China
Africa
Explore chapters and articles related to this topic
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Pregabalin was subsequently developed specifically for the treatment of neuropathic pain. It has a linear dose–response relationship, longer half-life and higher oral bioavailability and potency. Commonly recommended daily doses are 150–600 mg given in two divided doses, starting at the lower end of the dose range and titrating upwards as needed. Starting doses of 25 mg are recommended in older and frail patients. Adverse effects and efficacy should govern titration to higher doses.
Attention Deficit Hyperactivity Disorder
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Margaret J.J. Thompson, Anan El Masry, Samuele Cortese, Wai Chen
More in-depth assessment of parents, children and families might aid the decision about treatment pathways, i.e. assessing the child and his/her parents’ understanding of the condition and the parents’ empathy towards their child and the treatment process, and to ascertain parent and child preferences and attributions towards medication. This will include an important discussion of the medication that could be used and the possible side-effects. This will assist both parents and children to ‘own’ the treatment decisions and encourage compliance. Not all parents wish to use medication and would prefer behavioural work (Tarver et al., 2015). A thorough assessment should take place before medication is started with baseline measurements of height, weight, pulse rate and blood pressure, at a minimum. It is important to take a history of baseline symptoms of stomach aches, headache, bruising and frequent nosebleeds, tics, sleep and eating patterns, as these symptoms may be present as side-effects of medication. A careful history should rule out a child and/or family history of heart disease, fits, tics and glaucoma (see European guidelines: Taylor et al., 2004; Banaschewski et al., 2006). Titration of the medicine dosage is important with regular monitoring of effect and of blood pressure, pulse rate, height, weight and a list of possible side-effects to determine whether to continue the medication, increase the dosage or change to a different preparation, either a long-acting brand or a different brand.
Low-Dose Naltrexone
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Dosing of LDN should be individualized with a “start low and go slow” approach. Patients may experience temporary and transient side effects upon initiation of LDN, including sleep disturbances and vivid dreams, nausea, and irritability. Side effects can be mitigated by decreasing the dose and titrating. A temporary addition of an H2 blocker, or administering LDN sublingual may be tried if nausea is experienced. Taking LDN in the morning instead of evening is recommended in cases of sleep disturbances. Low-dose naltrexone does not work immediately and can typically take anywhere from a few weeks to many months before patients begin to feel better due to LDN’s immune-modulating effects.
Current perspectives on the diagnosis and management of acute transverse myelitis
Published in Expert Review of Neurotherapeutics, 2023
Nanthaya Tisavipat, Eoin P Flanagan
In resource-limited settings, azathioprine and mycophenolate mofetil are potential options although have lower efficacy [195,196]. Both are daily oral medications that require titration. Azathioprine is generally started at 25 mg/day and increased to the target dose of 2–3 mg/kg/day. TPMT gene, responsible for azathioprine metabolism, should be checked before initiating treatment since a loss-of-function mutation can result in severe myelosuppression with standard dose [197]. The target dose of mycophenolate mofetil is 1,000–2,000 mg/day, with some centers using weight-based target of 20–30 mg/kg/day. Having broad cellular toxicity effect, both azathioprine and mycophenolate require monitoring for leukopenia. They also have a lag period of 3–6 months before taking full effects, and thus prolonged bridging oral steroids is required. Use of these agents in the long term is associated with hematological malignancies which is a drawback for their long-term administration in this disease. Rituximab or its biosimilars may also be an option in lower resource settings as its reduced costs and lower doses (1 g IV of rituximab x 1 dose) every 6 months could be considered as cost saving while maintaining the efficacy [198].
Relationship between the dose titration and adherence of mirogabalin in patients with peripheral neuropathic pain depending on renal function: a nationwide electronic medical record database study
Published in Expert Opinion on Pharmacotherapy, 2023
Karin Kato, Sho Kodama, Kazuhito Shiosakai, Takeshi Kimura
Study results showed that adherence to mirogabalin was associated with dose titration after initiation. In addition, mirogabalin treatment’s persistence was also associated with dose titration, titration to the effective dose, and dose titration patterns by period. The most likely explanation for this result is that patients with the dose titration may lead the optimal therapeutic effect in terms of efficacy and safety. Two previous studies found that patients who took mirogabalin from an initial dose and titrated gradually based on their renal function were more likely to continue the treatment and improve their pain scores [23,24]. Another database research on the dose titration of pregabalin in patients with neuropathic pain argued that the therapeutic optimal effect may affect the adherence and persistence of pain treatment; however, they only provide information on pregabalin treatment [21]. Our findings also suggest that further persistence can be achieved if the physician adjusts the duration of dose titration even after adjusting the patient’s background factors related to the efficacy and safety of the drug.
Curcumin-loaded microemulsion: formulation, characterization, and in vitro skin penetration
Published in Drug Development and Industrial Pharmacy, 2023
Irene Carolina Luna-Canales, Norma Laura Delgado-Buenrostro, Yolanda I. Chirino, Guadalupe Nava-Arzaluz, Elizabeth Piñón-Segundo, Graciela Martínez-Cruz, Adriana Ganem-Rondero
It has been reported that the first ME was prepared in 1928, but it was not until 1958 that MEs are known under this name. Since then, MEs have found application in a wide range of fields [35]. The formulation of a ME implies:The selection of possible components (i.e. surfactant, co-surfactant, oil, and aqueous phase). This can be carried out through drug solubility studies.The construction of pseudo-ternary diagrams, which allows defining ME formation zones. Through this diagram, it is possible to determine the relative amount of ME components, and thus the optimized formulation can be found out. The phase titration method is one of the methods proposed for ME preparation. In this method, mixtures of oil, surfactant, and cosurfactant in different proportions, are titrated with distilled water until the mixture becomes a ME. In this work, the selected components were oleic acid as an oily phase, Tween® 80 as a surfactant, and Transcutol® HP as a co-surfactant. Three surfactant:co-surfactant ratios (1:1, 1:2, and 2:1) were tested to build the pseudo-ternary diagrams. The systems with transparent or translucent appearance and low viscosity were recorded as MEs.