Attention Deficit-Hyperactivity Disorder
Merlin G. Butler, F. John Meaney in Genetics of Developmental Disabilities, 2019
Initial medication titration can be accomplished in weekly intervals by phone or office visit. Screening for side effects, and attainment of target goals gives the best measurement of medication effectiveness. Once the best dose is determined (the dose where the child is having maximum success in achieving target goals and having the fewest side effects), monitoring can be stretched to monthly and ultimately quarterly office visits. However, with each monthly refill request, it is helpful to check on adherence, impairment, and side effects. Second-line medications include selective norepinephrine reuptake inhibitors (atomoxetine), antidepressants (imipramine and desipramine), alpha adrenergics (clonidine and guanfacine), and buproprion. Adequate studies to evaluate the use of such medications for ADHD are considerably more limited than the information available on stimulant medications and the potential side effects can be more serious. Atomoxetine is a selective norepinephrine reuptake inhibitor. Phase 3 trials demonstrated promising effects. The side effects include appetite suppression, drowsiness, and nausea. The tricyclic antidepressants (imipramine and desipramine) have strong evidence of efficacy but have more significant side effects with dry mouth and possible cardiac arrhythmias and have a fairly narrow margin of safety. The antihypertensive medications, while appearing to work clinically, have very limited rigorous evidence of efficacy and the evidence is also limited for buproprion.
Neuropharmacologic considerations in the treatment of vegetative state and minimally conscious state following brain injury
Mark J. Ashley, David A. Hovda in Traumatic Brain Injury, 2017
There are no clinical studies evaluating the efficacy of atomoxetine for prolonged disorders of consciousness following traumatic brain injury. However, Ripley88 asserts that, theoretically, this norepinephrine reuptake inhibitor may be useful if added to agents that affect different aspects of the catecholaminergic neurotransmitter systems.
The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain
Published in Expert Opinion on Pharmacotherapy, 2022
Ryan S. D’Souza, Brendan Langford, Rachel E. Wilson, Yeng F. Her, Justin Schappell, Jennifer S. Eller, Timothy C. Evans, Jonathan M. Hagedorn
The most widely used SNRI agents include duloxetine, venlafaxine, and milnacipran (Table 4). A review of 18 trials found that a duloxetine dose as low as 60 mg daily was effective in treating neuropathic pain including diabetic peripheral neuropathy, fibromyalgia, and painful physical symptoms in depression [60]. Duloxetine may also offer short-term pain reduction and improvement in physical function in patients with osteoarthritis and chronic low back pain as early as within 2 weeks of initiation [61]. A systematic review of 11 RCTs revealed that venlafaxine was efficacious for neuropathic pain, particularly when higher dosages were administered (150–225 mg) for longer durations. This strategy may lead to greater norepinephrine reuptake inhibition and greater activation of noradrenergic pathways involved in analgesia and descending inhibition of pain signal transmission [62]. Milnacipran is an FDA-approved agent for treatment of fibromyalgia with Level I evidence indicating that doses of 100–200 mg/day of milnacipran are superior to placebo (number needed to treat: 11) [63].
Evaluation of Natural Product Compositions for Appetite Suppression
Published in Journal of Dietary Supplements, 2019
Mesfin Yimam, Ping Jiao, Mei Hong, Lidia Brownell, Young-Chul Lee, Eu-Jin Hyun, Hyun-Jin Kim, Tae-Woo Kim, Jeong-Bum Nam, Mi-Ran Kim, Qi Jia
Despite the high incidence of obesity, available treatment options are very limited. While the current pharmaceutical drugs such as orlistat (pancrease lipase inhibitor), lorcaserin (Belviq, selective 5-HT2C serotonin receptor agonist), phentermine/topiramate (Qsymia, sympathomimetic/GABA and glutamate modulator), naltrexone/bupropion (Contrave, dopamine-norepinephrine reuptake inhibitor/opioid receptor antagonist), and liraglutide (GLP-1 receptor agonist) seem to show 2.6%–8.8% placebo-subtracted weight loss (weight loss as a result of treatment corrected for the weight loss observed by the placebo group), for some their unwanted side effects outweigh their benefit (such as fatty or oily stools and flatulence for orlistat; constipation for lorcaserin; mild dizziness, anxiety, and irritablility for qsymia; dizziness, diarrhea, and headache for naltrexone/bupropion) (Rodríguez and Campbell, 2016). In fact, for these reasons, lorcaserin and phentermin/topiramate are still not approved by the European Medicines Agency. This limitation leaves no option to patients except to seek an alternative. Some dietary supplements with a proven record of safety and efficacy supported by scientific evidence may bridge the gap to fulfill the unmet demands.
Managing autonomic dysfunction in Parkinson’s disease: a review of emerging drugs
Published in Expert Opinion on Emerging Drugs, 2020
Dinkar Kulshreshtha, Jacky Ganguly, Mandar Jog
Ampreloxetine (TD-9855), a once daily norepinephrine reuptake inhibitor, is currently under study for management of OH in PD patients. In a phase 2 trial, a 4-week once a day treatment with Ampreloxetine was associated with an increase in SBP >7 mm Hg and the effect was sustained for 20 weeks with deterioration in symptoms on stopping the medication after 20 weeks. There were no serious side effects and the drug was well tolerated by all subjects. Currently, a multi-center, phase 3 trial evaluating its efficacy in autonomic dysfunction in PD/MSA/Primary autonomic failure is under way which is estimated to complete by February 2021 [31,32]. Similarly, atomoxetine, a selective norepinephrine transporter blocker, used in the management of attention deficit hyperactive disorder, is under a phase 2 randomized cross-over double-blinded clinical trial to look for its effect on nOH in MSA patients when compared to placebo. It is estimated to complete by December 2020 [33]. CERC-301 is a NR2B-specific, NMDA receptor antagonist and its use in diabetic orthostatic hypotension in a phase I proof-of-concept trial has recently started and the first patient has recently been enrolled [34].
Related Knowledge Centers
- Adrenaline
- Drug Action
- Neurotransmission
- Reuptake Inhibitor
- Attention Deficit Hyperactivity Disorder
- Norepinephrine
- Neurotransmitter
- Narcolepsy
- Drug
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