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Novel treatment modalities
Published in Seema Chopra, Endometriosis, 2020
NSAIDs in varying formulations and dosages such as tolfenamic acid (200 mg three times per day) [48] and naproxen sodium (275 mg four times per day) [49] for the treatment of menstrual pain associated with endometriosis were considered superior to placebo. Although rofecoxib (25 mg per day) improved pelvic pain and dyspareunia secondary to endometriosis [50], the drug was reported to have an increased cardiovascular risk and was withdrawn from further use [51]. Thus, superiority of one drug over the other is not evident in the literature. At the same time, women on long-term prescription NSAIDs must be informed about the adverse events these drugs may be responsible for (such as peptic ulcers, risk of hypertension and cardiovascular events, and acute kidney injury).
Chronic daily headache: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
NSAIDs can be used for both symptomatic and preventive headache treatment. Naproxen sodium is effective in prevention at a dose of one or two 275-mg tablets twice a day.112 Other effective NSAIDs include tolfenamic acid, ketoprofen, mefenamic acid, fenoprofen, and ibuprofen.113,114 Aspirin was found to be effective in one study115 and equal to placebo in another.116 The short-acting NSAIDs, such as ibuprofen and aspirin, may cause rebound, and their use should be limited. It is uncertain whether or not the other NSAIDs cause rebound. CM, CTTH, NDPH, and HC may all be unilateral. The only feature that separates HC is indomethacin responsiveness, which is not unique to HC. We used absolute responsiveness to indomethacin to define the presence of the disorder. It is uncertain if nonresponsive patients have the same biology as indomethacin-responsive patients do. HC is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early in treatment. We give indomethacin a therapeutic trial (up to 150–225 mg/day for 2 weeks) to rule out HC, but otherwise limit the use of other NSAIDs.
Headache
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Peer Tfelt-Hansen, Rigmor Jensen
How do the triptans compare with other drugs for acute migraine treatment? As shown in Table 34.4, sumatriptan (100 mg), eletriptan (40 and 80 mg), almotriptan (12.5 mg), and rizatriptan (10 mg) were superior to oral ergotamine plus caffeine (2 mg+200 mg).62[II] Oral sumatriptan (100 mg) was not superior to aspirin with metoclopramide for the first treated attack (but superior for the second and third attacks),62[II] and was comparable to lysine acetylsalicylate plus metoclopramide (1620 mg (~900 mg aspirin) +10 mg).81[II] Sumatriptan (50 mg) was equivalent to effervescent aspirin (1000 mg) in two trials.82, 83[II] Sumatriptan was superior to tolfenamic acid rapid release in a randomized clinical trial, 75 versus 58 percent.69 Rectal sumatriptan (25 mg) was inferior to rectal ergotamine plus caffeine (2 mg+ 200 mg), but caused fewer adverse events (8 versus 27 percent).62[II] In four out of five RCTs where a triptan and an ergot alkaloid were compared, there were less recurrences after the ergot alkaloid than after the triptan.62, 67[II]
Current and emerging treatment options for endometriosis
Published in Expert Opinion on Pharmacotherapy, 2018
Simone Ferrero, Giulio Evangelisti, Fabio Barra
Table 1 summarizes the characteristics of main drug classes used for the treatment of endometriosis. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat endometriosis-related pain symptoms. Surprisingly, there is little evidence to support the use of NSAIDs in the treatment of endometriosis [12]. Tolfenamic acid (200 mg three times per day) [13] and naproxen sodium (275 mg four times per day) [14] have been shown to be superior to placebo for the treatment of dysmenorrhea secondary to endometriosis. Moreover, rofecoxib (25 mg per day) was shown to improve pelvic pain and dyspareunia caused by endometriosis [15], This drug, however, was withdrawn from the market after a study showed an increased cardiovascular risk after long-term use [16]. There is no evidence that one NSAID is more effective than another. Furthermore, patients using in long-term NSAIDs must be aware that these drugs may be responsible significant AEs (such as gastrointestinal ulcers, cardiovascular events, hypertension, and acute renal failure) [12].
A comprehensive in vitro biological investigation of metal complexes of tolfenamic acid
Published in Alexandria Journal of Medicine, 2018
Md. Mahabob Ullah Mazumder, Abhijit Sukul, Sajal Kumar Saha, Asif Alam Chowdhury, Yasir Mamun
Pharmacological investigation on metal complexes of tolfenamic acid was the main purpose of designing the study. In addition, search for new pharmacological responses such as antioxidant, anticancer, and antimicrobial potency was, also, a key drive to prepare the new compounds; therefore, complexes of tolfenamic acid, which might exhibit enhanced biological properties than its parent compound. The Co and Cu complex can be developed as antitumor drugs having very promising antioxidant properties. They can also be used for their cytoprotective role in neurodegenerative diseases. Moreover, the Cu and Co complexes possess significant cytotoxic potency compared to vincristine, which may lead to the development of new anticancer drugs; however, further researches are needed to test the compound against other anticancer agents. Emergence of Cu and Zn complexes of tolfenamic acid as future antimicrobial agents can be predicted and bioactivity guided studies can be further performed with a view to developing new classes of antimicrobial agents.
Survivin as a biological biomarker for diagnosis and therapy
Published in Expert Opinion on Biological Therapy, 2021
Yuming Li, Wenshu Lu, Jiarun Yang, Mark Edwards, Shisong Jiang
Tolfenamic acid (TA) has been shown anticancer activity in several cancer models, inhibiting both tumor growth and angiogenesis. As a small molecule inhibitor, it induces the degradation of specificity proteins (Sps), leading to a decrease in expression of SVN in various in vitro and in vivo tumor settings such as pancreatic cancer cells [93,94], human medulloblastoma (MB) cell lines, a mouse xenograft model [95], Ewing sarcoma (ES) cells [96], and colon cancer cells [97]. Though these findings point to the use of TA as a potential cancer treatment, a clinical trial of TA in pancreatic cancer in 2014 was withdrawn without a published reason (NCT02159248).