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Canadian Urological Association Journal... Oct 2011Although the prevalence of overactive bladder (OAB) is similar in both male and female populations, females have a greater tendency to seek medical advice regarding...
Although the prevalence of overactive bladder (OAB) is similar in both male and female populations, females have a greater tendency to seek medical advice regarding their symptoms. A review of the evidence of therapy among women shows that a variety of modalities has been shown to be effective for symptom improvement in women with OAB. Bladder retraining/re-education should be considered for all women with OAB. With respect to first-line pharmacotherapy with antimuscarinic agents, the development of extended release preparations, bladder selective M3 antagonists and alternative routes of delivery, have improved compliance and persistence. Other pharmacotherapeutic options with potential for providing benefit include antidepressants, vasopressin analogues, alpha-adrenoceptor antagonists and beta-adrenoceptor agonists. There are also a number of newer agents currently being investigated, including calcium channel blocking agents, potassium channel opening drugs, beta agonists and neurokinin receptor antagonists. Intravesical injections of botulinum toxin may be an alternative, while surgery can be considered for truly intractable cases.
PubMed: 21989527
DOI: 10.5489/cuaj.11185 -
American Journal of Kidney Diseases :... Aug 2010In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists is yet undefined. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists is yet undefined.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING & POPULATION
In- and outpatients with euvolemic or hypervolemic hyponatremia.
SELECTION CRITERIA FOR STUDIES
We included all RCTs regardless of publication status or language.
INTERVENTION
Vasopressin antagonists with or without fluid restriction versus placebo or no treatment with or without fluid restriction.
OUTCOMES
Response rate defined as normalization of serum sodium level or significant increase in serum sodium level at 3-7 days (primary) and later, change from baseline serum sodium level at 3-7 days and later, adverse events, rate of rapid sodium level correction, and rate of hypernatremia.
RESULTS
15 RCTs were identified. Vasopressin antagonist treatment significantly increased response rate both early (RR, 3.15; 95% CI, 2.27-4.37; 11 trials) and late (RR, 2.27; 95% CI, 1.79-2.89; 4 trials). Response rates were high in trials assessing mostly euvolemic patients and those assessing mostly hypervolemic patients, with greater effect estimate in the former. Change from baseline serum sodium level was significantly increased both early (weighted mean difference, 5.27 mEq/L; 95% CI, 4.27-6.26, 13 trials) and late (weighted mean difference, 3.49 mEq/L; 95% CI, 2.56-4.41, 8 trials). Although there was an increased rate of rapid sodium correction (RR, 2.52; 95% CI, 1.26-5.08, 8 trials) with vasopressin antagonists, hypernatremia rates were not significantly higher (RR, 2.21; 95% CI, 0.61-7.96; 5 trials), adverse events were not increased, and there were no reports of osmotic demyelination syndrome.
LIMITATIONS
Significant heterogeneity in the primary outcome.
CONCLUSIONS
Vasopressin antagonists are effective for the treatment of hypervolemic and euvolemic hyponatremia.
Topics: Antidiuretic Hormone Receptor Antagonists; Azepines; Benzamides; Benzazepines; Humans; Hyponatremia; Morpholines; Pyrroles; Randomized Controlled Trials as Topic; Spiro Compounds; Tolvaptan; Treatment Outcome
PubMed: 20538391
DOI: 10.1053/j.ajkd.2010.01.013 -
Endocrine Reviews Feb 2010Opioid abuse has increased in the last decade, primarily as a result of increased access to prescription opioids. Physicians are also increasingly administering opioid... (Review)
Review
Opioid abuse has increased in the last decade, primarily as a result of increased access to prescription opioids. Physicians are also increasingly administering opioid analgesics for noncancer chronic pain. Thus, knowledge of the long-term consequences of opioid use/abuse has important implications for fully evaluating the clinical usefulness of opioid medications. Many studies have examined the effect of opioids on the endocrine system; however, a systematic review of the endocrine actions of opioids in both humans and animals has, to our knowledge, not been published since 1984. Thus, we reviewed the literature on the effect of opioids on the endocrine system. We included both acute and chronic effects of opioids, with the majority of the studies done on the acute effects although chronic effects are more physiologically relevant. In humans and laboratory animals, opioids generally increase GH and prolactin and decrease LH, testosterone, estradiol, and oxytocin. In humans, opioids increase TSH, whereas in rodents, TSH is decreased. In both rodents and humans, the reports of effects of opioids on arginine vasopressin and ACTH are conflicting. Opioids act preferentially at different receptor sites leading to stimulatory or inhibitory effects on hormone release. Increasing opioid abuse primarily leads to hypogonadism but may also affect the secretion of other pituitary hormones. The potential consequences of hypogonadism include decreased libido and erectile dysfunction in men, oligomenorrhea or amenorrhea in women, and bone loss or infertility in both sexes. Opioids may increase or decrease food intake, depending on the type of opioid and the duration of action. Additionally, opioids may act through the sympathetic nervous system to cause hyperglycemia and impaired insulin secretion. In this review, recent information regarding endocrine disorders among opioid abusers is presented.
Topics: Analgesics, Opioid; Animals; Endocrine System; Endocrine System Diseases; Female; Humans; Hypogonadism; Male; Opiate Alkaloids; Opioid-Related Disorders
PubMed: 19903933
DOI: 10.1210/er.2009-0009 -
The Cochrane Database of Systematic... Jan 2008Postoperative adynamic bowel atony interferes with recovery following abdominal surgery. Prokinetic pharmacologic drugs are widely used to accelerate postoperative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative adynamic bowel atony interferes with recovery following abdominal surgery. Prokinetic pharmacologic drugs are widely used to accelerate postoperative recovery.
OBJECTIVES
To evaluate the benefits and harms of systemic acting prokinetic drugs to treat postoperative adynamic ileus in patients undergoing abdominal surgery.
SEARCH STRATEGY
Trials were identified by computerised searches of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the Cochrane Colorectal Cancer Group specialised register. The reference lists of included trials and review articles were tracked and authors contacted.
SELECTION CRITERIA
Randomised controlled parallel-group trials (RCT) comparing the effect of systemically acting prokinetic drugs against placebo or no intervention.
DATA COLLECTION AND ANALYSIS
Four reviewers independently extracted the data and assessed trial quality. Trial authors were contacted for additional information if needed.
MAIN RESULTS
Thirty-nine RCTs met the inclusion criteria contributing a total of 4615 participants. Most trials enrolled a small number of patients and showed moderate to poor (reporting of) methodological quality, in particular regarding allocation concealment and intention-to-treat analysis. Fifteen systemic acting prokinetic drugs were investigated and ten comparisons could be summarized. Six RCTs support the effect of Alvimopan, a novel peripheral mu receptor antagonist. However, the trials do not meet reporting guidelines and the drug is still in an investigational stage. Erythromycin showed homogenous and consistent absence of effect across all included trials and outcomes. The evidence is insufficient to recommend the use of cholecystokinin-like drugs, cisapride, dopamine-antagonists, propranolol or vasopressin. Effects are either inconsistent across outcomes, or trials are too small and often of poor methodological quality. Cisapride has been withdrawn from the market due to adverse cardiac events in many countries. Intravenous lidocaine and neostigmine might show a potential effect, but more evidence on clinically relevant outcomes is needed. Heterogeneity among included trials was seen in 10 comparisons. No major adverse drug effects were evident.
AUTHORS' CONCLUSIONS
Alvimopan may prove to be beneficial but proper judgement needs adherence to reporting standards. Further trials are needed on intravenous lidocaine and neostigmine. The remaining drugs can not be recommended due to lack of evidence or absence of effect.
Topics: Abdomen; Adult; Gastrointestinal Agents; Humans; Intestinal Pseudo-Obstruction; Peristalsis; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 18254064
DOI: 10.1002/14651858.CD004930.pub3 -
Endocrine Practice : Official Journal... 2006To review the types and causes of hyponatremia and examine the various strategies for treatment of this disorder. (Review)
Review
OBJECTIVE
To review the types and causes of hyponatremia and examine the various strategies for treatment of this disorder.
METHODS
A systematic review of the current literature is provided, targeting endocrinology clinicians who consult with hospital medical and surgical staff when managing patients with hyponatremia. Treatment for euvolemic and hypervolemic hyponatremia with arginine vasopressin receptor antagonists is presented, which provides a new treatment option for patients with disorders of water metabolism.
RESULTS
Hyponatremia is recognized as the most common electrolyte disorder encountered in the clinical setting and is associated with a variety of conditions including dilutional disorders, such as congestive heart failure and the syndrome of inappropriate antidiuretic hormone secretion, and depletional disorders, such as diarrhea and vomiting or blood loss. Most cases of mild hyponatremia can be treated effectively. Acute, severe hyponatremia that is untreated or treated ineffectively, however, can lead to serious neurologic outcomes or death. With the poor prognosis for morbidity and mortality in patients with severe hyponatremia, hospital-based clinicians must identify those at risk for hyponatremia and suggest appropriate treatment intervention. A new class of drugs, the arginine vasopressin receptor antagonists, targets receptors on collecting duct cells of the nephron and causes aquaresis, the excretion of free water. This therapy leads to the restoration of sodium-water homeostasis in patients with euvolemic and hypervolemic hyponatremia.
CONCLUSION
With many hospitalized patients at risk for hyponatremia, especially elderly patients in critical care and postsurgical units, identification of involved patients, recommendation of appropriate treatment, and awareness of new therapeutic options are critical.
Topics: Algorithms; Antidiuretic Hormone Receptor Antagonists; Humans; Hyponatremia; Inappropriate ADH Syndrome; Models, Biological; Neurophysins; Prevalence; Protein Precursors; Sodium; Vasopressins; Water-Electrolyte Imbalance
PubMed: 16901803
DOI: 10.4158/EP.12.4.446