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Compatibility of commonly used drugs in lactation
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
Sometimes analgesia is insufficient to reduce pain, e.g. in acute back pain where there is a spasm of the muscles. Diazepam– PPB 99%, oral bioavailability complete, RID 0.88–7.14%, half-life 43 hours. Long-term use would lead to accumulation but anecdotal reports of low-dose diazepam over 2–3 days to relieve muscle spasm indicate no adverse effects. Appropriate to use for anxiety before procedure or anxiety over a flight as a single dose. Methocarbamol– PPB 46–50%, oral bioavailability complete, but no studies in breastmilk.
Nonopiate Analgesics and Adjuvants
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Methocarbamol (Robaxin) is a centrally acting skeletal muscle relaxant. It may inhibit nerve transmission in the internuncial neurons of the spinal cord. It has a 30- to 45-minute onset of action. Peak levels are found in about two hours, and its duration of action is four to six hours. It comes as 500- and 750-mg tablets. Tablets containing methocarbamol and aspirin (Robaxisal) are also available. The recommended dose of Robaxin is 750 mg three times a day. As with all of these medications, it should be taken for 7 to 10 days. It is well tolerated, with initial side effects which resolve over time, including lightheadedness, dizziness, vertigo, headache, rash, GI upset, nasal congestion, fever, blurred vision, urticaria, and mild muscular incoordination. In situations of severe, seemingly intractable muscle spasm, Robaxin may be given intravenously in doses of about 1 g every 8 to 12 hours.
Nonopiate Analgesics and Adjuvants
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
A useful combination may include methocarbamol 750 mg three times a day for 10 days in patients with significant spasm, accompanied by ketoprofen, 75 mg, every six to eight hours as needed, with food as needed. For the acute posttraumatic soft tissue injury, one tablet of each taken together every six to eight hours for two to three doses works very well. These muscle relaxants are for acute cases of muscle spasm and pain. If there is no help within 10 days or so, they most probably won’t work. In such cases, particularly in patients with painful muscle spasm lasting three weeks or longer, tizanidine would be the drug of choice.
COMET – effectiveness and tolerability of methocarbamol versus oral opioid-analgesics as add-on measure in patients with non-specific low back pain refractory to recommended 1st line treatments. A retrospective analysis of depersonalized propensity score matched open-label real-world 4-week data from the German Pain e-Registry
Published in Current Medical Research and Opinion, 2022
Michael A. Ueberall, Gerhard Mueller-Schwefe
A recent evaluation of the prescription patterns for patients with LBP in Switzerland confirmed NSAIDs (with 53.7%), and acetaminophen/paracetamol (with 24.6%), as the most prevalently prescribed treatments.16 Opioid analgesics and muscle relaxants were prescribed significantly less, preferably add-on, and with a comparable frequency (13.7 and 12.7%) raising questions regarding the current positioning of both treatment alternatives under real-world conditions. In contrast to opioids which are associated with a considerable risk of serious iatrogenic complications (physical dependence, abuse/misuse, cognitive impairment, tendency to fall, deaths, etc.), muscle relaxants do not carry a significant risk of dependence and/or ab-/misuse, etc. In addition, opioid analgesics act symptomatically while muscle relaxants pursue a causal approach (which supports the recovery of physical activity). Due to this discrepancy, we were interested to evaluate the efficacy and tolerability of methocarbamol (the most prevalently prescribed muscle relaxant in Germany) vs. those of conventional oral long-acting opioid analgesics.
Simultaneous determination of methocarbamol and aspirin in presence of their pharmacopeial-related substances in combined tablets using novel HPLC-DAD method
Published in Drug Development and Industrial Pharmacy, 2019
Fawzi A. El-Yazbi, Omayma A. Amin, Eman I. El-Kimary, Essam F. Khamis, Sameh E. Younis
Methocarbamol (MET); 3–(2-methoxyphenoxy)-propane-1,2-diol-1-carbamate (Figure 1(a)) is a central muscle relaxant [1,2]. Aspirin (ASP); 2-(Acetyloxy) benzoic acid (Figure 1(b)) is an analgesic with antipyretic effects [1,2]. MET is widely used in combination with ASP to relieve painful muscle spasms; either co-formulated or co-administered. The USP reports guaifenesin, GUA, and salicylic acid, SAL (Figure 1(c) and (d)) as impurities [3]. Moreover, GUA and SAL are starting materials in the synthesis of MET and ASP, respectively, besides to being products of their hydrolysis [4,5]. The USP states that the quantity of GUA and SAL should not exceed 2 and 3% of MET and ASP contents, respectively, in their tablets [3]. Therefore, quantitative estimation of both GUA and SAL holds a critical position in the quality control of MET and ASP combined tablets as recommended by the ICH guidelines [6].
Hypertrophic cervical spine pachymeningitis due to sarcoidosis: a case report
Published in Hospital Practice, 2019
Hussam A. Yacoub, P. Mark Li, Joshua A. Bemporad, Dmitry Khaitov, Daniel F. Brown
Several weeks later, evaluation revealed only partial improvement in motor strength and residual sensory disturbance. Symptoms were treated with gabapentin and methocarbamol. ESR and CRP were normal 4 weeks after surgery. Eight weeks after surgery, a follow-up cervical spine MRI revealed new soft tissue thickening with contrast enhancement in the anterior spinal canal from the level of C6–C7 to the level of superior T2; the appearance was consistent with pachymeningitis. This, along with recurrence of paresthesia, warranted further work-up.