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Opioid dose ranges

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https://www.readbyqxmd.com/read/28101968/defined-daily-doses-ddd-do-not-accurately-reflect-opioid-doses-used-in-contemporary-chronic-pain-treatment
#1
Suzanne Nielsen, Natasa Gisev, Raimondo Bruno, Wayne Hall, Milton Cohen, Briony Larance, Gabrielle Campbell, Marian Shanahan, Fiona Blyth, Nicholas Lintzeris, Sallie Pearson, Richard Mattick, Louisa Degenhardt
OBJECTIVE: To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients. DESIGN: Descriptive, cross-sectional study, utilising a 7-day medication diary. SETTING: Community-based treatment settings, Australia. SUBJECTS: A sample of 1101 people prescribed opioids for chronic non-cancer pain. METHODS: Opioid dose data was collected via a self-completed 7-day medication diary capturing names, strengths and doses of each medication taken in the past week...
January 19, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28089187/effect-of-periarticular-morphine-injection-for-total-knee-arthroplasty-a-randomized-double-blind-trial
#2
Kentaro Iwakiri, Yoshito Minami, Yoichi Ohta, Akio Kobayashi
BACKGROUND: The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA...
December 27, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28088507/patient-reported-outcomes-and-opioid-use-in-outpatients-with-chronic-pain
#3
Lisa R Witkin, David Zylberger, Neel Mehta, Madeleine Hindenlang, Christopher Johnson, Jacob Kean, Susan D Horn, Charles E Inturrisi
: The Weill Cornell Medical College (WCMC) Pain Registry database contains patient characteristics, treatments, and outcomes for a prospective cohort of 1159 chronic pain patients who were seen at the WCMC Pain Medicine outpatient clinic from 7/08/2011 to 12/10/2014. Patients aged 45-64 comprised 43% followed by age >=65 at 37%. Fifty-eight percent were female. Average pain intensity (Brief Pain Inventory) was reported as mild by 22.3% of patients, moderate by 34.7%, and severe by 43...
January 11, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28073687/adverse-event-detection-using-the-fda-post-marketing-drug-safety-surveillance-system-cardiotoxicity-associated-with-loperamide-abuse-and-misuse
#4
Kimberley A Swank, Eileen Wu, Cindy Kortepeter, Jana McAninch, Robert L Levin
OBJECTIVE: The purpose of this investigation was to identify and characterize post-marketing reports of cardiotoxicity, including torsades de pointes (TdP), associated with loperamide use. METHODS: We searched the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database for post-marketing reports of serious cardiac adverse events associated with loperamide use from December 28, 1976 (U.S. drug approval date), through December 14, 2015. We also conducted a Pubmed and Google Scholar search to identify additional published reports of cardiotoxicity associated with loperamide in the medical literature through February 11, 2016...
January 7, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28063863/correlation-between-observational-scales-of-sedation-and-comfort-and-bispectral-index-scores-bis
#5
Michael Barbato, Greg Barclay, Jan Potter, Wilf Yeo, Joseph Chung
CONTEXT: When palliative care patients enter the phase of unconsciousness preceding death it is standard practice to initiate or continue a subcutaneous infusion of an opioid plus or minus a sedative. The doses are determined somewhat empirically and adjustments are based on clinical assessment and observational measures of sedation and comfort. Following reports that these observational measures could be misleading, this study assesses their validity by comparing them with an objective measure of sedation, the Bispectral Index score (BIS)...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28053591/potentially-inappropriate-medications-prescribed-for-elderly-patients-through-family-physicians
#6
Abdulaziz Al Odhayani, Ayla Tourkmani, Mohammed Alshehri, Hala Alqahtani, Adel Mishriky
The elderly population is increasing throughout the globe, resulting in higher healthcare costs. Potential inappropriate medication (PIM) prescriptions are a major health problem affecting the elderly persons. Due to limited studies in PIM use in primary care and home healthcare in Saudi Arabia, we aim to examine the extent of PIM prescription for and use by elderly patients. This study was carried out with 798 elderly patients, arbitrarily selected from Prince Sultan Medical Military City through the patient register...
January 2017: Saudi Journal of Biological Sciences
https://www.readbyqxmd.com/read/28049031/the-efficacy-of-dynorphin-fragments-at-the-%C3%AE%C2%BA-%C3%AE-and-%C3%AE-opioid-receptor-in-transfected-hek-cells-and-in-an-animal-model-of-unilateral-peripheral-inflammation
#7
M Morgan, A Heffernan, F Benhabib, S Wagner, A K Hewavitharana, P N Shaw, P J Cabot
Dynorphin 1-17 is an endogenous peptide that is released at sites of inflammation by leukocytes, binding preferentially to κ-opioid receptors (KOP) to mediate nociception. We have previously shown that dynorphin 1-17 is rapidly biotransformed to smaller peptide fragments in inflamed tissue homogenate. This study aimed to determine the efficacy and potency of selected dynorphin fragments produced in an inflamed environment at the KOP, μ and δ-opioid receptors (MOP and DOP respectively) and in a model of inflammatory pain...
December 31, 2016: Peptides
https://www.readbyqxmd.com/read/28035588/clinical-pharmacokinetics-and-pharmacodynamics-of-naloxegol-a-peripherally-acting-%C3%A2%C2%B5-opioid-receptor-antagonist
#8
REVIEW
Khanh Bui, Diansong Zhou, Hongmei Xu, Eike Floettmann, Nidal Al-Huniti
Naloxegol is a peripherally acting µ-opioid receptor antagonist approved for use as an orally administered tablet (therapeutic doses of 12.5 and 25 mg) for the treatment of opioid-induced constipation. Over a wide dose range (i.e. single supratherapeutic doses up to 1000 mg in healthy volunteers), the pharmacokinetic properties of naloxegol appear to be time- and dose-independent. Naloxegol is rapidly absorbed, with mean time to maximum plasma concentration of <2 h. Following once-daily administration, steady state is achieved within 2-3 days and minimal accumulation is observed...
December 29, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/27995643/loperamide-trends-in-abuse-and-misuse-over-13-years-2002-2015
#9
Daniel R Lasoff, Cynthia H Koh, Bryan Corbett, Alicia B Minns, F Lee Cantrell
STUDY OBJECTIVE: With the increasing amount of information available on the Internet describing techniques for using loperamide either for self-treatment of opioid withdrawal syndromes or for recreational use ("legal highs"), the objective was to describe a statewide poison control system's experience with loperamide misuse and abuse, with specific interest in cases of cardiotoxicity, and to determine if there has been a recent increase in reported loperamide misuse or abuse cases. DESIGN: Retrospective review...
December 20, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27993764/implementation-of-solutions-to-reduce-opioid-induced-oversedation-and-respiratory-depression
#10
Barry Meisenberg, John Ness, Sumati Rao, Jane Rhule, Cathaleen Ley
PURPOSE: The implementation of interventions to mitigate the causes of opioid-induced oversedation and respiratory depression (OSRD) is reported. SUMMARY: A single-site retrospective review of eligible rescue naloxone cases was conducted to identify the causes of opioid-induced OSRD in a hospital as well as to identify risk factors. A survey was used to assess potential opioid knowledge deficits among hospitalist prescribers. Based on the findings of the case reviews and results of the opioid knowledge assessments, a series of interventions to address noted deficiencies was implemented over the ensuing months, including enhanced monitoring for sedation, improved clinical decision support in the electronic medical record (EMR), and various adjustments to dosing for high-risk patients...
December 19, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27980437/the-analgesic-efficacy-of-intravenous-lidocaine-infusion-after-laparoscopic-fundoplication-a-prospective-randomized-double-blind-placebo-controlled-trial
#11
Gregory J Dale, Stephanie Phillips, Gregory L Falk
This study aimed to determine if intravenous lidocaine infusion reduces postoperative pain intensity following laparoscopic fundoplication surgery and to also validate the safety of intravenous lidocaine at the dose tested. This was an equally randomized, double-blind, placebo-controlled, parallel-group, single center trial. Adult patients undergoing laparoscopic fundoplication were recruited. The intervention group received 1 mg/kg intravenous lidocaine bolus prior to induction of anesthesia, then an intravenous infusion at 2 mg/kg/h for 24 hours...
2016: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/27896019/naloxone-and-metabolites-quantification-in-cord-blood-of-prenatally-exposed-newborns-and-correlations-with-maternal-concentrations
#12
Samantha L Wiegand, Madeleine J Swortwood, Marilyn A Huestis, John Thorp, Hendreé E Jones, Neeta L Vora
Objective To quantify naloxone and metabolite concentrations in newborns prenatally exposed to sublingual buprenorphine/naloxone and to correlate neonatal and maternal metabolite concentrations. Methods This is a prospective observational cohort study. Eleven pregnant women treated for opioid use disorder with sublingual buprenorphine/naloxone were enrolled. Maternal and newborn blood was collected and analyzed for naloxone, buprenorphine, and metabolites via liquid chromatography tandem mass spectrometry...
October 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/27870477/ascending-single-dose-double-blind-placebo-controlled-safety-study-of-noribogaine-in-opioid-dependent-patients
#13
Paul Glue, Gavin Cape, Donna Tunnicliff, Michelle Lockhart, Fred Lam, Noelyn Hung, C Tak Hung, Sarah Harland, Jane Devane, R S Crockett, John Howes, Borje Darpo, Meijian Zhou, Holger Weis, Lawrence Friedhoff
Ibogaine is a psychoactive substance that may reduce opioid withdrawal symptoms. This was the first clinical trial of noribogaine, ibogaine's active metabolite, in patients established on methadone opioid substitution therapy (OST). In this randomized, double-blind, placebo-controlled single ascending-dose study, we evaluated the safety, tolerability, and pharmacokinetics of noribogaine in 27 patients seeking to discontinue methadone OST who had been switched to morphine during the previous week. Noribogaine doses were 60, 120, or 180 mg (n = 6/dose level) or matching placebo (n = 3/dose level)...
November 2016: Clinical Pharmacology in Drug Development
https://www.readbyqxmd.com/read/27855148/notes-from-the-field-cardiac-dysrhythmias-after-loperamide-abuse-new-york-2008-2016
#14
William Eggleston, Jeanna M Marraffa, Christine M Stork, Maria Mercurio-Zappala, Mark K Su, Rachel S Wightman, Karen R Cummings, Joshua G Schier
Loperamide is an over-the-counter antidiarrheal with opioid-receptor agonist properties. Recommended over-the-counter doses (range = 2-8 mg daily) do not produce opioid effects in the central nervous system because of poor oral bioavailability and P-glycoprotein efflux* of the medication (1); recent reports suggest that large doses (50-300 mg) of loperamide produce euphoria, central nervous system depression, and cardiotoxicity (2-4). Abuse of loperamide for its euphoric effect or for self-treatment of opioid withdrawal is increasing (5)...
November 18, 2016: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/27849111/pharmacological-interventions-for-pruritus-in-adult-palliative-care-patients
#15
REVIEW
Waldemar Siemens, Carola Xander, Joerg J Meerpohl, Sabine Buroh, Gerd Antes, Guido Schwarzer, Gerhild Becker
BACKGROUND: This is an update of the original Cochrane review published in 2013 (Issue 6). Pruritus occurs in patients with disparate underlying diseases and is caused by different pathologic mechanisms. In palliative care patients, pruritus is not the most prevalent but is one of the most puzzling symptoms. It can cause considerable discomfort and affects patients' quality of life. OBJECTIVES: To assess the effects of different pharmacological treatments for preventing or treating pruritus in adult palliative care patients...
16, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27829810/effect-of-tramadol-on-metamizol-pharmacokinetics-and-pharmacodynamics-after-single-and-repeated-administrations-in-arthritic-rats
#16
Luis Alfonso Moreno-Rocha, Francisco Javier López-Muñoz, José Raúl Medina-López, Adriana Miriam Domínguez-Ramírez
Combined administration of certain doses of opioid compounds with a non-steroidal anti-inflammatory drug can produce additive or supra-additive effects while reducing unwanted effects. We have recently reported that co-administration of metamizol with tramadol produces antinociceptive effect potentiation, after acute treatment. However, none information about the effect produced by the combination after chronic or repeated dose administration exists. The aims of this study were to investigate whether the antinociceptive synergism produced by the combination of metamizol and tramadol (177...
November 2016: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
https://www.readbyqxmd.com/read/27826213/management-of-moderate-to-severe-chronic-low-back-pain-with-buprenorphine-buccal-film-using-novel-bioerodible-mucoadhesive-technology
#17
REVIEW
Joseph V Pergolizzi, Robert B Raffa, Charles Fleischer, Gianpietro Zampogna, Robert Taylor
With a global prevalence of ~9%-12%, low back pain (LBP) is a serious public health issue, associated with high costs for treatment and lost productivity. Chronic LBP (cLBP) involves central sensitization, a neuropathic pain component, and may induce maladaptive coping strategies and depression. Treating cLBP is challenging, and current treatment options are not fully satisfactory. A new BioErodible MucoAdhesive (BEMA(®)) delivery system for buprenorphine has been developed to treat cLBP. The buccal buprenorphine (BBUP) film developed for this product (Belbuca™) allows for rapid delivery and titration over a greater range of doses than was previously available with transdermal buprenorphine systems...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27799763/prescription-of-opioids-for-breathlessness-in-end-stage-copd-a-national-population-based-study
#18
Zainab Ahmadi, Eva Bernelid, David C Currow, Magnus Ekström
BACKGROUND: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. OBJECTIVES: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. METHODS: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27779775/clonidine-for-sedation-and-analgesia-and-withdrawal-in-critically-ill-infants-and-children
#19
REVIEW
Amanda C Capino, Jamie L Miller, Peter N Johnson
The need for sedation and analgesia and treatment of iatrogenic drug withdrawal is common in critically ill children. First-line therapy typically includes opioid agonists. However, clonidine, a central α2 agonist, has been suggested as a treatment option for sedation and analgesia and iatrogenic drug withdrawal. Therefore, we conducted a literature search to identify articles evaluating the use of enteral (PO) and transdermal clonidine in critically ill infants and children for sedation and analgesia and treatment of iatrogenic drug withdrawal...
December 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27779356/oral-morphine-dosing-predictions-based-on-single-dose-in-healthy-children-undergoing-surgery
#20
Joy M Dawes, Erin M Cooke, Jacqueline A Hannam, Katherine A Brand, Pamela Winton, Ricardo Jimenez-Mendez, Katarina Aleksa, Gillian R Lauder, Bruce C Carleton, Gideon Koren, Michael J Rieder, Brian J Anderson, Carolyne J Montgomery
BACKGROUND: Oral morphine has been proposed as an effective and safe alternative to codeine for after-discharge pain in children following surgery but there are few data guiding an optimum safe oral dose. AIMS: The aim of this study was to characterize the absorption pharmacokinetics of enteral morphine in order to simulate time-concentration profiles in children given common oral morphine dose regimens. METHODS: Children (2-6 years, n = 34) undergoing elective surgery and requiring opioid analgesia were randomized to receive preoperative oral morphine (100 mcg·kg(-1) , 200 mcg·kg(-1) , 300 mcg·kg(-1) )...
January 2017: Paediatric Anaesthesia
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