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Titrate from narcotics

Marilyn Moro, Karen Gannon, Kathy Lovell, Margaret Merlino, James Mojica, Matt T Bianchi
PURPOSE: Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%-15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. METHODS: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night)...
2016: Nature and Science of Sleep
Natalya Dinat, Edmore Marinda, Shirra Moch, Andrew S C Rice, Peter R Kamerman
UNLABELLED: We conducted a randomized, double-blind, placebo-controlled, crossover study at a single center in South Africa, to ascertain whether amitriptyline is an effective analgesic for painful HIV-associated sensory neuropathy of moderate to severe intensity in: i) antiretroviral drug naive individuals, and ii) antiretroviral drug users. 124 HIV-infected participants (antiretroviral drug naive = 62, antiretroviral drug users = 62) who met the study criteria for painful HIV-associated sensory neuropathy were randomized to once-daily oral amitriptyline (titrated to a median: interquartile range of 50: 25-50 mg) or placebo for six weeks, followed by a three-week washout period and subsequent treatment crossover...
2015: PloS One
Mona Darwish, Ronghua Yang, William Tracewell, Philmore Robertson, Mary Bond
PURPOSE: A hydrocodone extended-release (ER) formulation was developed to provide sustained pain relief with twice-daily dosing. Developed using the CIMA abuse-deterrence technology platform (CIMA Labs Inc, Brooklyn Park, Minnesota), this formulation also provides resistance against rapid release of hydrocodone when tablets are comminuted and resistance against dose dumping when tablets are taken with alcohol. Two open-label studies evaluated hydrocodone ER pharmacokinetics (PK) after single- and multiple-dose administration in healthy, naltrexone-blocked subjects...
February 1, 2015: Clinical Therapeutics
Adrian Bartoli, Edward Michna, Ellie He, Warren Wen
BACKGROUND: Hydrocodone/acetaminophen combination analgesics are frequently prescribed for chronic pain management; however, acetaminophen presents potential hepatotoxicity to patients and thus dose limitations. These opioid medications are also widely abused. Once-daily, single-entity hydrocodone (Hysingla™ ER tablets [HYD]) is a novel formulation with abuse-deterrent properties for the management of chronic pain and represents a suitable option for those patients receiving analgesics containing the same opioid analgesic, hydrocodone...
January 2015: Postgraduate Medicine
Chunxia Huang, Yuen-Shan Ho, Olivia Tsz-Wa Ng, Michael G Irwin, Raymond Chuen-Chung Chang, Gordon Tin-Chun Wong
Exposure to anesthetic agents has been linked to abnormal tau protein phosphorylation, an antecedent to the development of neurofibrillary tangles. This study evaluates the direct and indirect effects of dexmedetomidine. Primary culture of cortical neurons established from Sprague-Dawley (SD) rat embryos were exposed to dexmedetomidine for 1 or 6 hours, and the degree of tau phosphorylation at the AT8, AT180, and S396 sites was assessed by western blot analysis. To assess and compare their relative in vivo effects, the same agent was administered intravenously to 8 to 10 week old male SD rats and titrated to the loss of the righting reflex for 2 hours...
2015: Journal of Alzheimer's Disease: JAD
Matthias Görges, Nicholas West, Rebecca Deyell, Pamela Winton, Wesley Cheung, Gillian Lauder
BACKGROUND: Treatment of neuroblastoma with targeted immunotherapy using chimeric anti-GD2 monoclonal antibodies (ch14.18) is associated with significant pain requiring management with a high-dose opioid infusion. We present a case series of six children, for whom dexmedetomidine and hydromorphone infusions safely and effectively reduced the pain of ch14.18 therapy in the oncology ward setting. PROCEDURE: The ch14.18 infusion is administered for ≥ 10 hr over four consecutive days in each of 5 cycles...
January 2015: Pediatric Blood & Cancer
Jordan F Karp, Meryl A Butters, Amy E Begley, Mark D Miller, Eric J Lenze, Daniel M Blumberger, Benoit H Mulsant, Charles F Reynolds
OBJECTIVE: To describe the clinical effect and safety of low-dose buprenorphine, a κ-opioid receptor antagonist, for treatment-resistant depression (TRD) in midlife and older adults. METHOD: In an 8-week open-label study, buprenorphine was prescribed for 15 adults aged 50 years or older with TRD, diagnosed with the Structured Clinical Interview for DSM-IV, between June 2010 and June 2011. The titrated dose of buprenorphine ranged from 0.2-1.6 mg/d. We assessed clinical change in depression, anxiety, sleep, positive and negative affect, and quality of life...
August 2014: Journal of Clinical Psychiatry
Paolo Mannelli, Li-Tzy Wu, Kathleen S Peindl, Marvin S Swartz, George E Woody
BACKGROUND: The approval of extended release injectable naltrexone (XR-NTX; Vivitrol(®)) has introduced a new option for treating opioid addiction, but studies are needed to identify its place within the spectrum of available therapies. The absence of physiological opioid dependence is a necessary and challenging first step for starting XR-NTX. Outpatient detoxification gives poor results and inpatient detoxification is either unavailable or too brief for the physiological effects of opioids to resolve...
May 1, 2014: Drug and Alcohol Dependence
Ajlan Atasoy, Gordana Bogdanovic, Archil Aladashvili, Zeljka Cvijetic, Mircea Dediu, Nada Cicmil-Saric, Armen Nersesyan, Athanasios Athanasiou, Nazim Serdar Turhal
PURPOSE: While pain is highly prevalent in cancer patients and its management is universally challenging, it is more commonly undertreated in the developing world. Southeastern European countries have limited resources and manpower to allocate for delivery of effective care for cancer-related pain. The purpose of this study was to explore the practice methods and the barriers to effective pain management in Southeastern Europe. METHODS: We conducted a Web-based survey using a specially designed questionnaire among physicians practicing in member countries of the Balkan Union of Oncology (BUON)...
October 2013: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
Andrew B Norman, Michael R Tabet, Mantana K Norman, Vladimir L Tsibulsky
The change in frequency of cocaine self-administration as a function of the unit dose is widely assumed to represent a graded pharmacodynamic response. Alternatively, a pharmacological theory states that during maintained self-administration, a quantal response occurs at a minimum maintained cocaine concentration (satiety threshold). Rats self-administered cocaine at unit doses spanning an 8-fold range from 0.75 to 6 µmol/kg. Despite an approximately 7-fold difference in the interinjection intervals, there were no differences in the plasma cocaine concentration at the time of lever press across this range of unit doses, consistent with the satiety threshold representing an equiactive cocaine concentration...
February 2014: Journal of Pharmacology and Experimental Therapeutics
DaiWai M Olson, Meg G Zomorodi, Michael L James, Christopher E Cox, Eugene W Moretti, Kristina E Riemen, Carmelo Graffagnino
BACKGROUND: Pharmacological sedation is a necessary tool in the management of critically ill, mechanically ventilated patients. The intensive care unit (ICU) sedation strategy is to use the least amount of medication to meet safety and comfort goals. Titration of pharmacological agents is currently guided by clinical assessment tools. The purpose of this study was to determine whether the addition of a neurophysiological monitor, bispectral index (BIS), aided the ICU nurse in reducing the amount of drug used, compared to a clinical tool alone, in a general critical care population...
August 2014: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Alisia A Mitchell, Anne J Sapienza-Crawford, Kari L Hanley, Kristi J Lokey, Linda Wells, Gladstone C McDowell, Michael Stanton-Hicks
Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose...
September 2013: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Beatrice Setnik, Carl L Roland, Veeraindar Goli, Kenneth Sommerville, Lynn Webster
OBJECTIVE: To evaluate whether intact or crushed doses of an extended-release formulation of morphine sulfate surrounding an inner core of sequestered naltrexone (MSN) induces signs and symptoms of withdrawal in opioid-dependent patients. DESIGN: Randomized, double-blind, two-way crossover study. SETTING: Single center. PATIENTS: Fourteen patients with chronic moderate-to-severe noncancer pain receiving opioids were enrolled into the study; six completed the maintenance and treatment phases prior to early study discontinuation for issues with manufacturing; eight discontinued: adverse effects (4), noncompliance (1), patient decision (1), study termination (2)...
March 2013: Journal of Opioid Management
Jason E Pope, Timothy R Deer
INTRODUCTION: Ziconotide is an N-type calcium channel antagonist to treat chronic pain that is delivered intrathecally. It is the only intrathecal, FDA-approved, non-opioid analgesic and is recommended as first-line therapy. Despite these advantages, a small therapeutic window limits ziconotide's clinical utility, with adverse event (AE) challenges that include, but are not limited to, dizziness, nausea, and somulence. AREAS COVERED: Pharmacokinetics, pharmacodynamics, efficacy, safety, trialing, and chronic infusion after searching EMBASE, PubMed, and Cochrane Database of Systemic Reviews were used to search published literature from 1966 to January 1, 2013 to identify studies related to the intrathecal delivery of ziconotide...
May 2013: Expert Opinion on Pharmacotherapy
Katrina B Mitchell, Elie Khalil, Ann Brennan, Huibo Shao, Angela Rabbitts, Nicole E Leahy, Roger W Yurt, James J Gallagher
This study evaluated a 24-hour resuscitation protocol, established a formula to quantify resuscitation volume for the second 24 hours, described the relationship between the first and second 24 hours, and identified which patients required high volumes. A protocol for patients with burn >15% TBSA was implemented in 2009. Initial fluid was based on the Parkland calculation and adjusted to meet a goal urine output. Protocol compliance was defined as appropriate fluid titration to maintain urine output. Resuscitation ratio in the second 24 hours was tabulated as total fluid /(evaporative loss + maintenance fluid + estimated colloid)...
January 2013: Journal of Burn Care & Research: Official Publication of the American Burn Association
Joseph V Pergolizzi, Robert B Raffa, Robert Taylor, Swati Nagar, Sumedha Labhsetwar, Nicholas Sinclair, Errol M Gould
OBJECTIVE: The aging population generally has greater need for analgesics and is best served by having as many good therapeutic options as possible. Geriatric analgesia requires special consideration of age-associated physiologic changes that can affect drug dosing. The study of extended-release (ER) oxymorphone in older (≥ 65 years of age) versus younger (18-40 years of age) male and female volunteers was described. METHODS: In this multiple-dose, parallel-group, open-label trial, healthy volunteers received a single oral dose of 20 mg oxymorphone ER on day 1, followed by a 48-hour washout period, then two oral doses of 20 mg oxymorphone ER tablets every 12 hours from day 3 to day 8, and a single oral dose of 20 mg oxymorphone ER on day 9...
November 2012: Journal of Opioid Management
Ian S Wedmore, Russ S Kotwal, John G McManus, Andre Pennardt, Timothy S Talbot, Marcie Fowler, Laura McGhee
BACKGROUND: Acute pain, resulting from trauma and other causes, is a common condition that imposes a need for prehospital analgesia on and off the battlefield. The narcotic most frequently used for prehospital analgesia on the battlefield during the past century has been morphine. Intramuscular morphine has a delayed onset of pain relief that is suboptimal and difficult to titrate. Although intravenously administered morphine can readily provide rapid and effective prehospital analgesia, oral transmucosal fentanyl citrate (OTFC) is a safe alternative that does not require intravenous access...
December 2012: Journal of Trauma and Acute Care Surgery
Jeremy R Johnson, Dominique Lossignol, Mary Burnell-Nugent, Marie T Fallon
CONTEXT: Chronic pain in patients with advanced cancer poses a serious clinical challenge. The Δ9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (U.S. Adopted Name, nabiximols; Sativex(®)) is a novel cannabinoid formulation currently undergoing investigation as an adjuvant therapy for this treatment group. OBJECTIVES: This follow-up study investigated the long-term safety and tolerability of THC/CBD spray and THC spray in relieving pain in patients with advanced cancer...
August 2013: Journal of Pain and Symptom Management
E P Su, M Perna, F Boettner, D J Mayman, T Gerlinger, W Barsoum, J Randolph, G Lee
Pain, swelling and inflammation are expected during the recovery from total knee arthroplasty (TKA) surgery. The severity of these factors and how a patient copes with them may determine the ultimate outcome of a TKA. Cryotherapy and compression are frequently used modalities to mitigate these commonly experienced sequelae. However, their effect on range of motion, functional testing, and narcotic consumption has not been well-studied. A prospective, multi-center, randomised trial was conducted to evaluate the effect of a cryopneumatic device on post-operative TKA recovery...
November 2012: Journal of Bone and Joint Surgery. British Volume
Denis Dupoiron, Francois Bore, Daniele Lefebvre-Kuntz, Olivier Brenet, Sabine Debourmont, Florence Dixmerias, Nadia Buisset, Nathalie Lebrec, Dominique Monnin
BACKGROUND: Ziconotide is a new analgesic agent administered intrathecally. It is challenging to use and can induce several and sometimes serious adverse events. A low initial dosage followed by slow titration may reduce serious adverse events. OBJECTIVE: To determine whether a low starting dosage of ziconotide, followed by slow titration, decreases the incidence of major adverse events associated with ziconotide when used for intractable cancer pain. STUDY DESIGN: Observational cohort study...
September 2012: Pain Physician
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