known multifaceted effects on the central nervous system...
October 23, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28980198/randomized-double-blind-placebo-controlled-acute-comparator-trials-of-lisdexamfetamine-and-extended-release-methylphenidate-in-adolescents-with-attention-deficit-hyperactivity-disorder
#9
Jeffrey H Newcorn, Peter Nagy, Ann C Childress, Glen Frick, Brian Yan, Steven Pliszka
BACKGROUND: Psychostimulants are considered first-line pharmacotherapy for youth with attention-deficit/hyperactivity disorder (ADHD), but questions remain regarding the comparative efficacy of amphetamine- and methylphenidate-based agents. OBJECTIVE: Our objective was to describe two acute randomized, double-blind, placebo-controlled, head-to-head studies of lisdexamfetamine dimesylate (LDX) and osmotic-release oral system methylphenidate (OROS-MPH) in adolescents with ADHD...
October 4, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28948574/correlation-between-serum-concentrations-of-n-desmethylclozapine-and-granulocyte-levels-in-patients-with-schizophrenia-a-retrospective-observational-study
#10
Robert L Smith, Tore Haslemo, Ole A Andreassen, Erik Eliasson, Marja-Liisa Dahl, Olav Spigset, Espen Molden
BACKGROUND: Clozapine is restricted to use in patients with treatment-refractory schizophrenia due to the risk of a serious drop in absolute neutrophil granulocyte count (ANC). The formation of reactive, unstable metabolites (adducts) has been suggested as a mechanism of clozapine-induced granulocyte decline. These adducts are not detectable in vivo, but stable clozapine metabolites could potentially be indirect pharmacokinetic measures of adduct formation. OBJECTIVE: The present retrospective observational study investigated the correlation between concentrations of N-desmethylclozapine, the major stable clozapine metabolite, and ANC in a real-life population of clozapine-treated patients...
September 25, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29052031/do-pharmaceuticals-improve-driving-in-individuals-with-adhd-a-review-of-the-literature-and-evidence-for-clinical-practice
#11
REVIEW
Craig B H Surman, Ronna Fried, Lauren Rhodewalt, Heidi Boland
Attention-deficit/hyperactivity disorder (ADHD) is defined as a disorder of impaired attention and/or behavioral control. Studies suggest that the condition can dispose individuals to a higher risk of automobile accidents. ADHD symptoms respond to pharmacotherapy in a majority of uncomplicated cases. Evidence on how pharmacotherapies for ADHD impact driving behavior or outcomes could allow clinicians to support on-road safety rationally. We therefore undertook a review to identify the evidence base to date indicating positive or negative effects of pharmacotherapies on driving behavior in individuals with ADHD...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/29039138/the-role-of-gaba-receptor-agonists-in-anesthesia-and-sedation
#12
REVIEW
Janette Brohan, Basavana G Goudra
GABA (γ-aminobutyric acid) receptors, of which there are two types, are involved in inhibitory synapses within the central nervous system. The GABAA receptor (GABAAR) has a central role in modern anesthesia and sedation practice, which is evident from the high proportion of agents that target the GABAAR. Many GABAAR agonists are used in anesthesia practice and sedation, including propofol, etomidate, methohexital, thiopental, isoflurane, sevoflurane, and desflurane. There are advantages and disadvantages to each GABAAR agonist currently in clinical use...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28975553/selecting-rational-drug-combinations-in-epilepsy
#13
Bassel Abou-Khalil
Monotherapy remains the standard initial therapy of epilepsy, but when the first antiepileptic drug (AED) fails, combination therapy may be considered. The choice of combination therapy should take into consideration pharmacokinetic interactions, as well as pharmacodynamic interactions related to mechanism of action. There is evidence that an AED combination with different mechanisms of action is more likely to be successful than a combination with the same mechanisms. The combination of lamotrigine and valproate has been demonstrated to be synergistic in its efficacy...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28965335/pregabalin-use-among-users-of-illicit-drugs-a-cross-sectional-survey-in-southern-germany
#14
Brendan J Snellgrove, Tilman Steinert, Susanne Jaeger
BACKGROUND: The antiepileptic drug pregabalin is one of the best-selling pharmaceutical products worldwide. There are increasing concerns about its potential for misuse and dependence especially among patients with former or current substance use disorders (SUDs). OBJECTIVE: Our objective was to clarify the extent and pattern of pregabalin use as well as motives and predictors in this population. METHODS: We conducted a cross-sectional study with patients on a detoxification ward for illicit drugs at the Center for Psychiatry, Südwürttemberg, Ravensburg in southern Germany from August 2012 until July 2013...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28948486/efficacy-and-tolerability-of-phytomedicines-in-multiple-sclerosis-patients-a-review
#15
REVIEW
Mohammad Hosein Farzaei, Zahra Shahpiri, Roodabeh Bahramsoltani, Marjan Moghaddam Nia, Fariba Najafi, Roja Rahimi
Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disorder of the central nervous system (CNS) that can cause cognition, mobility, and sensory impairments. It is considered one of the most common non-traumatic causes of disability in the world. The aim of the present article was to review the clinical evidence related to medicinal plants in the management of MS symptoms. Electronic databases, including the Cochrane Library, Pubmed, and Scopus, were searched for entries from 1966 to February 2017...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28940143/narcolepsy-type-1-as-an-autoimmune-disorder-evidence-and-implications-for-pharmacological-treatment
#16
Lucie Barateau, Roland Liblau, Christelle Peyron, Yves Dauvilliers
Narcolepsy type 1 (NT1) is a rare sleep disorder caused by the very specific loss of hypothalamic hypocretin (Hcrt)/orexin neurons. The exact underlying process leading to this destruction is yet unknown, but indirect evidence strongly supports an autoimmune origin. The association with immune-related genetic factors, in particular the strongest association ever reported in a disease with an allele of a human leukocyte antigen (HLA) gene, and with environmental factors (i.e., the H1N1 influenza infection and vaccination during the pandemic in 2009) are in favor of such a hypothesis...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28856580/can-matching-adjusted-indirect-comparison-methods-mitigate-placebo-response-differences-among-patient-populations-in-adjunctive-trials-of-brivaracetam-and-levetiracetam
#17
Elyse Swallow, Anna Fang, James Signorovitch, Jonathan Plumb, Simon Borghs
BACKGROUND AND OBJECTIVE: Patients with focal seizures recruited into adjunctive antiepileptic drug (AED) trials have become more refractory and severe over time; concurrently, placebo responses have increased. To attempt to account for heterogeneity among trials, propensity-score weighted patient-level data were used to indirectly compare placebo responses reported in brivaracetam and levetiracetam trials. METHODS: Patient-level data from randomised, placebo-controlled brivaracetam (recruited 2007-2014) and levetiracetam (1993-1998) trials were pooled...
October 2017: CNS Drugs
https://www.readbyqxmd.com/read/28808933/cardiovascular-disease-in-clozapine-treated-patients-evidence-mechanisms-and-management
#18
REVIEW
Kathlyn J Ronaldson
Myocarditis occurs in about 3% of those initiated on clozapine but monitoring reduces the risk of serious outcome. Cardiomyopathy may develop after myocarditis, or from prolonged tachycardia. Monitoring using echocardiography is not deemed cost effective. Tachycardia, orthostatic hypotension and reduced heart rate variability are a group of clozapine-related adverse effects associated with autonomic dysfunction and may have serious consequences in the long term. Elevated heart rate and poor heart rate variability can be treated with a β-blocker or a non-dihydropyridine calcium channel blocker, while orthostatic hypotension can be alleviated by increased fluid intake and abdominal binding, but may require pharmacological intervention...
September 2017: CNS Drugs
https://www.readbyqxmd.com/read/28808918/idarucizumab-in-dabigatran-treated-patients-with-acute-ischemic-stroke-receiving-alteplase-a-systematic-review-of-the-available-evidence
#19
REVIEW
Slaven Pikija, Laszlo K Sztriha, J Sebastian Mutzenbach, Stefan M Golaszewski, Johann Sellner
BACKGROUND AND PURPOSE: Current guidelines do not recommend the use of intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke who receive direct oral anticoagulants. While the humanized monoclonal antibody idarucizumab can quickly reverse the anticoagulant effects of the thrombin inhibitor dabigatran, safety data for subsequent tissue plasminogen activator treatment are sparse. Here, we review current knowledge about dabigatran reversal prior to systemic reperfusion treatment in acute ischemic stroke...
September 2017: CNS Drugs
https://www.readbyqxmd.com/read/28791656/egfr-as-a-target-for-glioblastoma-treatment-an-unfulfilled-promise
#20
Manfred Westphal, Cecile L Maire, Katrin Lamszus
The receptor for epidermal growth factor (EGFR) is a prime target for cancer therapy across a broad variety of tumor types. As it is a tyrosine kinase, small molecule tyrosine kinase inhibitors (TKIs) targeting signal transduction, as well as monoclonal antibodies against the EGFR, have been investigated as anti-tumor agents. However, despite the long-known enigmatic EGFR gene amplification and protein overexpression in glioblastoma, the most aggressive intrinsic human brain tumor, the potential of EGFR as a target for this tumor type has been unfulfilled...
September 2017: CNS Drugs
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