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[PMID]:28467329
[Au] Autor:Fornasari D; Allegri M; Gerboni S; Fanelli G
[Ad] Endereço:. guido.fanelli@unipr.it.
[Ti] Título:A "novel" association to treat pain: tramadol/dexketoprofen. The first drug of a "new pharmacological class".
[So] Source:Acta Biomed;88(1):17-24, 2017 Apr 28.
[Is] ISSN:0392-4203
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo: Acute and chronic pain have an important socio-economical impact. In order to help physicians to choose the appropriate drug, especially for cancer pain, in 1986 WHO has developed a three-step analgesic "ladder" for cancer pain relief in adults. Later it has also been used for acute pain and chronic non-cancer pain. In step I nonsteroidal anti-inflammatory drugs (NSAIDs) are considered with or without adjuvants, in step II the use of weak opioids for mild-moderate pain, with or without NSAIDs and adjuvant, is suggested, while the step III is reserved to strong opioids for moderate-severe pain with or without non-opioids or adjuvants. In the last two decades, a better pathophysiology knowledge has improved pain management shifting our view from the pain ladder to a modern pain pyramid, in which drugs are selected not only on the basis of pain intensity, but mainly according to mechanisms underlying pain, including peripheral and spinal sensitization which is the main trigger of chronic pain. The best pharmacological approach has become multimodal, in which drugs belonging to different steps should be combined, matching the mechanisms of action with the type of pain. An important corollary of combining analgesic drugs with different mechanism of action is that proper matching achieves the same effect with lower doses, better outcome and fewer adverse effects. In this new perspective, fixed-dose pharmaceutical combinations of different drugs are very useful to fulfil pharmacodynamics, pharmacokinetics and adherence criteria, enriching the pain pyramid of half-steps between the first and second step and between the second and third step. Hence, a new fixed combination of a NSAID with peripheral and central anti-infilammatory activities, such as dexketoprofen, and a weak opioid, such as tramadol, with double analgesic activity in the spinal cord as an opioid and, at the same time, on the descending modulatory pathways, is expected to cover a wide range of acute and recurrent painful conditions, ranging from nociceptive inflammatory pain to neuropathic pain of moderate/severe intensity. In this review we evaluate the rationale that justifies its use as new class of pharmacological modality to treat pain accordingly also to a more update view of WHO pain ladder.
[Mh] Termos MeSH primário: Analgésicos Opioides/farmacologia
Anti-Inflamatórios não Esteroides/farmacologia
Cetoprofeno/análogos & derivados
Cetoprofeno/farmacologia
Dor/tratamento farmacológico
Tramadol/farmacologia
[Mh] Termos MeSH secundário: Combinação de Medicamentos
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Drug Combinations); 39J1LGJ30J (Tramadol); 90Y4QC304K (Ketoprofen)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.23750/abm.v88i1.6361


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[PMID]:29049655
[Au] Autor:Jin J
[Ti] Título:Risks of Codeine and Tramadol in Children.
[So] Source:JAMA;318(15):1514, 2017 10 17.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Codeína/efeitos adversos
Tosse/tratamento farmacológico
Tramadol/efeitos adversos
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Adolescente
Analgésicos não Entorpecentes/uso terapêutico
Criança
Pré-Escolar
Seres Humanos
Lactente
Uso Indevido de Medicamentos sob Prescrição
Transtornos do Sono-Vigília/induzido quimicamente
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:PATIENT EDUCATION HANDOUT
[Nm] Nome de substância:
0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 362O9ITL9D (Acetaminophen); 39J1LGJ30J (Tramadol); Q830PW7520 (Codeine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.13534


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[PMID]:28953949
[Au] Autor:Shin HW; Ju BJ; Jang YK; You HS; Kang H; Park JY
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
[Ti] Título:Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis.
[So] Source:PLoS One;12(9):e0184649, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA) effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB). This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery. METHODS: We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs) that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software. RESULTS: We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004), motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003), and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001) compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001) and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010). In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05) but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies. CONCLUSIONS: In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and shorten the time to onset of sensory and motor blocks without altering adverse effects.
[Mh] Termos MeSH primário: Adjuvantes Farmacêuticos
Anestésicos Locais/farmacologia
Bloqueio do Plexo Braquial
Tramadol/farmacologia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adjuvants, Pharmaceutic); 0 (Anesthetics, Local); 39J1LGJ30J (Tramadol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184649


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[PMID]:28799579
[Au] Autor:Montero Matamala A; Bertolotti M; Contini MP; Guerrero Bayón C; Nizzardo A; Paredes Lario I; Pizà Vallespir B; Scartoni S; Tonini G; Capriati A; Pellacani A
[Ad] Endereço:Department of Anesthesiology, Reanimation and Pain Clinic, University Hospital Arnau de Vilanova, Lleida, Spain.
[Ti] Título:Tramadol hydrochloride 75 mg/dexketoprofen 25 mg oral fixed-dose combination in moderate-to-severe acute pain: sustained analgesic effect over a 56-h period in the postoperative setting.
[So] Source:Drugs Today (Barc);53(6):339-347, 2017 Jun.
[Is] ISSN:1699-3993
[Cp] País de publicação:Spain
[La] Idioma:eng
[Ab] Resumo:Multimodal analgesia constitutes a common strategy in pain management. A tramadol hydrochloride 75 mg/dexketoprofen 25 mg oral fixed combination (TRAM/DKP 75 mg/25 mg) has been recently registered and released in Europe for the treatment of moderate-to-severe acute pain. This paper provides additional analyses on the results of two phase III clinical trials (DEX-TRA-04 and DEX-TRA-05) on postoperative pain to document its sustained effect. The analysis was applied to a modified intention-to-treat population (mITT, n = 933) of patients undergoing active treatment from the first dose, to assess the sustained effect of TRAM/DKP 75 mg/25 mg on pain intensity (PI-VAS 0-100) over 56 h from first drug intake. The superior analgesic effect of TRAM/DKP 75 mg/25 mg over 56 h in terms of difference in PI-VAS (mean [SE]) was shown for DEX-TRA-04 (-11.0 [0.55] over dexketoprofen 25 mg and -9.1 [0.55] over tramadol 100 mg, P ≤ 0.0001) and for DEX-TRA-05 (-10.4 [0.51] over dexketoprofen 25 mg and -8.3 [0.51] over tramadol 100 mg, P ≤ 0.0001). The statistical analysis performed on data coming from both studies confirms the superior sustained analgesia of TRAM/DKP 75 mg/25 mg over tramadol 100 mg and dexketoprofen 25 mg. These results are consistent with the previously published data obtained on the ITT population and strongly support the role of this oral fixed-dose combination in the treatment of moderate-to-severe acute pain.
[Mh] Termos MeSH primário: Analgésicos/uso terapêutico
Cetoprofeno/análogos & derivados
Dor Pós-Operatória/tratamento farmacológico
Tramadol/administração & dosagem
Trometamina/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril/efeitos adversos
Ensaios Clínicos Fase III como Assunto/estatística & dados numéricos
Método Duplo-Cego
Esquema de Medicação
Combinação de Medicamentos
Feminino
Seres Humanos
Histerectomia/efeitos adversos
Cetoprofeno/administração & dosagem
Masculino
Meia-Idade
Estudos Multicêntricos como Assunto/estatística & dados numéricos
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 0 (Drug Combinations); 023C2WHX2V (Tromethamine); 39J1LGJ30J (Tramadol); 90Y4QC304K (Ketoprofen); N674F7L21E (dexketoprofen trometamol)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE
[do] DOI:10.1358/dot.2017.53.6.2636487


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[PMID]:28768953
[Au] Autor:Hosono T; Kondo A; Kambayashi Y; Homma M
[Ad] Endereço:Pharmacy Department, University of Tsukuba Hospital.
[Ti] Título:Effects of Tramadol Coadministration on Prothrombin Time-International Normalized Ratio in Patients Receiving Warfarin.
[So] Source:Yakugaku Zasshi;137(8):999-1003, 2017.
[Is] ISSN:1347-5231
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:Several case studies have reported a possible drug interaction between warfarin and tramadol where tramadol coadministration enhanced the antithrombotic effects of warfarin. To assess this drug interaction, changes in prothrombin time-international normalized ratio (PT-INR) before and after tramadol coadministration were investigated in patients receiving warfarin. For this study, we examined 54 patients (male/female: 22/32, 68.4±12.7 years) who were being treated with warfarin for deep vein thrombosis, atrial fibrillation, arteriosclerosis obliterans, congestive heart failure, and other vascular diseases. Significant increases in PT-INR were observed 9.5 (1-118) d after coadministration of tramadol (1.81±0.56 vs. 2.47±1.10, p<0.01). Twenty-eight patients (PT-INR increased group) with PT-INR elevation of greater than 0.5 or dose reduction of warfarin after coadministration of tramadol were compared with other groups of patients to find drug interaction risk factors. Logistic regression analysis revealed that lower levels of albumin (3.5 g/dL or less) [odds ratio (OR) 22.1; 95%CI 2.9-169.9]; lower eGFR (50 mL/min or less) (OR 7.7; 95%CI 1.4-42.0); and PT-INR before tramadol coadministration (OR 38.2; 95%CI 3.7-397.6) were characteristic of the PT-INR increased group. These results suggest that tramadol coadministration enhanced the antithrombotic effects of warfarin in patients with higher PT-INR, lower albumin levels and decreased renal function as the risk factors for this drug interaction.
[Mh] Termos MeSH primário: Fibrinolíticos/administração & dosagem
Fibrinolíticos/farmacologia
Coeficiente Internacional Normatizado
Tempo de Protrombina
Tramadol/administração & dosagem
Tramadol/farmacologia
Varfarina/administração & dosagem
Varfarina/farmacologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doenças Cardiovasculares/tratamento farmacológico
Interações Medicamentosas
Sinergismo Farmacológico
Quimioterapia Combinada
Feminino
Taxa de Filtração Glomerular
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Fatores de Risco
Albumina Sérica/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents); 0 (Serum Albumin); 39J1LGJ30J (Tramadol); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1248/yakushi.16-00270


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[PMID]:28700791
[Au] Autor:Dunn KE; Tompkins DA; Bigelow GE; Strain EC
[Ad] Endereço:Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Título:Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial.
[So] Source:JAMA Psychiatry;74(9):885-893, 2017 Sep 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. Objective: To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. Design, Setting, and Participants: A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Main Outcomes and Measures: Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Results: Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; χ2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P < .001), but no group effects or group × phase interactions. Analyses of area under the curve of SOWS total scores showed significant reductions (F2,159 = 17.7, P < .001) in withdrawal severity between the taper and post-taper periods for clonidine (taper mean, 13.1; post-taper mean, 3.2; P < .001) and tramadol ER (taper mean, 7.4; post-taper mean, 2.8; P = .03), but not buprenorphine (taper mean, 6.4; post-taper mean, 7.4). Use of concomitant medication increased significantly (F2,159 = 30.7, P < .001) from stabilization to taper in the clonidine (stabilization mean, 0.64 [SE, .05]; taper mean, 1.54 [SE, .10]; P < .001) and tramadol ER (stabilization mean, 0.53 [SE, .05]; taper mean, 1.19 [SE, .09]; P = .003) groups and from stabilization to post taper in the buprenorphine group (stabilization mean, 0.46 [SE, .05] post-taper mean, 1.17 [SE, .09]; P = .006), suggesting higher withdrawal for those groups during those periods. Naltrexone initiation was voluntary and the percentage of participants choosing naltrexone therapy within the clonidine (8 [22.2%]), tramadol ER (7 [19.4%]), or buprenorphine (3 [9.7%]) groups did not differ significantly (χ2 = 2.5, P = .29). Conclusions and Relevance: The results of this trial suggest that tramadol ER is more effective than clonidine and comparable to buprenorphine in reducing opioid withdrawal symptoms during a residential tapering program. Data support further examination of tramadol ER as a method to manage opioid withdrawal symptoms. Trial Registration: Clinicaltrials.gov Identifier: NCT01188421.
[Mh] Termos MeSH primário: Tratamento de Substituição de Opiáceos/métodos
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Síndrome de Abstinência a Substâncias/tratamento farmacológico
Tramadol/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Analgésicos/uso terapêutico
Analgésicos Opioides/uso terapêutico
Buprenorfina/uso terapêutico
Clonidina/uso terapêutico
Preparações de Ação Retardada/uso terapêutico
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Naltrexona/uso terapêutico
Antagonistas de Entorpecentes/uso terapêutico
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics); 0 (Analgesics, Opioid); 0 (Delayed-Action Preparations); 0 (Narcotic Antagonists); 39J1LGJ30J (Tramadol); 40D3SCR4GZ (Buprenorphine); 5S6W795CQM (Naltrexone); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.1838


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[PMID]:28689766
[Au] Autor:Barbosa J; Faria J; Leal S; Afonso LP; Lobo J; Queirós O; Moreira R; Carvalho F; Dinis-Oliveira RJ
[Ad] Endereço:IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal; UCIBIO, REQUIMTE - Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, Unive
[Ti] Título:Acute administration of tramadol and tapentadol at effective analgesic and maximum tolerated doses causes hepato- and nephrotoxic effects in Wistar rats.
[So] Source:Toxicology;389:118-129, 2017 Aug 15.
[Is] ISSN:1879-3185
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Tramadol and tapentadol are two atypical synthetic opioid analgesics, with monoamine reuptake inhibition properties. Mainly aimed at the treatment of moderate to severe pain, these drugs are extensively prescribed for multiple clinical applications. Along with the increase in their use, there has been an increment in their abuse, and consequently in the reported number of adverse reactions and intoxications. However, little is known about their mechanisms of toxicity. In this study, we have analyzed the in vivo toxicological effects in liver and kidney resulting from an acute exposure of a rodent animal model to both opioids. Male Wistar rats were intraperitoneally administered with 10, 25 and 50mg/kg tramadol and tapentadol, corresponding to a low, effective analgesic dose, an intermediate dose and the maximum recommended daily dose, respectively, for 24h. Toxicological effects were assessed in terms of oxidative stress, biochemical and metabolic parameters and histopathology, using serum and urine samples, liver and kidney homogenates and tissue specimens. The acute exposure to tapentadol caused a dose-dependent increase in protein oxidation in liver and kidney. Additionally, exposure to both opioids led to hepatic commitment, as shown by increased serum lipid levels, decreased urea concentration, increased alanine aminotransferase and decreased butyrylcholinesterase activities. It also led to renal impairment, as reflected by proteinuria and decreased glomerular filtration rate. Histopathological findings included sinusoidal dilatation, microsteatosis, vacuolization, cell infiltrates and cell degeneration, indicating metabolic changes, inflammation and cell damage. In conclusion, a single effective analgesic dose or the maximum recommended daily dose of both opioids leads to hepatotoxicity and nephrotoxicity, with tapentadol inducing comparatively more toxicity. Whether these effects reflect risks during the therapeutic use or human overdoses requires focused attention by the medical community.
[Mh] Termos MeSH primário: Analgésicos Opioides/toxicidade
Doença Hepática Induzida por Substâncias e Drogas/etiologia
Taxa de Filtração Glomerular/efeitos dos fármacos
Nefropatias/induzido quimicamente
Rim/efeitos dos fármacos
Fígado/efeitos dos fármacos
Fenóis/toxicidade
Tramadol/toxicidade
[Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem
Animais
Biomarcadores/sangue
Doença Hepática Induzida por Substâncias e Drogas/metabolismo
Doença Hepática Induzida por Substâncias e Drogas/patologia
Relação Dose-Resposta a Droga
Injeções Intraperitoneais
Rim/metabolismo
Rim/patologia
Rim/fisiopatologia
Nefropatias/metabolismo
Nefropatias/patologia
Nefropatias/fisiopatologia
Fígado/metabolismo
Fígado/patologia
Masculino
Dose Máxima Tolerável
Estresse Oxidativo/efeitos dos fármacos
Fenóis/administração & dosagem
Proteinúria/induzido quimicamente
Ratos Wistar
Medição de Risco
Fatores de Tempo
Tramadol/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Biomarkers); 0 (Phenols); 39J1LGJ30J (Tramadol); H8A007M585 (tapentadol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE


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[PMID]:28683172
[Au] Autor:Wiffen PJ; Wee B; Derry S; Bell RF; Moore RA
[Ad] Endereço:Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LE.
[Ti] Título:Opioids for cancer pain - an overview of Cochrane reviews.
[So] Source:Cochrane Database Syst Rev;7:CD012592, 2017 07 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Opioid (morphine-like) drugs are commonly used to treat moderate or severe cancer pain, and are recommended for this purpose in the World Health Organization (WHO) pain treatment ladder. The most commonly-used opioid drugs are buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, tramadol, and tapentadol. OBJECTIVES: To provide an overview of the analgesic efficacy of opioids in cancer pain, and to report on adverse events associated with their use. METHODS: We identified systematic reviews examining any opioid for cancer pain published to 4 May 2017 in the Cochrane Database of Systematic Reviews in the Cochrane Library. The primary outcomes were no or mild pain within 14 days of starting treatment, withdrawals due to adverse events, and serious adverse events. MAIN RESULTS: We included nine reviews with 152 included studies and 13,524 participants, but because some studies appeared in more than one review the number of unique studies and participants was smaller than this. Most participants had moderate or severe pain associated with a range of different types of cancer. Studies in the reviews typically compared one type of opioid or formulation with either a different formulation of the same opioid, or a different opioid; few included a placebo control. Typically the reviews titrated dose to effect, a balance between pain relief and adverse events. Various routes of administration of opioids were considered in the reviews; oral with most opioids, but transdermal administration with fentanyl, and buprenorphine. No review included studies of subcutaneous opioid administration. Pain outcomes reported were varied and inconsistent. The average size of included studies varied considerably between reviews: studies of older opioids, such as codeine, morphine, and methadone, had low average study sizes while those involving newer drugs tended to have larger study sizes.Six reviews reported a GRADE assessment (buprenorphine, codeine, hydromorphone, methadone, oxycodone, and tramadol), but not necessarily for all comparisons or outcomes. No comparative analyses were possible because there was no consistent placebo or active control. Cohort outcomes for opioids are therefore reported, as absolute numbers or percentages, or both.Reviews on buprenorphine, codeine with or without paracetamol, hydromorphone, methadone, tramadol with or without paracetamol, tapentadol, and oxycodone did not have information about the primary outcome of mild or no pain at 14 days, although that on oxycodone indicated that average pain scores were within that range. Two reviews, on oral morphine and transdermal fentanyl, reported that 96% of 850 participants achieved that goal.Adverse event withdrawal was reported by five reviews, at rates of between 6% and 19%. Participants with at least one adverse event were reported by three reviews, at rates of between 11% and 77%.Our GRADE assessment of evidence quality was very low for all outcomes, because many studies in the reviews were at high risk of bias from several sources, including small study size. AUTHORS' CONCLUSIONS: The amount and quality of evidence around the use of opioids for treating cancer pain is disappointingly low, although the evidence we have indicates that around 19 out of 20 people with moderate or severe pain who are given opioids and can tolerate them should have that pain reduced to mild or no pain within 14 days. This accords with the clinical experience in treating many people with cancer pain, but overstates to some extent the effectiveness found for the WHO pain ladder. Most people will experience adverse events, and help may be needed to manage the more common undesirable adverse effects such as constipation and nausea. Perhaps between 1 in 10 and 2 in 10 people treated with opioids will find these adverse events intolerable, leading to a change in treatment.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Dor do Câncer/tratamento farmacológico
Literatura de Revisão como Assunto
[Mh] Termos MeSH secundário: Acetaminofen/administração & dosagem
Acetaminofen/uso terapêutico
Administração Cutânea
Administração Oral
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Buprenorfina/administração & dosagem
Buprenorfina/uso terapêutico
Codeína/administração & dosagem
Codeína/uso terapêutico
Fentanila/administração & dosagem
Fentanila/uso terapêutico
Seres Humanos
Hidromorfona/administração & dosagem
Hidromorfona/uso terapêutico
Metadona/administração & dosagem
Metadona/uso terapêutico
Oxicodona/administração & dosagem
Oxicodona/uso terapêutico
Fenóis/administração & dosagem
Fenóis/uso terapêutico
Tramadol/administração & dosagem
Tramadol/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Phenols); 362O9ITL9D (Acetaminophen); 39J1LGJ30J (Tramadol); 40D3SCR4GZ (Buprenorphine); CD35PMG570 (Oxycodone); H8A007M585 (tapentadol); Q812464R06 (Hydromorphone); Q830PW7520 (Codeine); UC6VBE7V1Z (Methadone); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012592.pub2


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[PMID]:28616956
[Au] Autor:Duehmke RM; Derry S; Wiffen PJ; Bell RF; Aldington D; Moore RA
[Ad] Endereço:Cardiac Unit, Papworth Hospital, Papworth Everard, Cambridge, UK, CB3 8RE.
[Ti] Título:Tramadol for neuropathic pain in adults.
[So] Source:Cochrane Database Syst Rev;6:CD003726, 2017 06 15.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This review is an update of a review of tramadol for neuropathic pain, published in 2006; updating was to bring the review in line with current standards. Neuropathic pain, which is caused by a lesion or disease affecting the somatosensory system, may be central or peripheral in origin. Peripheral neuropathic pain often includes symptoms such as burning or shooting sensations, abnormal sensitivity to normally painless stimuli, or an increased sensitivity to normally painful stimuli. Neuropathic pain is a common symptom in many diseases of the peripheral nervous system. OBJECTIVES: To assess the analgesic efficacy of tramadol compared with placebo or other active interventions for chronic neuropathic pain in adults, and the adverse events associated with its use in clinical trials. SEARCH METHODS: We searched CENTRAL, MEDLINE, and Embase for randomised controlled trials from inception to January 2017. We also searched the reference lists of retrieved studies and reviews, and online clinical trial registries. SELECTION CRITERIA: We included randomised, double-blind trials of two weeks' duration or longer, comparing tramadol (any route of administration) with placebo or another active treatment for neuropathic pain, with subjective pain assessment by the participant. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality and potential bias. Primary outcomes were participants with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)), or moderate pain relief (at least 30% pain relief over baseline or much or very much improved on PGIC). Where pooled analysis was possible, we used dichotomous data to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH), using standard methods. We assessed the quality of the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS: We identified six randomised, double-blind studies involving 438 participants with suitably characterised neuropathic pain. In each, tramadol was started at a dose of about 100 mg daily and increased over one to two weeks to a maximum of 400 mg daily or the maximum tolerated dose, and then maintained for the remainder of the study. Participants had experienced moderate or severe neuropathic pain for at least three months due to cancer, cancer treatment, postherpetic neuralgia, peripheral diabetic neuropathy, spinal cord injury, or polyneuropathy. The mean age was 50 to 67 years with approximately equal numbers of men and women. Exclusions were typically people with other significant comorbidity or pain from other causes. Study duration for treatments was four to six weeks, and two studies had a cross-over design.Not all studies reported all the outcomes of interest, and there were limited data for pain outcomes. At least 50% pain intensity reduction was reported in three studies (265 participants, 110 events). Using a random-effects analysis, 70/132 (53%) had at least 50% pain relief with tramadol, and 40/133 (30%) with placebo; the risk ratio (RR) was 2.2 (95% confidence interval (CI) 1.02 to 4.6). The NNT calculated from these data was 4.4 (95% CI 2.9 to 8.8). We downgraded the evidence for this outcome by two levels to low quality because of the small size of studies and of the pooled data set, because there were only 110 actual events, the analysis included different types of neuropathic pain, the studies all had at least one high risk of potential bias, and because of the limited duration of the studies.Participants experienced more adverse events with tramadol than placebo. Report of any adverse event was higher with tramadol (58%) than placebo (34%) (4 studies, 266 participants, 123 events; RR 1.6 (95% CI 1.2 to 2.1); NNH 4.2 (95% CI 2.8 to 8.3)). Adverse event withdrawal was higher with tramadol (16%) than placebo (3%) (6 studies, 485 participants, 45 events; RR 4.1 (95% CI 2.0 to 8.4); NNH 8.2 (95% CI 5.8 to 14)). Only four serious adverse events were reported, without obvious attribution to treatment, and no deaths were reported. We downgraded the evidence for this outcome by two or three levels to low or very low quality because of small study size, because there were few actual events, and because of the limited duration of the studies. AUTHORS' CONCLUSIONS: There is only modest information about the use of tramadol in neuropathic pain, coming from small, largely inadequate studies with potential risk of bias. That bias would normally increase the apparent benefits of tramadol. The evidence of benefit from tramadol was of low or very low quality, meaning that it does not provide a reliable indication of the likely effect, and the likelihood is very high that the effect will be substantially different from the estimate in this systematic review.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Neuralgia/tratamento farmacológico
Tramadol/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Analgésicos Opioides/efeitos adversos
Seres Humanos
Meia-Idade
Neuralgia/etiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Tramadol/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 39J1LGJ30J (Tramadol)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD003726.pub4


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[PMID]:28564673
[Au] Autor:Wick EC; Grant MC; Wu CL
[Ad] Endereço:Department of Surgery, University of California, San Francisco.
[Ti] Título:Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review.
[So] Source:JAMA Surg;152(7):691-697, 2017 Jul 01.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens. Observations: Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or the N-methyl-d-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia. Nonsteroidal anti-inflammatory agents are not associated with an increase in postoperative bleeding. A meta-analysis of 27 randomized clinical trials found no difference in postoperative bleeding between the groups taking ketorolac tromethamine (33 of 1304 patients [2.5%]) and the control groups (21 of 1010 [2.1%]) (odds ratio [OR], 1.1; 95% CI, 0.61-2.06; P = .72). After adoption of the multimodal analgesia approach for a colorectal ERAS pathway, most patients used less opioids while in the hospital and many did not need opioids after hospital discharge, although approximately 50% of patients received some opioid during their stay. Conclusions and Relevance: Multimodal analgesia is readily available and the evidence is strong to support its efficacy. Surgeons should use this effective approach for patients both using and not using the ERAS pathway to reduce opioid consumption.
[Mh] Termos MeSH primário: Analgésicos não Entorpecentes/uso terapêutico
Analgésicos Opioides/uso terapêutico
Anestesia por Condução
Dor Pós-Operatória/terapia
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Aminas/uso terapêutico
Anti-Inflamatórios não Esteroides/uso terapêutico
Ácidos Cicloexanocarboxílicos/uso terapêutico
Seres Humanos
Lidocaína/uso terapêutico
N-Metilaspartato/antagonistas & inibidores
Cuidados Pós-Operatórios
Pregabalina/uso terapêutico
Tramadol/uso terapêutico
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics, Non-Narcotic); 0 (Analgesics, Opioid); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Cyclohexanecarboxylic Acids); 362O9ITL9D (Acetaminophen); 39J1LGJ30J (Tramadol); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid); 6384-92-5 (N-Methylaspartate); 6CW7F3G59X (gabapentin); 98PI200987 (Lidocaine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170601
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2017.0898



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