-
Journal of the American Academy of... Dec 2017Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new... (Review)
Review
BACKGROUND
Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new treatment options such as oral antidepressants.
OBJECTIVE
To evaluate the use of oral antidepressants in chronic pruritus by a systematic overview of the available relevant literature.
METHODS
The PubMed, EMBASE, Cochrane, and Web of Science databases were searched. Studies providing original data on the efficacy of oral antidepressants in patients with chronic pruritus were included. We assessed the risk for bias by using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.
RESULTS
A total of 35 studies evaluating the oral use of fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, nortriptyline, doxepin, and mirtazapine were included. The majority of included articles showed a marked improvement of pruritus during treatment with oral antidepressants.
LIMITATIONS
Recommendations are mainly based on open-label trials, case series, and case reports.
CONCLUSION
Oral antidepressants should be considered in patients with chronic pruritus that is unresponsive to topical treatment and oral antihistamines, particularly in patients with uremic pruritus, cholestatic pruritus, or paraneoplastic pruritus. More evidence based on randomized-controlled trials is required.
Topics: Administration, Oral; Antidepressive Agents; Antidepressive Agents, Tricyclic; Chronic Disease; Humans; Pruritus; Selective Serotonin Reuptake Inhibitors
PubMed: 29033248
DOI: 10.1016/j.jaad.2017.08.025 -
Sleep Medicine Reviews Apr 2018Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and... (Review)
Review
Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and chronic insomnia disorder. Evidence from case reports and cross-sectional studies suggests that antidepressants may induce or worsen restless legs syndrome and increase periodic limb movements. We undertook a systematic review of the literature to identify and collate all prospective studies that measured restless legs syndrome symptoms and/or periodic limb movements following the introduction of an antidepressant. Eighteen studies were eligible for inclusion. Current data indicate that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an antidepressant. Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements. One small study of normal volunteers suggested that venlafaxine may be associated with an increase in restless legs syndrome symptoms and periodic limb movements. Sertraline, fluoxetine, and amitriptyline appear to increase periodic limb movements that do not disrupt sleep and are thus unlikely to be clinically significant. On the other hand, bupropion may reduce restless legs syndrome symptoms, at least in the short term. Sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements. The current evidence is limited by poor study design, inadequate use of standardized questionnaires, and heterogeneous populations studied for variable lengths of time. Future research should attempt to remedy these shortcomings.
Topics: Antidepressive Agents; Comorbidity; Cross-Sectional Studies; Humans; Prospective Studies; Restless Legs Syndrome; Sleep
PubMed: 28822709
DOI: 10.1016/j.smrv.2017.06.002 -
Anais Brasileiros de Dermatologia 2016Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch... (Review)
Review
Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch complaints and the negative effects in the quality of life are observed in several medical fields. Although the partially obscure pathophysiology, some researchers decided to check and test the use of psychotropic drugs in resistant itch to conventional topical treatments and antihistamines. The objective of this study was to evaluate scientific evidence in psychotropic use in the treatment of itch of various causes. This is a systematic review of scientific literature. The following databases were used: PubMed, Web of Science, Scopus and Scielo. Randomized controlled trials that should focus on treatment with psychotropic drugs of pruritus of various causes were the inclusion criteria. All articles were analyzed by the authors, and the consensus was reached in cases of disagreement. Fifteen articles were included after analysis and selection in databases, with the majority of clinical trials focusing on psychopharmacological treatment of itch on account of chronic kidney disease. Clinical trials with psychotropic drugs mostly indicated significant improvement in the itching. In most trials of chronic kidney disease as basal disease for itch, greater effectiveness was observed with the use of psychotropic drugs compared with placebo or other antipruritic. However, the small amount of controlled trials conducted precludes the generalization that psychiatric drugs are effective for itch of various causes.
Topics: Amines; Antipruritics; Cyclohexanecarboxylic Acids; Doxepin; Gabapentin; Humans; Kidney Diseases; Pruritus; Psychotropic Drugs; Randomized Controlled Trials as Topic; Reproducibility of Results; Treatment Outcome; gamma-Aminobutyric Acid
PubMed: 28099602
DOI: 10.1590/abd1806-4841.20164878 -
Archives of Gerontology and Geriatrics 2017The present study aims to systematically review all potentially inappropriate medications for older persons included in prescribing criteria published in the last decade. (Review)
Review
OBJECTIVE
The present study aims to systematically review all potentially inappropriate medications for older persons included in prescribing criteria published in the last decade.
METHODS
A systematic review of published studies was performed. Articles describing the development of criteria for PIM Use in Older Adults published in the last decade and which provided a list of medications that should be considered inappropriate were included. The searches were conducted on Pubmed/Medline for articles published from 1st of January 2006 to 31st of December 2015. We analyzed the medications/classes reported in all criteria, most common classes and how many indications each medication made.
RESULTS
From 778 articles, 14 articles were included in our analysis (containing 14 different criteria). Europe was responsible for 8 criteria (57.2% of total) followed by Asia (3 criteria) and USA (2 criteria). More than 85% used a Delphi method. There were 729 different medications/classes reported in all criteria. Diazepam was included in all 14 criteria followed by amitriptyline (13 criteria) and doxepin (12 criteria). We found benzodiazepines, NSAIDs, antihistamines and antipsychotics were the most common drugs reported as potentially inappropriate for older persons.
CONCLUSION
The present study systematically compiled all medications included in 14 different criteria published last decade. Benzodiazepines, NSAIDs, antihistamines and antipsychotics were the most common drugs reported as potentially inappropriate for older persons. These results could help health professionals and panel experts to plan future criteria.
Topics: Humans; Inappropriate Prescribing; Pharmaceutical Preparations
PubMed: 27649514
DOI: 10.1016/j.archger.2016.09.003 -
Parkinsonism & Related Disorders Jun 2016Daytime sleepiness and sleep disorders are frequently reported in Parkinson's disease (PD). However, their impact on quality of life has been underestimated and few... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Daytime sleepiness and sleep disorders are frequently reported in Parkinson's disease (PD). However, their impact on quality of life has been underestimated and few clinical trials have been performed.
OBJECTIVES
We aimed to assess the efficacy and safety of pharmacological interventions for daytime sleepiness and sleep disorders in PD.
METHODS
Systematic review of randomized controlled trials comparing any pharmacological intervention with no intervention or placebo for the treatment of daytime sleepiness and sleep problems in PD patients.
RESULTS
Ten studies (n = 338 patients) were included. Four trials addressed interventions for excessive daytime sleepiness. Meta-analysis of the three trials evaluating modafinil showed a significant reduction in sleepiness, as assessed by the Epworth Sleepiness Scale (ESS) (- 2.24 points, 95% CI - 3.90 to - 0.57, p < 0.05). In one study, treatment with caffeine was associated with a non-significant improvement of 1.71 points in ESS (95% CI, - 3.57 to 0.13). The six remaining trials assessed interventions for insomnia and REM sleep Behaviour Disorder (RBD). Single study results suggest that doxepin and YXQN granules might be efficacious, while pergolide may be deleterious for insomnia and that rivastigmine may be used to treat RBD in PD patients. However, there is insufficient evidence to support or refute the efficacy of any of these interventions. No relevant side effects were reported.
CONCLUSIONS
Whilst providing recommendations, this systematic review depicts the lack of a body of evidence regarding the treatment of sleep disorders in PD patients; hence, further studies are warranted.
Topics: Disorders of Excessive Somnolence; Dopamine Agonists; Humans; Parkinson Disease; Randomized Controlled Trials as Topic; Sleep Wake Disorders; Wakefulness-Promoting Agents
PubMed: 27010071
DOI: 10.1016/j.parkreldis.2016.03.002 -
The Cochrane Database of Systematic... Oct 2015Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively in PD.
OBJECTIVES
To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE (via PubMed); Ovid EMBASE; EBSCO CINAHL; Ovid PsycINFO; PEDro; and the WHO International Clinical Trials Registry Platform Search Portal up to April 2015. References of included studies and identified review articles were screened for additional studies. There were no restrictions based on language, date of publication or study setting.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that report on subjective fatigue in people with PD.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, data collection and risk of bias assessments.
MAIN RESULTS
Eleven studies were eligible for this systematic review, with a total of 1817 people. Three studies included only people who experienced clinically relevant fatigue (Fatigue Severity Scale score ≥ 4 out of 7 or Multidimensional Fatigue Inventory total score > 48 out of 100), whereas all other studies did not select participants on the basis of experienced fatigue. Nine studies investigated the effects of medication (i.e. levodopa-carbidopa, memantine, rasagiline, caffeine, methylphenidate, modafinil or doxepin) on subjective fatigue. All studies were placebo controlled. There was insufficient evidence to determine the effect of doxepin on the impact of fatigue on activities in daily life (ADL) or fatigue severity (one study, N = 12, standardised mean difference (SMD) = -1.50, 95% confidence interval (CI) -2.84 to -0.15; low quality evidence). We found high quality evidence that rasagiline reduced or slowed down the progression of physical aspects of fatigue (one study, N = 1176, SMD = -0.27, 95% CI -0.39 to -0.16, I(2) = 0%). None of the other pharmacological interventions affected subjective fatigue in PD. With regard to adverse effects, only levodopa-carbidopa showed an increase for the risk of nausea (one study, N = 361, risk ratio (RR) = 1.85, 95% CI 1.05 to 3.27; high quality evidence). Two studies investigated the effect of exercise on fatigue compared with usual care. We found low quality evidence for the effect of exercise on reducing the impact of fatigue on ADL or fatigue severity (two studies, N = 57, SMD = -0.45, 95% CI -1.21 to 0.32, I(2) = 44%).
AUTHORS' CONCLUSIONS
Based on the current evidence, no clear recommendations for the treatment of subjective fatigue in PD can be provided. Doxepin may reduce the impact of fatigue on ADL and fatigue severity; however, this finding has to be confirmed in high quality studies. Rasagiline may be effective in reducing levels of physical fatigue in PD. No evidence was found for the effectiveness of levodopa-carbidopa, memantine, caffeine, methylphenidate, modafinil or exercise. Studies are needed to investigate the effect of exercise intensity on exercise capacity and subjective fatigue. Future studies should focus on interventions that address the maladaptive behavioural or cognitive aspects of fatigue in people with PD. Characteristics, such as severity and nature of perceived fatigue and underlying mood disorders should be considered to identify responders and non-responders when studying interventions for fatigue. The development of a core-set of self-report fatigue questionnaires with established responsiveness and known minimal important difference values will facilitate the interpretation of change in fatigue scores.
Topics: Central Nervous System Stimulants; Dopamine Agents; Exercise; Fatigue; Humans; Parkinson Disease; Randomized Controlled Trials as Topic
PubMed: 26447539
DOI: 10.1002/14651858.CD010925.pub2 -
European Journal of Pain (London,... Jan 2016Many treatment modalities are used for itch treatment in daily medical practices without adequate evidence of their efficacy. The purpose of this study was to provide an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Many treatment modalities are used for itch treatment in daily medical practices without adequate evidence of their efficacy. The purpose of this study was to provide an evidence-based review of the literature as to the clinical benefits of systemic anti-itch treatments.
DATABASES AND DATA TREATMENT
We performed a systematic review and, when appropriate, meta-analysis from available placebo-controlled randomized controlled trails (RCTs). A systematic search of the literature was performed using Pub Med, Cochrane Library and EMBASE. The primary outcome was the change in the itch score comparing the intervention group and placebo group. The meta-analysis method was used to calculate the pooled outcome of each treatment modality.
RESULTS
Twenty-six eligible RCTs were included. We found evidence for the effectiveness of: naltrexone (in cholestatic itch and atopic eczema), nalfurafine (in uraemic itch), gabapentin (in uraemic itch) and ursodeoxycholic acid (in intrahepatic cholestasis of pregnancy). The results of two RCTs with naltrexone in uremic itch are conflicting. On the other hand, we did not find any benefit from ondansetron (in cholestatic and uraemic itch), ergocalciferol (in uraemic itch), colesevelam (in cholestatic itch) or gabapentin (in cholestatic itch). The possible effectiveness of sertraline, paroxetine, cromolyn sodium, zinc sulphate, omega-3 fatty acid, montelukast, doxepin and rifampin need to be confirmed from future large studies, because the available evidence is insufficient.
CONCLUSIONS
The findings from this study suggest the effective therapeutic approaches for itch. The major limitations are that there are small numbers of available RCTs and methodological differences across studies.
Topics: Humans; Outcome Assessment, Health Care; Pruritus; Randomized Controlled Trials as Topic
PubMed: 26416344
DOI: 10.1002/ejp.766 -
International Urogynecology Journal May 2016Bladder pain syndrome/interstitial cystitis (BPS/IC) has various treatments; however, no standardized treatment has been established. The aim was to analyze different... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Bladder pain syndrome/interstitial cystitis (BPS/IC) has various treatments; however, no standardized treatment has been established. The aim was to analyze different types of treatment of BPS/IC and their effectiveness.
METHODS
A literature review with a search strategy for articles related to BPS/IC published between 1990 and 2014 was conducted on MEDLINE, PUBMED, and SCOPUS. Only randomized controlled trials in women were included in the meta-analysis, while other experimental studies were used as bases for a systematic review of the topic. Clinical trial quality was defined according to the Jadad scale.
RESULTS
Of 356 articles, 13 were included in the analysis. The intervention methods were as follows: instillation of hyaluronic acid, botulinum toxin A, intravesical lidocaine, hyperbaric chamber, massage, physiotherapy, phosphate-buffered saline, piroxicam in combination with doxepin, and others. We did not find any treatment with at least two randomized controlled trials for meta-analysis. Among the assessment tools for symptoms of BPS/IC, the most frequently used were the visual analogue scale, voiding record, and the O'Leary-Sant questionnaire.
CONCLUSION
Existing studies were not able to define the best approach for the treatment of BPS/IC. The lack of standardized treatment may be related to the diversity of interventions used; therefore, further studies with better methodological quality are needed.
Topics: Acetylcholine Release Inhibitors; Adjuvants, Immunologic; Administration, Intravesical; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents; Botulinum Toxins, Type A; Cystitis, Interstitial; Drug Therapy, Combination; Female; Humans; Hyaluronic Acid; Hyperbaric Oxygenation; Lidocaine; Pentosan Sulfuric Polyester; Physical Therapy Modalities; Sodium Chloride
PubMed: 26272202
DOI: 10.1007/s00192-015-2815-5 -
Sleep Medicine Reviews Feb 2015Doxepin, a sedating tricyclic drug, at 3 mg and 6 mg doses was recently approved by the U.S. food and drug administration (FDA) for the treatment of insomnia. The... (Review)
Review
Doxepin, a sedating tricyclic drug, at 3 mg and 6 mg doses was recently approved by the U.S. food and drug administration (FDA) for the treatment of insomnia. The objective of this systematic review was to obtain a precise summary of the efficacy and safety of doxepin as a hypnotic. We searched key databases and trial registers up to March 2014 and contacted pharmaceutical companies and the FDA for unpublished data. A total of nine randomized placebo-controlled trials were analyzed. Six studies were on doxepin 1-6 mg/d, two on doxepin 25-300 mg/d, and one on ramelteon 8 mg and doxepin 3 mg combined. All low-dose studies were industry-sponsored. We found that low-dose doxepin had a small to medium effect size against placebo for sleep maintenance and sleep duration but not for sleep initiation at both immediate and short-term posttreatment. There was no significant next-day residual effect with low-dose doxepin. Headache and somnolence were the most common side effects. We concluded that low-dose doxepin for 1-2 nights appeared to be safe and effective in improving sleep. However, a clear conclusion on its short-term benefits and risks as well as withdrawal effects was not possible due to the small number of studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dose-Response Relationship, Drug; Doxepin; Drug Therapy, Combination; Female; Humans; Indenes; Male; Middle Aged; Randomized Controlled Trials as Topic; Sleep Initiation and Maintenance Disorders; Treatment Outcome; United States; United States Food and Drug Administration; Young Adult
PubMed: 25047681
DOI: 10.1016/j.smrv.2014.06.001