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[PMID]:27060723
[Au] Autor:Sandhu A; Kao D; Mehler PS; Haigney MC; Krantz MJ
[Ad] Endereço:Department of Medicine, Division of Cardiology, University of Colorado Health Sciences Center, United States; Denver Health Medical Center, Cardiology Division, United States.
[Ti] Título:Cardiovascular disorders associated with naloxone monotherapy and in fixed-dose combination with opioids: Data from international safety surveillance.
[So] Source:Int J Cardiol;212:360-3, 2016 Jun 01.
[Is] ISSN:1874-1754
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The widespread use of opioids has resulted in sharp rise of associated complications, particularly opioid-induced constipation (OIC). Opioid receptor antagonists have been proposed to treat OIC, but could precipitate rapid opioid withdrawal. As cardiovascular safety data are lacking, we assessed disproportionate reporting of adverse cardiac events associated with naloxone across large, international pharmacovigilance systems. METHODS: Post-marketing data from the World Health Organization (WHO) and FDA Adverse Events Reporting System (FAERS) were evaluated for naloxone and the synthetic opioids oxycodone and tilidine. The proportional reporting ratio (PRR), a measure of reporting frequency analogous to an odds ratio, was assessed. The primary outcome was reporting frequency of the MedDRA System Organ Class (SOC) 'Cardiac Disorders' for naloxone alone and in fixed-dose combination with opioids. Opioid mono-preparations served as quasi-experimental controls. A PRR greater than 2.0 was considered significant. RESULTS: In total, 14,827,374 million adverse drug event reports were reviewed. In WHO, there were 1757 reports of SOC cardiac disorders among 10,866 total reports for oxycodone (PRR 2.38 [95% CI 2.28-2.49, χ(2)=1504]). For oxycodone-naloxone, there were 43/453 reports of SOC cardiac disorders (PRR 1.45 [95% CI 1.09-1.92, χ(2)=6.4]). For the synthetic opioid tilidine there were 13/179 reports (PRR 1.13 [95% CI 0.67-1.91, χ(2)=0.2]) and for tilidine-naloxone, 30/505 reports (PRR 0.92 [95% CI 0.65-1.31, χ(2)=0.2]). In FAERS, the PRR for SOC cardiac disorders was 0.95 [95% CI 0.89-1.01, χ(2)=2.1] for naloxone (all administration routes) and 1.16 [95% CI 0.93-1.45, χ(2)=1.3] for naloxone (oral only). In comparison, the PRR was 1.66 [95% CI 1.63-1.69, χ(2)=4278] for oxycodone and 1.52 [CI 1.28-1.80, χ(2)=1500] for oxycodone-naloxone. CONCLUSIONS: Available pharmacovigilance data do not suggest disproportionate reporting of adverse cardiovascular events for opioid antagonists used to treat OIC.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/epidemiologia
Naloxona/efeitos adversos
Oxicodona/efeitos adversos
Tilidina/efeitos adversos
[Mh] Termos MeSH secundário: Doenças Cardiovasculares/induzido quimicamente
Combinação de Medicamentos
Seres Humanos
Farmacovigilância
Organização Mundial da Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drug Combinations); 36B82AMQ7N (Naloxone); CD35PMG570 (Oxycodone); GY33N31E9Y (Tilidine)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160410
[St] Status:MEDLINE


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[PMID]:26747067
[Au] Autor:Yayan J; Rasche K
[Ad] Endereço:Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany. josef.yayan@hotmail.com.
[Ti] Título:Treatment Options for Central Sleep Apnea: Comparison of Ventilator, Oxygen, and Drug Therapies.
[So] Source:Adv Exp Med Biol;905:79-86, 2016.
[Is] ISSN:0065-2598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Central sleep apnea (CSA) is a sleep-related disorder characterized by pauses in breathing during sleep when the brain respiratory network momentarily interrupts transmission of impulses to the respiratory musculature. CSA presents significant problems being an independent risk factor for cardiovascular events and death. There are several available treatment options according to CSA severity. Currently, adaptive servo-ventilation is considered best for CSA patients. The goal of the present study was to retrospectively investigate different treatment methods employed for CSA, such as different modes of ventilation, oxygen therapy, and drugs to determine the most effective one. Data were obtained from hospital records during 2010-2015. The diagnosis of CSA and the optimal treatment method were supported by polysomnography examinations. Devices used during sleep to support breathing included continuous positive airway pressure, bi-level positive airway pressure, or adaptive servo-ventilation. We classified 71 (2.9 %) patients as having CSA from 2,463 patients with sleep-disordered breathing. Of those 71 patients, 54 (76.1 %, 95 % CI 66.2-86.0 %) were male and 17 (23.9 %, 95 % CI 14.0-33.8 %) were female, and they had a mean age of 67.1 ± 14.1. Four (5.6 %) patients underwent a combination therapy, 39 (54.9 %) received a ventilator in proper ventilation mode, 25 (35.2 %) received oxygen therapy, 7 (9.9 %) received medication, and 4 (5.6 %) received no treatment. We conclude that although the majority of patients needed treatment for central sleep apnea, a clear advantage in using ventilators when compared to oxygen therapy or drug therapy could not be found.
[Mh] Termos MeSH primário: Antagonistas Adrenérgicos alfa/uso terapêutico
Analgésicos Opioides/uso terapêutico
Pressão Positiva Contínua nas Vias Aéreas/métodos
Dopaminérgicos/uso terapêutico
Hipnóticos e Sedativos/uso terapêutico
Oxigenoterapia/métodos
Antagonistas da Serotonina/uso terapêutico
Apneia Central do Sono/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Clozapina/uso terapêutico
Feminino
Seres Humanos
Levodopa/uso terapêutico
Masculino
Mianserina/análogos & derivados
Mianserina/uso terapêutico
Meia-Idade
Polissonografia
Piridinas/uso terapêutico
Estudos Retrospectivos
Apneia Central do Sono/diagnóstico
Tiazinas/uso terapêutico
Tilidina/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic alpha-Antagonists); 0 (Analgesics, Opioid); 0 (Dopamine Agents); 0 (Hypnotics and Sedatives); 0 (Pyridines); 0 (Serotonin Antagonists); 0 (Thiazines); 250PJI13LM (Mianserin); 46627O600J (Levodopa); 5O6VWA87VA (prothipendyl); 7K383OQI23 (zolpidem); A051Q2099Q (mirtazapine); GY33N31E9Y (Tilidine); J60AR2IKIC (Clozapine)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170620
[Lr] Data última revisão:
170620
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160110
[St] Status:MEDLINE
[do] DOI:10.1007/5584_2015_183


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[PMID]:26099752
[Au] Autor:Niemier K; Schindler M; Volk T; Baum K; Wolf B; Eberitsch J; Seidel W
[Ad] Endereço:Klinik für Manuelle Therapie Hamm, Ostenallee 83, 59071, Hamm, Deutschland, kay.niemier@kmt-hamm.de.
[Ti] Título:[Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits. A randomized, double blind study as part of a multimodal treatment concept].
[Ti] Título:Wirksamkeit periduraler Steroidinjektionen in der Therapie von nichtradikulären chronischen Rückenschmerzen. Eine randomisierte, doppelverblindete Vergleichsstudie im Rahmen eines multimodalen Behandlungskonzeptes..
[So] Source:Schmerz;29(3):300-7, 2015 Jul.
[Is] ISSN:1432-2129
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:BACKGROUND: Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome. METHODS: A double blind randomized prospective trial was carried out. Patients treated in hospital for a chronic lumbar pain syndrome without neurological deficits within a multimodal treatment program were screened for indications for an epidural steroid injection (e.g. diseased lumbar disc and intention to treat). Patients eligible for the study were randomized into two groups. The treatment group received an epidural injection of 80 mg triamcinolone and 8 ml bupivacaine 0.25 %. The control group received only an epidural injection of 8 ml bupivacaine 0.25 %. RESULTS: In both groups pain intensity and treatability showed a statistically significant improvement after the epidural injection. The differences between the control and treatment groups were small and not clinically relevant. A small subgroup might profit from the steroid injection. In addition the treatability was dependent on psychometric values and the long-term outcome from a reduction of muscular skeletal dysfunctions. DISCUSSION: After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.
[Mh] Termos MeSH primário: Analgesia Epidural
Bupivacaína/administração & dosagem
Discite/tratamento farmacológico
Dor Lombar/tratamento farmacológico
Triancinolona/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Terapia Combinada
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Injeções Epidurais
Análise de Intenção de Tratamento
Masculino
Meia-Idade
Oxicodona/uso terapêutico
Medição da Dor/efeitos dos fármacos
Modalidades de Fisioterapia
Efeito Placebo
Estudos Prospectivos
Piridinas/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Sulfonas/uso terapêutico
Tilidina/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Pyridines); 0 (Sulfones); 1ZK20VI6TY (Triamcinolone); CD35PMG570 (Oxycodone); GY33N31E9Y (Tilidine); WRX4NFY03R (etoricoxib); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150624
[St] Status:MEDLINE
[do] DOI:10.1007/s00482-015-0020-6


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[PMID]:25223231
[Au] Autor:Eichbaum C; Mathes K; Burhenne J; Markert C; Blank A; Mikus G
[Ad] Endereço:Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany.
[Ti] Título:Pre-systemic elimination of tilidine: localization and consequences for the formation of the active metabolite nortilidine.
[So] Source:Basic Clin Pharmacol Toxicol;116(2):129-33, 2015 Feb.
[Is] ISSN:1742-7843
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The therapeutic activity of tilidine, an opioid analgesic, is mainly related to its active metabolite nortilidine. Nortilidine formation mainly occurs during the high intestinal first-pass metabolism of tilidine by N-demethylation. Elimination of the active nortilidine to the inactive bisnortilidine is also mediated by N-demethylation and is supposed to take place in the liver, probably at a smaller rate. The aim of this study was the investigation of the pre-systemic elimination of tilidine using grapefruit juice (GFJ) as an intestinal CYP3A4 inhibitor and efavirenz (EFV) as a CYP3A4 activator. A randomized, open, placebo-controlled, cross-over study was conducted in 12 healthy volunteers using 100 mg tilidine solution p.o., regular strength GFJ 250 mL (3 times at 12-hr intervals) and EFV 400 mg (12 hr before tilidine administration). Tilidine, nortilidine and bisnortilidine in plasma and urine were quantified by a validated LC/MS/MS analysis. GFJ did not change any pharmacokinetic parameter of tilidine and its metabolites, which suggests that intestinal CYP3A4 does not contribute to the first-pass metabolism of tilidine. No effect of EFV on the pharmacokinetics of the active nortilidine was observed except a significant reduction of the terminal elimination half-life by 15%. Overall elimination (renal and metabolic clearances) was unaffected by every treatment. CYP3A4 does not seem to play a major role in tilidine first-pass and overall metabolism. Other unknown metabolites and their enzymes responsible for their formation have to be investigated as they account for the majority of renally excreted metabolites.
[Mh] Termos MeSH primário: Analgésicos Opioides/farmacocinética
Citocromo P-450 CYP3A/metabolismo
Tilidina/análogos & derivados
[Mh] Termos MeSH secundário: Adulto
Benzoxazinas/farmacologia
Bebidas
Cromatografia Líquida/métodos
Citrus paradisi
Estudos Cross-Over
Feminino
Meia-Vida
Seres Humanos
Masculino
Meia-Idade
Espectrometria de Massas em Tandem/métodos
Tilidina/farmacocinética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Benzoxazines); 53948-51-9 (bisnortilidine); 7145G6817J (nortilidine); EC 1.14.13.67 (CYP3A4 protein, human); EC 1.14.14.1 (Cytochrome P-450 CYP3A); GY33N31E9Y (Tilidine); JE6H2O27P8 (efavirenz)
[Em] Mês de entrada:1509
[Cu] Atualização por classe:161125
[Lr] Data última revisão:
161125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140917
[St] Status:MEDLINE
[do] DOI:10.1111/bcpt.12328


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[PMID]:24935086
[Au] Autor:Poetzsch M; Baumgartner MR; Steuer AE; Kraemer T
[Ad] Endereço:Department of Forensic Pharmacology and Toxicology, ZIFM - Zurich Institute of Forensic Medicine, University of Zurich, Zurich, (Switzerland).
[Ti] Título:Segmental hair analysis for differentiation of tilidine intake from external contamination using LC-ESI-MS/MS and MALDI-MS/MS imaging.
[So] Source:Drug Test Anal;7(2):143-9, 2015 Feb.
[Is] ISSN:1942-7611
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Segmental hair analysis has been used for monitoring changes of consumption habit of drugs. Contamination from the environment or sweat might cause interpretative problems. For this reason, hair analysis results were compared in hair samples taken 24 h and 30 days after a single tilidine dose. The 24-h hair samples already showed high concentrations of tilidine and nortilidine. Analysis of wash water from sample preparation confirmed external contamination by sweat as reason. The 30-day hair samples were still positive for tilidine in all segments. Negative wash-water analysis proved incorporation from sweat into the hair matrix. Interpretation of a forensic case was requested where two children had been administered tilidine by their nanny and tilidine/nortilidine had been detected in all hair segments, possibly indicating multiple applications. Taking into consideration the results of the present study and of MALDI-MS imaging, a single application as cause for analytical results could no longer be excluded. Interpretation of consumption behaviour of tilidine based on segmental hair analysis has to be done with caution, even after typical wash procedures during sample preparation. External sweat contamination followed by incorporation into the hair matrix can mimic chronic intake. For assessment of external contamination, hair samples should not only be collected several weeks but also one to a few days after intake. MALDI-MS imaging of single hair can be a complementary tool for interpretation. Limitations for interpretation of segmental hair analysis shown here might also be applicable to drugs with comparable physicochemical and pharmacokinetic properties.
[Mh] Termos MeSH primário: Cabelo/química
Entorpecentes/análise
Tilidina/análise
[Mh] Termos MeSH secundário: Adulto
Cromatografia Líquida
Toxicologia Forense
Seres Humanos
Lactente
Masculino
Meia-Idade
Entorpecentes/administração & dosagem
Espectrometria de Massas por Ionização por Electrospray
Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
Espectrometria de Massas em Tandem
Tilidina/administração & dosagem
Tilidina/análogos & derivados
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Narcotics); 7145G6817J (nortilidine); GY33N31E9Y (Tilidine)
[Em] Mês de entrada:1509
[Cu] Atualização por classe:161125
[Lr] Data última revisão:
161125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140618
[St] Status:MEDLINE
[do] DOI:10.1002/dta.1674


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[PMID]:23844964
[Au] Autor:Radbruch L; Glaeske G; Grond S; Münchberg F; Scherbaum N; Storz E; Tholen K; Zagermann-Muncke P; Zieglgänsberger W; Hoffmann-Menzel H; Greve H; Cremer-Schaeffer P
[Ad] Endereço:Department of Palliative Medicine, University Hospital Bonn, Sigmund Freud Strasse 25, Bonn, Germany. Lukas.Radbruch@malteser.org
[Ti] Título:Topical review on the abuse and misuse potential of tramadol and tilidine in Germany.
[So] Source:Subst Abus;34(3):313-20, 2013.
[Is] ISSN:1547-0164
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tramadol and tilidine (in combination with naloxone) are used as weak opioid analgesics in Germany. Tramadol is not scheduled in the German Narcotic Drugs Act. Tilidine is scheduled, whereas Tilidine in fixed combinations with naloxone is exempt from some of the provisions of the Narcotic Drugs Act. Recent reports on misuse of both substances led to an evaluation of their potential for misuse, abuse, and dependency by the expert advisory committee established by the German Federal Government, resident at the Federal Institute for Drugs and Medical Devices. METHODS: A subcommittee formulated key questions and identified available data sources for each of these questions. Additional information was solicited where necessary, including a survey among a panel of pharmacists, a survey in an addiction clinic, analysis of prescription patterns, and information from the boards of pharmacists of the federal states and the Federal Bureau of Criminal Investigation. RESULTS: Analgesic efficiency in the treatment of acute and chronic pain has been proven for both tramadol and tilidine/naloxone. For tramadol, high evidence has been confirmed in systematic reviews, and tramadol is listed in national and international guidelines on acute and chronic pain management. Animal and human studies found a low potential for misuse, abuse, and dependency for both substances. Information from 2 tramadol safety databases allowed calculation of the incidence of abuse or dependency as 0.21 and 0.12 cases per million defined daily dosages (DDDs), with lower incidences in recent years. For tilidine/naloxone, the incidence was calculated as 0.43 cases per million DDDs for oral solution and 0.18 for slow-release tablets. In an online survey among German pharmacies as well as in the reports from state pharmacy boards, fraud attempts were repeated more frequently with tilidine/naloxone than with tramadol in the last 2 years. The Federal Bureau of Criminal Investigations reported prescription fraud only with tilidine/naloxone and predominantly in the region of Berlin. Dependency on tramadol or tilidine/naloxone is reported only rarely from addiction counseling centers. One third of the patients surveyed in an addiction clinic reported experiences with tramadol or tilidine/naloxone, but mostly with duration of less than 4 weeks and with a medical prescription based on a reasonable indication. Also, occasional illegal use of opioid analgesics as a substitute of heroin was reported. An evaluation of pooled data from statutory health insurance companies found 2.5% of persons receiving at least 1 prescription of tramadol or the combination of tilidine and naloxone in 2009 (1.6% with tramadol and 1.0% with tilidine/naloxone). High usage with more than 180 DDDs per year was found in 8.6% of patients treated with tramadol and 17.2% of patients with tilidine/naloxone. CONCLUSIONS: In conclusion, the subcommittee of the expert advisory committee found a low potential for misuse, abuse, and dependency for tramadol, and a low prevalence in clinical practice. Considerable less information is available for the combination of tilidine and naloxone. However, the cumulation of evidence indicated a higher risk of misuse, abuse, and dependency for tilidine/naloxone solution, but not for slow-release tablets.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Transtornos Relacionados ao Uso de Opioides/epidemiologia
Automedicação/efeitos adversos
Tilidina/administração & dosagem
Tilidina/efeitos adversos
Tramadol/administração & dosagem
Tramadol/efeitos adversos
[Mh] Termos MeSH secundário: Analgésicos Opioides/uso terapêutico
Quimioterapia Combinada/efeitos adversos
Fraude/estatística & dados numéricos
Alemanha/epidemiologia
Seres Humanos
Incidência
Naloxona/administração & dosagem
Naloxona/efeitos adversos
Naloxona/uso terapêutico
Dor/tratamento farmacológico
Tilidina/uso terapêutico
Tramadol/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 36B82AMQ7N (Naloxone); 39J1LGJ30J (Tramadol); GY33N31E9Y (Tilidine)
[Em] Mês de entrada:1406
[Cu] Atualização por classe:150330
[Lr] Data última revisão:
150330
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130713
[St] Status:MEDLINE
[do] DOI:10.1080/08897077.2012.735216


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[PMID]:23768028
[Au] Autor:Vinetti M; Duprez T; Hantson P
[Ti] Título:Severe postoperative hyperthermic syndrome after addition of tilidine/naloxone to duloxetine therapy.
[So] Source:Clin Toxicol (Phila);51(6):516-7, 2013 Jul.
[Is] ISSN:1556-9519
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgésicos/efeitos adversos
Febre/induzido quimicamente
Naloxona/efeitos adversos
Antagonistas de Entorpecentes/efeitos adversos
Entorpecentes/efeitos adversos
Complicações Pós-Operatórias/induzido quimicamente
Tiofenos/efeitos adversos
Tilidina/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Encéfalo/efeitos dos fármacos
Interações Medicamentosas
Cloridrato de Duloxetina
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Naloxona/administração & dosagem
Antagonistas de Entorpecentes/administração & dosagem
Entorpecentes/administração & dosagem
Neuroimagem
Tilidina/administração & dosagem
[Pt] Tipo de publicação:CASE REPORTS; LETTER
[Nm] Nome de substância:
0 (Analgesics); 0 (Narcotic Antagonists); 0 (Narcotics); 0 (Thiophenes); 36B82AMQ7N (Naloxone); 9044SC542W (Duloxetine Hydrochloride); GY33N31E9Y (Tilidine)
[Em] Mês de entrada:1308
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:130618
[St] Status:MEDLINE
[do] DOI:10.3109/15563650.2013.808748


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[PMID]:23340881
[Au] Autor:Scharnagel R; Kaiser U; Schütze A; Heineck R; Gossrau G; Sabatowski R
[Ad] Endereço:UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland. ruediger.scharnagel@uniklinikum-dresden.de
[Ti] Título:[Chronic non-cancer-related pain. Long-term treatment with rapid-release and short-acting opioids in the context of misuse and dependency].
[Ti] Título:Chronische nichttumorbedingte Schmerzen. Langzeitbehandlung mit schnell freisetzenden und kurz wirksamen Opioiden im Kontext von Missbrauch und Abhängigkeit..
[So] Source:Schmerz;27(1):7-19, 2013 Feb.
[Is] ISSN:1432-2129
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Annually published data show a continual increase in the volume of opioid prescriptions in Germany, thus indicating an intensification of opioid therapy. The majority of opioids are prescribed to treat chronic non-cancer-related pain. On the basis of current guidelines, as well as in terms of the lack of data regarding long-term use of opioids and their effectiveness beyond a period of 3 months, this development must be viewed critically. With reference to four case reports, we discuss and evaluate opioid therapy in relation to medication misuse and the development of drug dependency. Particular emphasis is placed on the administration of rapid-release and short-acting opioid preparations, which we consider to be particularly problematic.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Dor Crônica/tratamento farmacológico
Assistência de Longa Duração
Transtornos Relacionados ao Uso de Opioides/etiologia
Uso Indevido de Medicamentos sob Prescrição
[Mh] Termos MeSH secundário: Dor Abdominal/tratamento farmacológico
Adulto
Analgésicos Opioides/farmacocinética
Dor Crônica/sangue
Dor Crônica/etiologia
Neuropatias Diabéticas/tratamento farmacológico
Relação Dose-Resposta a Droga
Esquema de Medicação
Uso de Medicamentos/estatística & dados numéricos
Feminino
Fentanila/administração & dosagem
Fentanila/efeitos adversos
Fentanila/farmacocinética
Fidelidade a Diretrizes
Transtornos da Cefaleia/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Transtornos Relacionados ao Uso de Opioides/diagnóstico
Oxicodona/administração & dosagem
Oxicodona/efeitos adversos
Oxicodona/farmacocinética
Relações Médico-Paciente
Padrões de Prática Médica
Fatores de Risco
Tilidina/administração & dosagem
Tilidina/efeitos adversos
Tilidina/farmacocinética
[Pt] Tipo de publicação:CASE REPORTS; ENGLISH ABSTRACT; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); CD35PMG570 (Oxycodone); GY33N31E9Y (Tilidine); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1403
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130124
[St] Status:MEDLINE
[do] DOI:10.1007/s00482-012-1278-6


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[PMID]:22827565
[Au] Autor:van der Hooft JJ; de Vos RC; Mihaleva V; Bino RJ; Ridder L; de Roo N; Jacobs DM; van Duynhoven JP; Vervoort J
[Ad] Endereço:Laboratory of Biochemistry, Wageningen University, Dreijenlaan 3, 6703 HA, Wageningen, The Netherlands. Justin.vanderhooft@wur.nl
[Ti] Título:Structural elucidation and quantification of phenolic conjugates present in human urine after tea intake.
[So] Source:Anal Chem;84(16):7263-71, 2012 Aug 21.
[Is] ISSN:1520-6882
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In dietary polyphenol exposure studies, annotation and identification of urinary metabolites present at low (micromolar) concentrations are major obstacles. To determine the biological activity of specific components, it is necessary to have the correct structures and the quantification of the polyphenol-derived conjugates present in the human body. We present a procedure for identification and quantification of metabolites and conjugates excreted in human urine after single bolus intake of black or green tea. A combination of a solid-phase extraction (SPE) preparation step and two high pressure liquid chromatography (HPLC)-based analytical platforms was used, namely, accurate mass fragmentation (HPLC-FTMS(n)) and mass-guided SPE-trapping of selected compounds for nuclear magnetic resonance spectroscopy (NMR) measurements (HPLC-TOFMS-SPE-NMR). HPLC-FTMS(n) analysis led to the annotation of 138 urinary metabolites, including 48 valerolactone and valeric acid conjugates. By combining the results from MS(n) fragmentation with the one-dimensional (1D)-(1)H NMR spectra of HPLC-TOFMS-SPE-trapped compounds, we elucidated the structures of 36 phenolic conjugates, including the glucuronides of 3',4'-di- and 3',4',5'-trihydroxyphenyl-γ-valerolactone, three urolithin glucuronides, and indole-3-acetic acid glucuronide. We also obtained 26 h-quantitative excretion profiles for specific valerolactone conjugates. The combination of the HPLC-FTMS(n) and HPLC-TOFMS-SPE-NMR platforms results in the efficient identification and quantification of less abundant phenolic conjugates down to nanomoles of trapped amounts of metabolite corresponding to micromolar metabolite concentrations in urine.
[Mh] Termos MeSH primário: Ingestão de Líquidos
Fenol/química
Fenol/urina
Chá/química
Urinálise/métodos
[Mh] Termos MeSH secundário: Cromatografia Líquida de Alta Pressão
Seres Humanos
Espectroscopia de Ressonância Magnética
Espectrometria de Massas
Fenol/metabolismo
Extração em Fase Sólida
Tilidina/química
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Tea); 339NCG44TV (Phenol); GY33N31E9Y (Tilidine)
[Em] Mês de entrada:1212
[Cu] Atualização por classe:131121
[Lr] Data última revisão:
131121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:120726
[St] Status:MEDLINE
[do] DOI:10.1021/ac3017339


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[PMID]:22714402
[Au] Autor:Maier C; Leclerc-Springer J
[Ad] Endereço:Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland. christoph.maier@rub.de
[Ti] Título:[Life-threatening fentanyl and propofol addiction: interview with a survivor].
[Ti] Título:Lebensbedrohliche Fentanyl- und Propofolabhängigkeit : Interview mit einer Überlebenden..
[So] Source:Anaesthesist;61(7):601-7, 2012 Jul.
[Is] ISSN:1432-055X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Anesthesiologists have a well-known increased risk of substance abuse including the intravenous administration of opioids and propofol. However, katamnestic reports from the point of view of propofol-addicted anesthesiologists themselves are missing which would aid a better understanding of the dynamics and progress of addiction. This article presents an interview with a formerly addicted female anesthesiologist who after long-term abuse with oral tilidine combined with naloxone switched to intravenous administration of fentanyl and later on propofol. Several life-threatening incidents occurred but after some severe setbacks occupational rehabilitation outside the field of anesthesiology was successful following inpatient treatment. This case shows exemplarily in accordance with the current literature that warning signs in addicted physicians are often ignored by colleagues and supervisors and rehabilitation is possible under professional therapy and continuous surveillance. Additionally, this case emphasizes the necessity of controlling the distribution of propofol to reduce the life-threatening professional risk to anesthesiologists.
[Mh] Termos MeSH primário: Analgésicos Opioides
Anestésicos Intravenosos
Fentanila
Transtornos Relacionados ao Uso de Opioides/terapia
Inabilitação do Médico/psicologia
Médicos
Propofol
Transtornos Relacionados ao Uso de Substâncias/terapia
[Mh] Termos MeSH secundário: Adulto
Anestesiologia
Feminino
Seres Humanos
Naloxona
Transtornos Relacionados ao Uso de Opioides/reabilitação
Desvio de Medicamentos sob Prescrição
Abuso de Substâncias por Via Intravenosa
Transtornos Relacionados ao Uso de Substâncias/reabilitação
Sobreviventes
Tilidina
[Pt] Tipo de publicação:CASE REPORTS; ENGLISH ABSTRACT; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Intravenous); 36B82AMQ7N (Naloxone); GY33N31E9Y (Tilidine); UF599785JZ (Fentanyl); YI7VU623SF (Propofol)
[Em] Mês de entrada:1403
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:120621
[St] Status:MEDLINE
[do] DOI:10.1007/s00101-012-2036-y



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