International journal of clinical practice. Supplement
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Int J Clin Pract Suppl · Feb 2003
ReviewBuprenorphine TDS: the clinical development rationale and results.
Buprenorphine, a powerful opioid, is newly available for delivery in a transdermal formulation. The transdermal system's matrix patch provides rate-controlled administration of the drug. Three double-blind, placebo-controlled trials were conducted to evaluate efficacy and tolerability of the buprenorphine transdermal system (buprenorphine TDS, Transtec). ⋯ Systemic adverse effects reported in the drug cohorts included nausea, vomiting and dizziness, and were typical of those reported in other studies of opioids; local adverse events, most commonly erythema and pruritus, were transient and mild to moderate. In an open-label, follow-up trial, in which 239 patients from the original clinical studies participated, 90% of patients reported that their analgesia was satisfactory or even better over a mean duration of 4.7 months; nearly 95% of patients found the patch to be user-friendly. The new buprenorphine TDS appears to be an important new modality for administering analgesia in patients with non-acute pain.
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Int J Clin Pract Suppl · Feb 2003
ReviewBuprenorphine and the transdermal system: the ideal match in pain management.
A system for the transdermal administration of the opioid drug buprenorphine has recently been introduced. Buprenorphine has physico-chemical properties, including a low molecular weight and high analgesic potency, that make it an excellent compound for transdermal drug delivery. The new technology (buprenorphine TDS, Transtec) is an advanced system that contains the active drug incorporated into a polymer matrix, which is at the same time the adhesive layer. ⋯ Buprenorphine TDS was developed for the treatment of moderate to severe cancer pain and severe pain which does not respond to non-opioid analgesics. Not only does this transdermal system provide excellent analgesia and a low incidence of adverse events, but its ease of use results in greater compliance. The patch provides excellent adhesion and has a low susceptibility to damage that might lead to toxicity or opioid abuse.
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Int J Clin Pract Suppl · Jul 2002
ReviewThe effects of glucose fluctuation on cognitive function and QOL: the functional costs of hypoglycaemia and hyperglycaemia among adults with type 1 or type 2 diabetes.
It is traditionally believed that while acute hypoglycaemia has detectable negative consequences, such as unpleasant symptoms and cognitive-motor disruptions, acute hyperglycaemia is not associated with such consequences. However, recent research with adults affected by either type 1 or 2 diabetes mellitus demonstrates that relatively mild hyperglycaemia is associated with unpleasant symptoms and cognitive disruptions. Both hyperglycaemia and hypoglycaemia can be associated with patient experiences of physical, affective, and cognitive symptoms, as well as cognitive-motor disruptions. ⋯ If the person is engaging in a relatively dangerous task, such as driving a vehicle, significant consequences could follow. Both hypoglycaemia and hyperglycaemia have been demonstrated to have not only acute, but also chronic effects in patients with type 1 as well as those with type 2 diabetes. Although hypoglycaemia occurs at a lower rate among patients with type 2 diabetes than among those with type 1, the number of patients with type 2 diabetes is so large that even this low rate results in many persons being affected.
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Int J Clin Pract Suppl · Jun 2002
ReviewThe tolerability and safety of cholinesterase inhibitors in the treatment of dementia.
Cholinesterase inhibitors (ChEIs) are dosed in two phases for the treatment of dementia, an initial dose-escalation phase to achieve a therapeutic dose and a maintenance phase where the therapeutic dose is given for long-term therapy. ChEIs are associated with a range of side effects as a result of cholinergic stimulation in different areas of the brain and the periphery Acute, centrally-mediated gastrointestinal events (mostly nausea and vomiting) are class effects of all ChEIs, and are reported mostly during the dose-escalation phase of therapy. These events have been associated more with the dual acetylcholinesterase/butyrylcholinesterase (AChE/BuChE) inhibitor rivastigmine than with the AChE-selective inhibitors donepezil and galantamine, probably due to rivastigmine's higher potency. ⋯ When dosed with care, ChEIs are well tolerated and patient compliance and patient and caregiver acceptability are good. The favourable tolerability and safety profiles of these agents make them suitable first-line therapy for dementia. In addition, patients who have tolerability and/or safety problems in maintenance treatment that limit the use of donepezil or galantamine may benefit from switching to rivastigmine.
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Int J Clin Pract Suppl · Mar 2002
ReviewCommunity-acquired lower respiratory tract infections: clinical experience with beta-lactam/beta-lactamase inhibitors.
Once universally susceptible to aminopenicillins and cephalosporins, an increasing percentage of the common respiratory pathogens that cause community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are now resistant to these agents and exhibit cross-resistance to other commonly used antibiotics. In an era of multidrug resistance, guidelines for the management of both CAP and AECB can help to guide appropriate antibiotic prescribing, encourage the rational use of antibiotics, which will help to limit the emergence of resistance, and conserve the use of new antimicrobial agents for more serious infections. Central to all current management guidelines is risk assessment, which includes an appreciation of local antibiotic resistance patterns. beta-Lactam antibiotics are still considered among the drugs of choice for the treatment of CAP and AECB, although their use can be compromised by high rates of resistance. The beta-lactam/beta-lactamase inhibitor combinations, such as ampicillin/sulbactam, provide a means of overcoming such resistance and represent a suitable alternative.