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Advances in Rheumatology (London,... Jan 2020EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the...
BACKGROUND
EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990).
OBJECTIVE
To analyze the therapeutic measures prescribed by Brazilian physicians.
MATERIALS AND METHODS
Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics.
RESULTS
We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%).
CONCLUSION
In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.
Topics: Amitriptyline; Analgesics; Analgesics, Non-Narcotic; Brazil; Cohort Studies; Combined Modality Therapy; Cross-Sectional Studies; Drug Therapy, Combination; Duloxetine Hydrochloride; Exercise; Female; Fibromyalgia; Health Education; Humans; Male; Middle Aged; Muscle Stretching Exercises; Pregabalin; Registries
PubMed: 31964420
DOI: 10.1186/s42358-019-0108-2 -
Current Pain and Headache Reports Mar 2021Though first bite syndrome is well known in surgical settings, it is not commonly included in the differential for sharp paroxysmal facial pain in the neurology... (Review)
Review
PURPOSE OF REVIEW
Though first bite syndrome is well known in surgical settings, it is not commonly included in the differential for sharp paroxysmal facial pain in the neurology literature. This paper will highlight the clinical features and relevant anatomy of first bite syndrome, with the goal of helping clinicians differentiate this from other similar facial pain disorders.
RECENT FINDINGS
First bite syndrome is severe sharp or cramping pain in the parotid region occurring with the first bite of each meal and improving with subsequent bites. Pathophysiology has been attributed to imbalanced sympathetic/parasympathetic innervation of the parotid gland. This is seen most typically in the post-surgical setting following surgery in the parotid or parapharyngeal region, but neoplastic etiologies have also been reported. It is common for patients to present with concurrent great auricular neuropathy and/or Horner's syndrome. Evidence regarding treatment is limited to case reports/series, however, botulinum toxin injections and neuropathic medicines have been helpful in select cases. It is critical for clinicians to be able to differentiate first bite syndrome from other paroxysmal facial pain. To help with this, we have proposed diagnostic criteria for clinical assessment. Patients often improve gradually over time, but symptomatic treatment with botulinum toxin or neuropathic medicine may be required.
Topics: Acetylcholine Release Inhibitors; Amitriptyline; Analgesics, Non-Narcotic; Botulinum Toxins; Carotid Body Tumor; Facial Pain; Head and Neck Neoplasms; Horner Syndrome; Humans; Muscle Relaxants, Central; Otorhinolaryngologic Surgical Procedures; Parapharyngeal Space; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Squamous Cell Carcinoma of Head and Neck; Tonsillar Neoplasms
PubMed: 33761012
DOI: 10.1007/s11916-021-00950-7 -
International Journal of Pharmaceutics Jun 2020The drug loading efficiency was evaluated using a binder-jet 3D printing process by incorporating an active pharmaceutical ingredient (API) in ink, and quantifying the...
The drug loading efficiency was evaluated using a binder-jet 3D printing process by incorporating an active pharmaceutical ingredient (API) in ink, and quantifying the printability property of ink solutions. A dimensionless parameter Ohnesorge was calculated to understand the printability property of the ink solutions. A pre-formulation study was also carried out for the raw materials and printed tablets using thermal analysis and compendial tests. The compendial characterization of the printed tablets was evaluated with respect to weight variation, hardness, disintegration, and size; Amitriptyline Hydrochloride was considered as the model API in this study. Four concentrations of the API ink solutions (5, 10, 20, 40 mg/mL) were used to print four printed tablet batches using the same tablet design file. The excipient mixture used in the study was kept the same and consists of Lactose monohydrate, Polyvinyl pyrrolidone K30, and Di-Calcium phosphate Anhydrate. The minimum drug loading achieved was 30 μg with a minimal variation (RSD) of <0.26%. The distribution of the API on the tablet surface and throughout the printed tablets were observed using SEM-EDS. In contrast, the micro-CT images of the printed tablets indicated the porous surface structure of the tablets. The immediate release properties of the printed tablets were determined using a dissolution study in a modified USP apparatus II.
Topics: Amitriptyline; Calcium Phosphates; Drug Liberation; Excipients; Ink; Lactose; Povidone; Printing, Three-Dimensional; Tablets; Technology, Pharmaceutical; X-Ray Microtomography
PubMed: 32416133
DOI: 10.1016/j.ijpharm.2020.119430 -
International Journal of Rheumatic... Apr 2023
Topics: Humans; Amitriptyline; Fibromyalgia; Off-Label Use
PubMed: 37002904
DOI: 10.1111/1756-185X.14618 -
Brazilian Journal of Otorhinolaryngology 2022Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages.
INTRODUCTION
Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages.
OBJECTIVE
To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients.
METHODS
Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B- group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated.
RESULTS
There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B- group patients (p<0.001 for all). The mean Migraine Disability Assessment Scale score gains (p<0.001) and vertigo attack frequency gains (p= 0.003) were significantly higher in the B+ patients than B- patients.
CONCLUSIONS
Both B+ and B- group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.
Topics: Adult; Humans; Flunarizine; Propranolol; Amitriptyline; Dizziness; Botulinum Toxins, Type A; Vertigo; Migraine Disorders; Headache
PubMed: 33722518
DOI: 10.1016/j.bjorl.2021.02.005 -
The Medical Letter on Drugs and... Mar 2023
Topics: Humans; Amitriptyline; Sleep Initiation and Maintenance Disorders; Off-Label Use; Antidepressive Agents
PubMed: 36897604
DOI: 10.58347/tml.2023.1672d -
Archives of Microbiology Mar 2022This study investigates the effects of antidepressants fluoxetine, sertraline, and amitriptyline on the development of antibiotic resistance in clinical Acinetobacter...
This study investigates the effects of antidepressants fluoxetine, sertraline, and amitriptyline on the development of antibiotic resistance in clinical Acinetobacter baumannii isolates. The isolates were exposed to fluoxetine, sertraline, and amitriptyline for 30 days, respectively. The bacteria that developed resistance to gentamicin, imipenem, colistin, and ciprofloxacin were isolated and expression levels of some antibiotic-resistance genes were determined by quantitative reverse-transcriptase PCR. Before and after the exposure, minimum inhibitory concentration (MIC) values of the bacteria were determined by the microdilution method. The statistical analysis was performed using Student's t test. A time-dependent increase was observed in the number of bacteria that developed resistance and increased the MIC value. After exposure to fluoxetine and sertraline, decreases were observed for efflux and outer membrane porin genes in isolates that developed colistin resistance, and increases were observed in isolates that developed ciprofloxacin resistance. These observations suggest that these antidepressants have similar effects on the development of resistance. While the exposure to fluoxetine did not result in the development of resistance to imipenem, it was observed after exposure to sertraline and amitriptyline, and a common decrease in ompA gene expression was determined in these isolates. To our knowledge, the comparative effects of selected antidepressants on the development of antibiotic resistance in A. baumannii are reported and presented in the literature here for the first time.
Topics: Acinetobacter baumannii; Amitriptyline; Antidepressive Agents; Drug Resistance, Multiple, Bacterial; Fluoxetine; Humans; Sertraline
PubMed: 35355118
DOI: 10.1007/s00203-022-02853-6 -
Indian Journal of Pharmacology 2020To evaluate and compare efficacy and tolerability of Vilazodone with Escitalopram and Amitriptyline in patients of major depressive disorder(MDD). (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparative evaluation of efficacy and tolerability of vilazodone, escitalopram, and amitriptyline in patients of major depressive disorder: A randomized, parallel, open-label clinical study.
OBJECTIVES
To evaluate and compare efficacy and tolerability of Vilazodone with Escitalopram and Amitriptyline in patients of major depressive disorder(MDD).
METHODS
This was a randomized, prospective, parallel-group, open label clinical study in which newly diagnosed patients of MDD were randomized to receive Tab Vilazodone 20 mg daily or Tab Escitalopram 20mg daily or Tab Amitriptyline 75mg daily for 12 weeks. Antidepressant activity was assessed by change in score from baseline to week 12 on HAMD-17 and MADRS scales while change in score on HAM-A scale was used to assess antianxiety effect. Change in scores on the three scales was also compared between the three treatment groups. Severity and causality of adverse events were assessed by the modified Hartwig & Siegel scale and Naranjo scale respectively. Data was analyzed in accordance with per protocol analysis.
RESULTS
Reduction in HAMD-17 and MADRS scores was significantly more in vilazodone group compared to the other two drugs indicating that vilazodone is more efficacious antidepressant. Number of remitters were also significantly more in the vilazodone group (=11) compared to escitalopram (=4) (<0.05) and amitriptyline (=0) (<0.001) at 12 weeks. Similar results were also obtained with HAM-A score. Number of patients showing MADRS sustained response at 12 weeks was statistically significantly more in vilazodone (=12) and escitalopram (=12) groups compared to amitriptyline (=01) (<0.001). Reported adverse events were constipation and sedation(amitriptyline group); nausea and headache(escitalopram and vilazodone groups). These adverse events were of mild severity. Most adverse events belonged to probable category.
CONCLUSION
Vilazodone is more efficacious and well tolerated antidepressant compared to escitalopram and amitriptyline.
Topics: Adult; Affect; Amitriptyline; Antidepressive Agents; Citalopram; Depressive Disorder, Major; Female; Humans; India; Male; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome; Vilazodone Hydrochloride; Young Adult
PubMed: 32565594
DOI: 10.4103/ijp.IJP_441_18 -
Journal of Analytical Toxicology Mar 2017A common treatment for chronic pain is prescription of analgesics, but their long-term use entails risk of morbidity, addiction and misuse. One way to reduce the risk of...
A common treatment for chronic pain is prescription of analgesics, but their long-term use entails risk of morbidity, addiction and misuse. One way to reduce the risk of abuse is prescribing of analgesics in a topical form. Physicians are urged to perform urine drug testing to ensure that patients are compliant with their medication regimens. However, there is little data on the efficiency of transdermal delivery for many analgesic drugs, and no data on expected urine drug levels. This study includes data from over 29,000 specimens tested for gabapentin, ketamine, cyclobenzaprine or amitriptyline used orally or topically. Gabapentin and amitriptyline concentrations were more likely to be below the limits of detection (25-40 ng/mL) in the urine of patients using them topically as compared with patients using them orally. Levels in gabapentin-positive topical specimens were much lower than in gabapentin-positive oral specimens (261 ng/mL vs >10,000 ng/mL). In contrast, ketamine and cyclobenzaprine were more readily detectable in the urine of topical users. Ketamine topical specimens were positive 12% more often than oral specimens, and mean topical specimen levels were 68-100% those of oral specimens. Cyclobenzaprine specimens were equally likely to be positive whether the dose was oral or topical, although mean levels after topical dosing were approximately 13-21% those after oral dosing. These findings are consistent with the reported percutaneous absorption efficiencies of gabapentin and ketamine, and are likely to be related to the absorption efficiencies of cyclobenzaprine and amitriptyline.
Topics: Administration, Oral; Administration, Topical; Amines; Amitriptyline; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Drug Monitoring; Gabapentin; Humans; Ketamine; Limit of Detection; Skin Absorption; Substance Abuse Detection; gamma-Aminobutyric Acid
PubMed: 28376226
DOI: 10.1093/jat/bkw110 -
Neuroscience Letters Sep 2018Pain control in opioid-dependent individuals is a clinical complication. The present study investigated the effects of different doses of amitriptyline in the three...
Pain control in opioid-dependent individuals is a clinical complication. The present study investigated the effects of different doses of amitriptyline in the three stages of the formalin test in morphine-dependent rats (MDRs). Morphine dependency was induced using the oral method, and then, amitriptyline-induced antinociceptive effects were measured at 4 doses (2.5, 5, 10, and 20 mg/kg) and compared with the control group in a formalin-based model of pain. There was no observed antinociceptive effect in the MDRs and morphine-naïve rats (MNRs) in phase I. In the interphase, amitriptyline induced pain suppression at doses of 5 and 20 mg/kg. In phase II, at doses of 5, 10, and 20 mg/kg, the hypoalgesic effect on pain-related behaviors was seen in the MNRs. In MDRs, amitriptyline at doses of 2.5 and 5 mg/kg caused the hyperalgesic effect, whereas at 10 and 20 mg/kg doses, it induced a hypoalgesic effect. A significant attenuation was observed in the latency to fall from the accelerating rotarod at doses of 10 and 20 mg/kg in the MDRs, and at a dose of 20 mg/kg in the MNRs. Data showed that amitriptyline dose-dependently induced paradoxical hypo- and hyper-algesic effects in MDRs.
Topics: Amitriptyline; Analgesics, Non-Narcotic; Analgesics, Opioid; Animals; Dose-Response Relationship, Drug; Hyperalgesia; Male; Morphine; Morphine Dependence; Pain; Pain Measurement; Rats; Rats, Wistar; Treatment Outcome
PubMed: 30081059
DOI: 10.1016/j.neulet.2018.08.001