Evidence From Basic Research for Opioid Combinations.
Evidence from basic research for opioid combinations.
Filed under: Methadone Side Effects
Expert Opin Drug Discov. 2012 Feb; 7(2): 165-78
Davis MP
Introduction: Single opioid analgesics are modestly effective in reducing pain but have a narrow therapeutic index and frequently produce intolerable side effects. Adjuvant analgesics are often used to improve the opioid therapeutic index. Basic science research has accumulated evidence that opioid combinations in animal models and in vitro have potential to improve the therapeutic index of opioids and/or prevent opioid tolerance. Areas covered: Opioid receptor pharmacology is reviewed including receptor genetics and downstream signaling. Receptor functional selectivity and ligand biased responses are discussed in relationship to opioid pharmacodynamics, signal modulation and synergy. The accumulated bench research over the past decade, in particular, provides a rationale for considering clinical trials of opioid combinations. These combinations include both selective agonist-agonist or agonist-antagonist pairs which are reviewed. Expert opinion: The use of opioid antagonists (naloxone and naltrexone), oxycodone, fentanyl and methadone with morphine improves analgesia in animal models and blunts physical dependence and conditioned place preference (a marker for psychological dependence). Sequential or simultaneous dosing schedules, dose levels or ratios need to be explored further. Pain phenotype may be an important factor predicting responses to combinations such that trial design will need to take this into account. Side effects will need to be monitored closely as little is known about the influence of opioid combinations on side effects.
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Rhabdomyolysis with acute renal failure secondary to taking methadone.
Filed under: Methadone Side Effects
Nefrologia. 2012 Mar 19; 32(2): 262-263
Valga-Amado F, Monzón-Vázquez TR, Hadad F, Torrente-Sierra J, Pérez-Flores I, Barrientos-Guzmán A
Use of Methadone as a Coanalgesic: Response to McKenna and Nicholson.
Filed under: Methadone Side Effects
J Pain Symptom Manage. 2012 Apr; 43(4): e5-6
Haughey C, Watson M, White C
Management of pain in the elderly at the end of life.
Filed under: Methadone Side Effects
Drugs Aging. 2012 Apr 1; 29(4): 285-305
Prommer E, Ficek B
Pain is one of the symptoms most frequently encountered in elderly patients at the end of life. The management of pain in the elderly in general has been associated with undertreatment. The geriatric population has been identified as a challenging population with respect to pain management because of issues related to co-morbidities, polypharmacy and cognitive dysfunction. In the geriatric population, the assessment of pain requires measurement of pain intensity, delineation of opioid responsiveness, and clarification of the impact of pain on patients’ psychological, social, spiritual and existential domains. Effective pain management is guided by the World Health Organization (WHO) analgesic stepladder, which categorizes pain intensity according to severity and recommends analgesic agents based on their strength and works effectively in the elderly patient population. Step 1 is reserved for mild pain. Patients in this category are treated with nonopioid analgesics such as acetaminophen, or a nonsteroidal anti-inflammatory, with consideration of an adjuvant analgesic if necessary. Step 2 is reserved for patients experiencing mild to moderate pain who are already taking a nonopioid analgesic, with or without an adjuvant analgesic, but are still experiencing poor analgesic control. Step 2 agents include acetaminophen products containing hydrocodone, oxycodone, codeine and tramadol. Patients with moderate to severe pain require strong analgesics belonging to step 3 of the WHO analgesic stepladder. Step 3 opioids include morphine, hydromorphone, fentanyl, levorphanol, methadone and oxycodone. Familiarity with opioid pharmacokinetics, equianalgesic dosing and adverse effects is necessary for the safe and effective use of these drugs. The appropriate use of adjuvant analgesics such as antiepileptic drugs, antidepressants and local anaesthetics can enhance the use of opioids, especially in cases where opioid responsiveness may be in question, such as with neuropathic pain. This paper will provide an overview of the analgesic considerations for elderly patients at the end of life.
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Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment.
Filed under: Methadone Side Effects
J Subst Abuse Treat. 2012 Mar 21;
Engstrom M, El-Bassel N, Gilbert L
Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.
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nutrition and the methadone patient – doctor talks about methadone patients who were given nutridone to help erase methadone side effects
Opioid Rotation Practices Linked to Fatalities
Filed under: Methadone Side Effects
… FDA's public health advisory on deaths and life-threatening changes in breathing and heart rate in patients newly started on methadone. Although prescribing a new pain reliever might be necessary because of loss of effectiveness or side effects, …
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Some neighborhoods are politically exempt from drug treatment centers …
Filed under: Methadone Side Effects
University of Maryland staff provide some answers as to why a methadone clinic was sited in southwest Baltimore. John Spearman, senior vice president at UM Medical Center, and Tony Lehman, chair of psychiatry, listen to residents protesting the new …
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