Articles: dextromethorphan-therapeutic-use.
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Caring for patients with prolonged persistent pain remains one of nursing's greatest challenges. Increased knowledge and understanding of pain pathways, however, has enabled new treatments to be incorporated into pain management regimes. ⋯ This review will explore the physiological processes associated with these phenomena, and the use of NMDA receptor antagonists such as ketamine and dextromethorphan to prevent and treat persistent pain. The importance of nurses understanding the modes of action of these drugs will be illustrated through presentation of two case histories.
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Dextrorphan, but not dextromethorphan, exerts weak antidystonic effects in mutant dystonic hamsters.
The effects of dextromethorphan and its metabolite dextrorphan on severity of dystonia were examined in mutant dystonic hamsters, an animal model of idiopathic paroxysmal dystonia, in which recent examinations have shown antidystonic effects of selective N-methyl-D-aspartate (NMDA) receptor antagonists. Dextromethorphan and dextrorphan are non-competitive NMDA receptor antagonists which additionally exhibit affinity for sigma receptors. Dextrorphan (20 and 40 mg/kg i.p.) significantly retarded the progression of dystonia at the higher dose, whereas dextromethorphan (20, 40, 60 mg/kg i.p.) failed to exert any antidystonic effects even at high doses which caused severe effects. The lack of antidystonic efficacy of dextromethorphan may be related to its higher affinity to sigma receptors compared with dextrorphan.
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The effects of combined single oral treatments with non-steroidal anti-inflammatory drugs (NSAIDs) and the non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist dextromethorphan (DM) on arthritic pain were examined in a rat model of adjuvant-induced arthritis. Although 12.5-100 mg/kg doses of DM alone produced no reliable effects, treatments with ibuprofen (IB, 50 and 100 mg/kg but not 12.5 or 25 mg/kg) produced mild analgesia in arthritic rats as determined using the Randall-Sellito test. IB showed a dose-response relationship which appeared to plateau at doses of 50 and 100 mg/kg. ⋯ For all six NSAIDS, the addition of 50 mg/kg DM reliably increased their analgesic potency, as indicated by reliable increases in previously effective NSAID doses (all six NSAIDs) as well as previously ineffective NSAID doses (IB, NP, DC, and PIR). These data demonstrate that DM greatly potentiates the analgesic activity of IB, DC, NP, PIR, ET, and KT and increases the peak effect over the NSAIDs alone. Similiar to DM's previously demonstrated enhancement of opioid analgesia in acute pain, the combination of DM and an NSAID may represent a novel analgesic approach to improved management of arthritic pain.
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Randomized Controlled Trial Clinical Trial
Dextromethorphan for the treatment of neuropathic pain: a double-blind randomised controlled crossover trial with integral n-of-1 design.
The aim was to compare the analgesic effectiveness and adverse effect incidence of oral dextromethorphan (DM) with placebo in patients with neuropathic pain. The first 10-day treatment period was a multiple-dose double-blind randomised controlled cross-over comparison of 13.5 mg of DM 3 times a day (t.d.s.) with placebo t.d.s.: 5 treatment pairs, each pair 1 day DM and 1 day placebo. The second 10-day treatment period used 27 mg of DM t.d.s. vs. placebo, with the same design. ⋯ Five patients continued with DM after the study for 1-3 months. No long-term clinical benefit was apparent in those who continued with open DM. Dextromethorphan at either 40.5 or 81 mg daily did not relieve neuropathic pain.
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J Am Board Fam Pract · Mar 1993
Randomized Controlled Trial Comparative Study Clinical TrialClinical trial examining effectiveness of three cough syrups.
Cough is one of the most common symptoms of respiratory infections for which patients seek relief. This study was done to assess the effectiveness of three commonly prescribed cough syrups. ⋯ It appears that codeine, dextromethorphan, and guaifenesin are equally effective in relieving cough symptoms.