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Hortkoff D, da Silva KL, Farago PV, Gomes JC, Reis A, Gomes GM. Effect of topical application of ibuprofen/arginine on the in-office bleaching-induced tooth sensitivity: A randomized, triple-blind controlled trial. J Dent 2024; 142:104875. [PMID: 38309571 DOI: 10.1016/j.jdent.2024.104875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The application of anti-inflammatories as topical desensitizers before dental bleaching is an approach to reduce bleaching-induced tooth sensitivity (TS). This randomized controlled trial compared the risk and intensity of TS and the color change resulting from in-office dental bleaching after using an experimental desensitizing gel containing ibuprofen and arginine. METHODS Sixty-two participants with upper canine shades A2 or darker were randomly assigned to either the ibuprofen-arginine desensitizing group or the placebo group. The desensitizing gel was applied for 15 min before in-office bleaching with 35 % hydrogen peroxide gel for 50 min (2 sessions). To assess the absolute risk and intensity of TS, visual (0-10) and numeric rating (0-5) scales were used, and group comparisons were made using the McNemar test, Wilcoxon test, and paired Student t-test (α = 0.05). Color change was evaluated using Vita Classical, Vita Bleachedguide (ΔSGU), and Vita EasyShade (ΔEab, ΔE00, and ΔWID) before and one month after the bleaching procedure. Group comparisons for color change were done using a paired t-test (α = 0.05). RESULTS The odds ratio for TS was 0.14 [95 % CI 0.02 to 0.6], meaning lower odds of TS for the desensitizing gel. A lower intensity of TS was also observed for the experimental group (p < 0.005) up to 48 h after bleaching. All color evaluation tools demonstrated effective and similar whitening for both groups (p > 0.05). CONCLUSIONS Using the experimental desensitizing gel containing ibuprofen and arginine effectively reduced the risk and intensity of TS without compromising the bleaching efficacy. CLINICAL RELEVANCE The topical application of ibuprofen/arginine on the in-office bleaching reduced risk and intensity of bleaching-induced tooth sensitivity.
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Affiliation(s)
- Diego Hortkoff
- Department of Dentistry, State University of Ponta Grossa - UEPG, 4748, Uvaranas - Ponta Grossa, Ponta Grossa, Paraná 84030-900, Brazil
| | - Karine Letícia da Silva
- Department of Dentistry, State University of Ponta Grossa - UEPG, 4748, Uvaranas - Ponta Grossa, Ponta Grossa, Paraná 84030-900, Brazil
| | - Paulo Vitor Farago
- Department of Pharmacy, State University of Ponta Grossa - UEPG, Ponta Grossa, Paraná, Brazil
| | - João Carlos Gomes
- Department of Dentistry, State University of Ponta Grossa - UEPG, 4748, Uvaranas - Ponta Grossa, Ponta Grossa, Paraná 84030-900, Brazil
| | - Alessandra Reis
- Department of Dentistry, State University of Ponta Grossa - UEPG, 4748, Uvaranas - Ponta Grossa, Ponta Grossa, Paraná 84030-900, Brazil
| | - Giovana Mongruel Gomes
- Department of Dentistry, State University of Ponta Grossa - UEPG, 4748, Uvaranas - Ponta Grossa, Ponta Grossa, Paraná 84030-900, Brazil.
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Gaul C, Förderreuther S, Lehmacher W, Weiser T. Correlation of effectiveness and tolerability assessments from a pharmacy-based observational study investigating the fixed-dose combination of 400 mg ibuprofen plus 100 mg caffeine for the treatment of acute headache. Front Neurol 2023; 14:1273846. [PMID: 37941578 PMCID: PMC10628638 DOI: 10.3389/fneur.2023.1273846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Observational studies are valuable for investigating correlations between patient-reported treatment outcomes. In this study, we report a secondary analysis of a published pharmacy-based observational (patient-centered "real-world" outcomes) study on experiences reported by patients who treated their headache with an over-the-counter analgesic. Methods A pharmacy-based exploratory survey was conducted in German community pharmacies. Patients buying a fixed-dose analgesic combination product (400 mg ibuprofen + 100 mg caffeine; IbuCaff) to treat their headache were offered a questionnaire that contained-among others-questions about time to onset of pain relief (OPR), assessment of time to onset of pain relief (AOPR), assessment of efficacy and tolerability, and pain intensity 2 h after intake. A correlation analysis of the data was performed. Moreover, perceived treatment effects compared to other acute headache medications used in the past were collected. Results The correlation between OPR and AOPR was high (Spearman rank correlation r = 0.594, p < 0.0001). Headache patients assessed the onset of analgesic action within 15 min as "very fast" and within 30 min as "fast". The other readouts were correlated as well [assessment of efficacy and % pain intensity difference (%PID) at 2 h: r = 0.487; OPR/AOPR and %PID at 2 h: r = 0.295/0.318; OPR/AOPR and assessment of tolerability: r = 0.206/0.397; OPR/AOPR and assessment of efficacy: r = 0.406/0.594; assessment of efficacy and assessment of tolerability: r = 0.608; p < 0.0001 for all correlations]. Compared to previous treatments, most patients (>89%) assessed the speed of analgesic action, efficacy, and tolerability of IbuCaff as equal to or better than for the previous treatment. Discussion Headache patients assessed the onset of analgesia within 15 min as "very fast" and within 30 min as "fast". Efficacy assessments for acute headache medication appear to be highly correlated.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Frankfurt, Germany
| | | | - Walter Lehmacher
- Emeritus, Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Thomas Weiser
- Medical Consumer Healthcare, Sanofi, Frankfurt, Germany
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Arabadzhiev IH, Nix C. Ibuprofen intake after apicoectomy-Quantitative indicator for postoperative pain. J Clin Exp Dent 2023; 15:e441-e445. [PMID: 37388431 PMCID: PMC10306380 DOI: 10.4317/jced.60559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/12/2023] [Indexed: 07/01/2023] Open
Abstract
Background Apicoectomy is one of the procedures that are most frequently performed by specialists in oral surgery. This paper presents an analysis of Ibuprofen consumption after apicoectomy and factors such as patient's age, sex and type of resected tooth. Ibuprofen intake is treated as a quantitative indicator of pain sensation. Material and Methods The presented data cover 89 operations with 98 resected teeth. All those apicoectomies were performed by one and the same specialist in oral surgery and all patients were scheduled for a control examination on the day following the intervention. The reported Ibuprofen intake was recorded and analyzed afterwards. Results The mean number of consumed Ibuprofen 400 mg tablets, necessary to eliminate the pain was 1.71 (SD±1.33). Gender was not established as responsible for statistically significant differences. Poor negative statistical correlation was established between age and number of consumed tablets. Older patients used a smaller amount of analgesics. The intake after resection of mandibular molars was statistically significantly higher versus that of the other teeth groups. Eighteen of the patients did not consume any analgesic tablets, constituting 18.3% of the whole group. Two patients needed 5 tablets which was the greatest reported intake. Conclusions Apicoectomy leads to low Ibuprofen intake. The sex is not a statistically significant factor for Ibuprofen use. Poor negative correlation is observed between age and the amount of administered analgesics. This consumption is increased at resection of mandibular molars compared to that for other teeth groups. Almost one fifth of the patients did not need analgesics during the first postoperative day. Key words:Apicoectomy, postoperative pain, Ibuprofen, oral surgery.
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Affiliation(s)
- Ivan-Hristov Arabadzhiev
- Oral Surgeon, Master in Dental Medicine, Master in Public Healthcare and Healthcare Manegement; Oral Surgeon at Oral Surgery Office Dr. Carsten Nix, Landstuhl, Germany
| | - Carsten Nix
- Oral Surgeon, Doctor of dental medicine, Owner of Oral Surgery Office Dr. Carsten Nix, Landstuhl, Germany
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Myers AL, Jeske AH. Provider-directed analgesia for dental pain. Expert Rev Clin Pharmacol 2023; 16:435-451. [PMID: 37083548 DOI: 10.1080/17512433.2023.2206118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry. AREAS COVERED This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain. EXPERT OPINION Substantial evidence-based literature shows combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) when short-course opioid prescription is appropriate in select patients, in which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
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Affiliation(s)
- Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arthur H Jeske
- Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Pergolizzi JV, Breve F, Magnusson P, LeQuang JK, Varassi G. Current and emerging COX inhibitors for treating postoperative pain following oral surgery. Expert Opin Pharmacother 2023; 24:347-358. [PMID: 36562415 DOI: 10.1080/14656566.2022.2161364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The numerous drugs in the NSAID class are often used to treat acute postoperative pain associated with oral surgery such as impacted third-molar extractions. These drugs are effective in this setting and dental pain studies often serve as models for acute pain relief and for registration of analgesics. With numerous cyclooxygenase (COX) inhibitors available as monotherapy, for use in combination with analgesic regimens, and in different doses and formulations, it was our aim to determine if there were clear-cut distinctions among these products and dosing regimens. AREAS COVERED This is a literature review of recent randomized controlled clinical trials evaluating NSAIDs for use in postoperative pain management following oral surgery. Of particular interest were head-to-head studies, which might offer some insight into comparative effectiveness. EXPERT OPINION Postoperative oral surgery pain is largely managed in real-world clinical practice using NSAIDs, either alone or in combination, and there is good evidence supporting their use especially in multimodal therapy. Head-to-head and comparative studies do not show a clear-cut 'optimal NSAID' in this setting, although ibuprofen, ketoprofen, dexketoprofen, and naproxen have gained most acceptance. Combination therapy with other analgesics or adjuvants is largely accepted.
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Affiliation(s)
| | - Franklin Breve
- Department of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Peter Magnusson
- School of Medicine, Orebro University, Örebro, SWE
- Cardiology, Center of Research and Development Region Gävleborg /Uppsala University, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, SWE, Sweden
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Muacevic A, Adler JR, LeQuang JAK, Breve F, Magnusson P. Fixed Dose Versus Loose Dose: Analgesic Combinations. Cureus 2023; 15:e33320. [PMID: 36741676 PMCID: PMC9894647 DOI: 10.7759/cureus.33320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023] Open
Abstract
Combinations of drugs may be fixed (two or more entities in a single product) or loose (two or more agents taken together but as individual agents) to help address multimechanistic pain. The use of opioids plus nonopioids can result in lower opioid consumption without sacrificing analgesic benefits. Drug combinations may offer additive or synergistic benefits. A variety of fixed-dose combination products are available on the market such as diclofenac plus thiocolchicoside, acetaminophen and caffeine, acetaminophen and opioid, ibuprofen and acetaminophen, tramadol and acetaminophen, and others. Fixed-dose combination products offer predictable pharmacokinetics and pharmacodynamics, known adverse events, and can reduce the pill burden. However, they are limited to certain drug combinations and doses; loose dosing allows prescribers the versatility to meet individual patient requirements as well as the ability to titrate as needed. Not all drug combinations offer synergistic benefits, which depend on the drugs and their doses. Certain drugs offer dual mechanisms of action in a single molecule, such as tapentadol, and these may further be used in combination with other analgesics. New technology allows for co-crystal productions of analgesic agents which may further improve drug characteristics, such as bioavailability. Combination analgesics are important additions to the analgesic armamentarium and may offer important benefits at lower doses than monotherapy.
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Gaul C, Gräter H, Weiser T, Michel MC, Lampert A, Plomer M, Förderreuther S. Impact of the Neck and/or Shoulder Pain on Self-reported Headache Treatment Responses – Results From a Pharmacy-Based Patient Survey. Front Neurol 2022; 13:902020. [PMID: 35923833 PMCID: PMC9339896 DOI: 10.3389/fneur.2022.902020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
Neck and/or shoulder pain (NSP) frequently occurs together with headache. Therefore, we explored how patients with and without concomitant NSP differ in their baseline characteristics and in perceived treatment responses to an analgesic. An anonymous survey was performed among 895 patients with headache (735 self-reported tension-type headache [TTH]) who used an analgesic fixed-dose combination containing 400 mg ibuprofen and 100 mg caffeine as a non-prescription treatment. NSP was abundant among patients in our survey (60%) and was associated with >1 additional day of headache per month. Patients with NSP reported predominantly sedentary work more frequently than those without (40 vs. 29%); they also reported physical tension/poor posture as a perceived trigger factor more frequently (70 vs. 16%). The reported pain reduction was comparable in those with and without concomitant NSP regardless of whether assessed as mean pain rating (from about 6 to 1.5 on a 10-point rating scale), patients experiencing a ≥50% in pain reduction (89.6 vs. 88.8%) or becoming pain-free within 2 h (57 vs. 64%). However, recurrence of pain and use of another dose within the same day were more frequent with than without NSP. We conclude that concomitant NSP is frequent in patients with headache but does not substantially alter responses to a non-prescription medication.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Frankfurt am Main, Germany
| | - Heidemarie Gräter
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Thomas Weiser
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Martin C. Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
- *Correspondence: Martin C. Michel
| | - Anette Lampert
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Manuel Plomer
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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Boppana SH, Peterson M, Du A, Gabriel RA, Kutikuppala LVS. Caffeine: What Is Its Role in Pain Medicine? Cureus 2022; 14:e25603. [PMID: 35795518 PMCID: PMC9250334 DOI: 10.7759/cureus.25603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Caffeine is the world's most widely used psychoactive legal substance. The involvement of caffeine in pain management has gotten minimal attention in the past, but it is getting more attention now. This article provides a brief assessment of the literature to clarify the role of caffeine as a pain reliever and stimulate the interest of researchers. Caffeine affects adenosine receptors, which are involved in nociception, and plays a significant role in pain regulation. Caffeine's usage as an adjuvant therapy has been extensively documented in the literature, and it is now accessible in certain over-the-counter drugs. The mixture of coffee and morphine for pain reduction in individuals with terminal cancer has shown mixed outcomes in studies. Caffeine can be utilized for hypnic headaches and post-dural puncture headaches since it is crucial in pain regulation. Caffeine has the potential to help in pain management. Caffeine's usage for migraines and end-stage cancer disease is not well acknowledged. Further research is essential to focus on caffeine's potential role in various forms of pain, including dosage escalation and outcome assessment standardization.
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Egli M, Deforth M, Keiser S, Meyenberger P, Muff S, Witt CM, Barth J. Effectiveness of a Brief Hypnotic Induction in Third Molar Extraction: A Randomized Controlled Trial (HypMol). THE JOURNAL OF PAIN 2022; 23:1071-1081. [PMID: 35108620 DOI: 10.1016/j.jpain.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Third molar extraction is a painful treatment for patients, and thus, it can be used to investigate the effects of analgesics on pain. Hypnosis can help to reduce pain and to decrease the intake of postoperative systemic analgesics. In this study, the effectiveness of a brief hypnotic induction for patients undergoing third molar extractions was investigated. Data were collected from 33 patients with third molar extractions on the right and left sides. Patients received 2 different types of pain interventions in this monocentric randomized crossover trial. Third molar extraction was conducted on 1 side with reduced preoperative local anesthetics and an additional brief hypnotic induction (Dave Elman technique). The other side was conducted with regular preoperative local anesthetics without a brief hypnotic induction (standard care). Intake of postoperative systemic analgesics was allowed in both treatments. Patients' expectations about hypnosis were assessed at baseline. The primary outcome was the area under the curve with respect to ground of pain intensity after the treatment. Secondary outcomes were the amount of postoperative analgesics consumed and the preferred treatment. There was no evidence that the area under the curve with respect to ground of pain differed between the 2 interventions (controlling for gender), but the patients' expectations affected the effectiveness of the brief hypnotic induction. This means that patients with high expectations about hypnosis benefit more from treatment with reduced preoperative local anesthetics and additional brief hypnotic induction. PERSPECTIVE: Hypnosis is used as a treatment to reduce pain in general and dental settings. In this study, additional a brief hypnotic induction with reduced preoperative local anesthetic use did not generally reduce posttreatment pain after third molar extraction more than regular local anesthetics. The expectation of the patients about the effectiveness of hypnosis affected the effectiveness of the brief hypnotic induction so that patients with high expectations had a larger benefit from a brief hypnotic induction than patients with low expectations.
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Affiliation(s)
- Mathias Egli
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Praxis Meyenberger, Wil, Switzerland
| | - Manja Deforth
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stefanie Keiser
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Stefanie Muff
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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Saimaiti A, Zhou DD, Li J, Xiong RG, Gan RY, Huang SY, Shang A, Zhao CN, Li HY, Li HB. Dietary sources, health benefits, and risks of caffeine. Crit Rev Food Sci Nutr 2022; 63:9648-9666. [PMID: 35574653 DOI: 10.1080/10408398.2022.2074362] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dietary intake of caffeine has significantly increased in recent years, and beneficial and harmful effects of caffeine have been extensively studied. This paper reviews antioxidant and anti-inflammatory activities of caffeine as well as its protective effects on cardiovascular diseases, obesity, diabetes mellitus, cancers, and neurodegenerative and liver diseases. In addition, we summarize the side effects of long-term or excessive caffeine consumption on sleep, migraine, intraocular pressure, pregnant women, children, and adolescents. The health benefits of caffeine depend on the amount of caffeine intake and the physical condition of consumers. Moderate intake of caffeine helps to prevent and modulate several diseases. However, the long-term or over-consumption of caffeine can lead to addiction, insomnia, migraine, and other side effects. In addition, children, adolescents, pregnant women, and people who are sensitive to caffeine should be recommended to restrict/reduce their intake to avoid potential adverse effects.
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Affiliation(s)
- Adila Saimaiti
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Dan-Dan Zhou
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jiahui Li
- School of Science, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Ruo-Gu Xiong
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ren-You Gan
- Research Center for Plants and Human Health, Institute of Urban Agriculture, Chinese Academy of Agricultural Sciences, National Agricultural Science & Technology Center, Chengdu, China
- Key Laboratory of Coarse Cereal Processing (Ministry of Agriculture and Rural Affairs), Sichuan Engineering & Technology Research Center of Coarse Cereal Industralization, School of Food and Biological Engineering, Chengdu University, Chengdu, China
| | - Si-Yu Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ao Shang
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cai-Ning Zhao
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hang-Yu Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Hua-Bin Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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Sologova D, Diachkova E, Gor I, Sologova S, Grigorevskikh E, Arazashvili L, Petruk P, Tarasenko S. Antibiotics Efficiency in the Infection Complications Prevention after Third Molar Extraction: A Systematic Review. Dent J (Basel) 2022; 10:dj10040072. [PMID: 35448066 PMCID: PMC9031928 DOI: 10.3390/dj10040072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 01/18/2023] Open
Abstract
(1) Background: Antibiotics are used in every medical field including dentistry, where they are used for the prevention of postoperative complications in routine clinical practice during the third molar extraction. (2) Methods: This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The present systematic review aimed to evaluate and systematize the use of antibacterial drugs in order to prevent postoperative complications in outpatient oral surgery for wisdom teeth extraction. We conducted a systematic review using electronic databases such as Medline PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Considering inclusion and exclusion criteria, we included randomized clinical trials published up to 2021 investigating the antibiotic prescription for third molar extraction. (3) Results: We selected 10 studies after the application of inclusion and exclusion criteria. The results showed that the most widely used antibiotic was amoxicillin both with and without clavulanic acid, in different dosages and duration. There were no statistically significant differences between treatment groups for development of postoperative complications. (4) Conclusions: Based on the analysis of the included studies, penicillin is currently the most widely prescribed group of antibiotics. The widespread use of this antibiotic group can lead to antimicrobial resistance (AMR). Due to increasing prevalence of bacteria resistance to penicillins, clinicians should carefully prescribe these antibiotics and be aware that the widespread use of amoxicillin may do more harm than good for the population.
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Affiliation(s)
- Diana Sologova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
- Correspondence: ; Tel.: +7-919-9975781
| | - Ekaterina Diachkova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
| | - Ilana Gor
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
| | - Susanna Sologova
- Department of Pharmacology, Nelyubin Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.S.); (E.G.)
| | - Ekaterina Grigorevskikh
- Department of Pharmacology, Nelyubin Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.S.); (E.G.)
| | - Liana Arazashvili
- Maxillofacial Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Str., 119991 Moscow, Russia; (L.A.); (P.P.)
| | - Pavel Petruk
- Maxillofacial Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Str., 119991 Moscow, Russia; (L.A.); (P.P.)
| | - Svetlana Tarasenko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia; (E.D.); (I.G.); (S.T.)
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Kennedy DO, Wightman EL. Mental Performance and Sport: Caffeine and Co-consumed Bioactive Ingredients. Sports Med 2022; 52:69-90. [PMID: 36447122 PMCID: PMC9734217 DOI: 10.1007/s40279-022-01796-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/05/2022]
Abstract
The plant defence compound caffeine is widely consumed as a performance enhancer in a sporting context, with potential benefits expected in both physiological and psychological terms. However, although caffeine modestly but consistently improves alertness and fatigue, its effects on mental performance are largely restricted to improved attention or concentration. It has no consistent effect within other cognitive domains that are important to sporting performance, including working memory, executive function and long-term memory. Although caffeine's central nervous system effects are often attributed to blockade of the receptors for the inhibitory neuromodulator adenosine, it also inhibits a number of enzymes involved both in neurotransmission and in cellular homeostasis and signal propagation. Furthermore, it modulates the pharmacokinetics of other endogenous and exogenous bioactive molecules, in part via interactions with shared cytochrome P450 enzymes. Caffeine therefore enjoys interactive relationships with a wide range of bioactive medicinal and dietary compounds, potentially broadening, increasing, decreasing, or modulating the time course of their functional effects, or vice versa. This narrative review explores the mechanisms of action and efficacy of caffeine and the potential for combinations of caffeine and other dietary compounds to exert psychological effects in excess of those expected following caffeine alone. The review focusses on, and indeed restricted its untargeted search to, the most commonly consumed sources of caffeine: products derived from caffeine-synthesising plants that give us tea (Camellia sinensis), coffee (Coffea genus), cocoa (Theabroma cacao) and guaraná (Paullinia cupana), plus multi-component energy drinks and shots. This literature suggests relevant benefits to mental performance that exceed those associated with caffeine for multi-ingredient energy drinks/shots and several low-caffeine extracts, including high-flavanol cocoa and guarana. However, there is a general lack of research conducted in such a way as to disentangle the relative contributions of the component parts of these products.
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Affiliation(s)
- David O. Kennedy
- Brain, Performance and Nutrition Research Centre, Northumbria University, Newcastle-upon-Tyne, NE1 8ST UK
| | - Emma L. Wightman
- Brain, Performance and Nutrition Research Centre, Northumbria University, Newcastle-upon-Tyne, NE1 8ST UK
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13
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Ramos EU, Benetti LP, Oliveira JCS, Bassi APF. Single-Dose Ibuprofen-Arginine as a Preventive for Pain, Edema, and Trismus After Impacted Lower Third Molar Surgery: A Randomized Split-Mouth Clinical Trial. Eur J Dent 2021; 16:396-402. [PMID: 34937107 PMCID: PMC9339938 DOI: 10.1055/s-0041-1735910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective
We examined if the association of ibuprofen with arginine has a better anti-inflammatory effect on pain, edema, and trismus after surgery of the impacted mandibular third molar than ibuprofen alone.
Materials and Methods
The study included 21 patients, 18 to 30 years of age, each with an impacted, and bilateral and symmetric third molar (total
n
= 21) that required transalveolar extraction. Patients were randomly assigned numbers from 1 to 21. Group A received ibuprofen-arginine as preoperative medication, while Group B received only ibuprofen. Both groups received the same postoperative medications: amoxicillin + acetaminophen. All patients were evaluated for pain at 6, 12, and 24 hours. They were evaluated for edema and trismus before surgery; immediately after surgery; and at 24, 48, and 72 hours postoperatively. Postoperative pain scores used the visual analog scale (BS-11). For facial edema and trismus, linear measurements used the method modified by Gabka and Matsumura.
Statistical Analysis
For the evaluation of data between Group A and Group B, we used the statistical software SPSS version 22. The Shapiro-Wilk, analysis of variance, the Bonferroni comparisons, and the Wilcoxon test were used. All tests were based on a significance level of 0.05.
Results
The study results reveal that the facial edema scores of Group A and Group B presented statistically significant differences (
p
< 0.05), while for postoperative trismus, there was no statistically significant difference (
p
> 0.05) between the scores of Group A and Group B.
Conclusion
As a conclusion, we can state that the use of ibuprofen-arginine allows for significantly better control of pain and edema, and shows a tendency toward better recovery from trismus, although without statistical significance. Based on this, we can assert that arginine improves the anti-inflammatory power of ibuprofen, thus generating better tissue healing after surgery of the impacted third molar.
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Affiliation(s)
- Edith Umasi Ramos
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Luan Pier Benetti
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Júlio César Silva Oliveira
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | - Ana Paula Farnezi Bassi
- Department of Surgery and Integrated Clinic, Division of Oral and Maxillofacial Surgery, São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil
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14
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Silva KLD, Sutil E, Hortkoff D, Terra RMO, Rezende M, Reis A, Loguercio AD, Vilela AP, Farago PV. Coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity: A randomized clinical trial. Braz Dent J 2021; 32:105-115. [PMID: 34755785 DOI: 10.1590/0103-6440202104138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
This clinical trial evaluated the effect of the coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity (TS). A triple-blind, parallel-design, randomized clinical trial was conducted on 84 patients who received ibuprofen/caffeine or placebo capsules. The drugs were administered for 48 hours, starting 1 hour before the in-office bleaching. Two bleaching sessions were performed with 35% hydrogen peroxide gel with 1-week interval. TS was recorded up to 48 hours after dental bleaching with a 0-10 visual analogic scale (VAS) and a 5-point numeric rating scale (NRS). The color was evaluated with VITA Classical and VITA Bleachedguide scales (ΔSGU) and VITA Easyshade spectrophotometer (ΔE*ab and ΔE00). The absolute risk of TS in both groups was evaluated using Fischer's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney test and a two-way repeated measures ANOVA, respectively. The color alteration between the groups was compared with the Student's t test. The significance level was 5%. There was no statistically significant difference between the groups for the absolute risk of TS (p = 1.00) or for the intensity of TS (p > 0.05). A bleaching of approximately 7 shade guide units was observed on the Vita Classical and Vita Bleachedguide scales, with no statistical difference between the groups. It was concluded that coadministration of ibuprofen and caffeine did not reduce the absolute risk or intensity of TS and did not interfere with the efficacy of dental bleaching.
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Affiliation(s)
| | - Elisama Sutil
- School of Dentistry. State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Diego Hortkoff
- School of Dentistry. State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Márcia Rezende
- School of Dentistry. School Paulo Picanço, Fortaleza, Ceará, Brazil
| | - Alessandra Reis
- School of Dentistry. State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Ana Paula Vilela
- School of Pharmacy, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Paulo Vitor Farago
- School of Pharmacy, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
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15
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Janczura M, Kobus-Moryson M, Sip S, Żarowski M, Wareńczak A, Cielecka-Piontek J. Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain-A Practical Review. J Clin Med 2021; 10:jcm10143118. [PMID: 34300284 PMCID: PMC8306558 DOI: 10.3390/jcm10143118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development.
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Affiliation(s)
- Magdalena Janczura
- Synteza sp. z o.o., św. Michała 67/71, 61-005 Poznań, Poland; (M.J.); (M.K.-M.)
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
| | | | - Szymon Sip
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
| | - Marcin Żarowski
- Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewski 49 Str., 60-355 Poznań, Poland;
| | - Agnieszka Wareńczak
- Clinic for Rehabilitation, Poznan University of Medical Sciences, 28 Czerwca 1956r. nr 135/147 Street, 61-545 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Faculty of Pharmacy, Poznań University of Medical Sciences, Święcickiego 4, 60-780 Poznań, Poland;
- Correspondence:
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16
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Pergolizzi JV, Magnusson P, LeQuang JA, Breve F, Taylor R, Wollmuth C, Varrassi G. Can NSAIDs and Acetaminophen Effectively Replace Opioid Treatment Options for Acute Pain? Expert Opin Pharmacother 2021; 22:1119-1126. [PMID: 33689517 DOI: 10.1080/14656566.2021.1901885] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Opioid analgesia for acute painful conditions has come under increasing scrutiny with the public health crisis of opioid overdose, leading clinicians to seek nonopioid alternatives, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol). AREAS COVERED This perspective evaluates recent clinical trials of nonopioids, opioids, and combination therapy for use in acute pain. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) often provide adequate analgesia, although these agents are not without risks. Combination therapy using a small amount of opioid together with a nonopioid pain reliever has been shown effective and reduces opioid consumption. EXPERT OPINION The short-term use of opioids under close clinical supervision, such as in-hospital use of opioid analgesics for postoperative pain, may be appropriate, but even here, combination therapy or nonopioid therapy may be preferred. The use of opioids even for acute pain of short duration has been questioned. The ideal analgesic has yet to be developed, but effective pain control pharmacological regimens for acute pain are available.
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Affiliation(s)
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Cardiology Research Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Frank Breve
- Department of Pharmacy, Temple University, Philadelphia, Pennsylvania, USA
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17
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Elmowitz JS, Shupak RP. Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Scoping Review. J Oral Maxillofac Surg 2021; 79:2000-2009. [PMID: 34097866 DOI: 10.1016/j.joms.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To conduct a scoping review regarding current pharmacological and non-pharmacological methods of postoperative pain control following oral and maxillofacial surgery. MATERIALS AND METHODS PubMed was used to conduct research for this study. Identification criteria included surgery: patients undergoing the extraction of third molars; therapy: pharmacological or non-pharmacological methods; and outcomes: postoperative pain control. The search included full-text RCTs published after October 13, 2014, that were electronically accessible on PubMed and in the English language. After assessing quality, a scoping review was performed. RESULTS Thirty-five RCTs were evaluated, which included a total of 3,791 subjects. The studies evaluated patients' postoperative pain by either utilizing a visual analogue scale (VAS), measuring the time between surgery and when rescue analgesics were used, measuring the amount of rescue analgesics used, or by distributing questionnaires. CONCLUSION COX-2 inhibitors may provide greater analgesic effects compared to traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Additionally, although the supplementation of an opioid analgesic to a NSAID regimen provides an increase in pain control, it does not further reduce pain levels in a patient alternating between ibuprofen and acetaminophen. Other methods of postoperative pain control mentioned in this review should be further explored in studies that contain larger sample sizes and that evaluate side effects of the treatment.
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18
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Adly MS, Adly AS, Alreshidi SF, Alotaibi AM, Alreshidi MF, Adly AS. Can paracetamol lower stress and anxiety by blunting emotions during and after computer guided dental implant surgeries? Findings from a randomized crossover clinical trial. J Dent Sci 2021; 16:137-144. [PMID: 33384790 PMCID: PMC7770301 DOI: 10.1016/j.jds.2020.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/17/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/PURPOSE Dental implants insertion can be a major factor in stress and anxiety. The aim was to evaluate the paracetamol ability to lower stress and anxiety when compared with ibuprofen during and after computer guided implant surgery utilizing CAD/CAM surgical template and a computer vision system for assessment. MATERIALS AND METHODS Thirty patients were enrolled in a crossover study design having bilateral missing lower molars. Patients were randomized into 2 equal groups with the first assigned for dental implant insertion in the lower molar area on one side with the administration of paracetamol (with 7-day follow-up) followed by 2-week washout period, then another implant was inserted on the contra-lateral side with ibuprofen. The second group received the same drugs but in reversed order. Salivary cortisol level was used to measure anxiety and a computer vision system was used to measure swelling. Visual-Analogue-Scale pain score from 0-to-100 was also utilized. RESULTS Only 29 patients completed the study. Stress and anxiety was found to be significantly lower in paracetamol group (4.1 ± 1.08 ng/mL and 6.2 ± 0.94 ng/mL for paracetamol/ibuprofen respectively). Pain score was 13.1 ± 1.1 and 12.9 ± 2.3 in paracetamol/ibuprofen groups respectively with no significant differences. Swelling showed significant difference favoring the paracetamol group (0.91 ± 0.41 and 0.61 ± 0.31 for paracetamol/ibuprofen respectively). CONCLUSION Paracetamol is effective in reducing stress by minimizing anxiety and blunting emotions of "fear-from-pain" so that pain is no longer perceived as much. However, paracetamol lacks the ability to control swelling at implant site. Computer guided flapless-implant surgery with immediate loading can be recommended for fearful patients.
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Affiliation(s)
- Mahmoud Sedky Adly
- Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
- Royal College of Surgeons of Edinburgh, Scotland, United Kingdom
| | - Afnan Sedky Adly
- Faculty of Physical Therapy, Cardiovascular-Respiratory Disorders and Geriatrics, Laser Applications in Physical Medicine, Cairo University, Cairo, Egypt
- Faculty of Physical Therapy, Internal Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | | | | | - Aya Sedky Adly
- Faculty of Computers and Artificial Intelligence, Helwan University, Cairo, Egypt
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19
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Förderreuther S, Lampert A, Hitier S, Lange R, Weiser T. The Impact of Baseline Pain Intensity on the Analgesic Efficacy of Ibuprofen/Caffeine in Patients with Acute Postoperative Dental Pain: Post Hoc Subgroup Analysis of a Randomised Controlled Trial. Adv Ther 2020; 37:2976-2987. [PMID: 32333328 PMCID: PMC7467437 DOI: 10.1007/s12325-020-01297-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 02/05/2023]
Abstract
Introduction A fixed dose combination (FDC) of ibuprofen 400 mg and caffeine 100 mg has been shown to be more effective than ibuprofen 400 mg alone for the treatment of acute postoperative dental pain in a phase III randomised controlled trial. A post hoc subgroup analysis of the primary data from an active-/placebo-controlled, double-blind, single-centre, parallel-group study was conducted in patients with moderate or severe baseline pain. Methods After dental surgery, patients with moderate or severe pain, which was determined on a 4-point verbal rating scale (‘no pain’ to ‘severe pain’), received a single dose of ibuprofen 400 mg/caffeine 100 mg FDC, ibuprofen 400 mg, caffeine 100 mg or placebo. Pain relief (PAR) and pain intensity were assessed 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5, 6, 7 and 8 h after administration of study medication. The primary study endpoint was the time-weighted sum of PAR and pain intensity difference (PID) from pre-dose baseline, summed for all post-dose assessment times from 0 to 8 h (SPRID0–8h). Results There were 237 patients with moderate pain and 325 with severe pain at baseline. SPRID0–8h was significantly improved with the FDC versus ibuprofen, caffeine and placebo in the moderate and severe pain subgroups. Adjusted mean SPRID0–8h difference for the FDC versus ibuprofen was 18.19 (p < 0.0001) for patients with moderate pain and 7.70 (p = 0.0409) for patients with severe pain. With the exception of the 7-h measurement in patients with moderate pain, PID was significantly improved with the FDC versus ibuprofen at all measured time points from 0.5 to 8 h. In the severe pain subgroup, PID was significantly improved for the FDC versus ibuprofen from 0.5 to 3 h post-dose, but was not significantly different thereafter. Conclusion The enhanced analgesic efficacy of ibuprofen/caffeine FDC versus ibuprofen is most pronounced in patients with moderate intensity pain at baseline, and also evident in patients with severe baseline pain. Trial Registration ClinicalTrials.gov identifier, NCT01929031. The non-steroidal anti-inflammatory drug (NSAID) ibuprofen is commonly used to relieve mild to moderate pain. Research suggests that combining ibuprofen with caffeine can increase the analgesic efficacy. Previously, a randomised, double-blind, placebo-controlled study showed that this ibuprofen/caffeine combination was significantly more effective than ibuprofen alone for relieving pain after dental surgery (wisdom tooth removal). Patients in that study had moderate or severe pain, so the researchers conducted another analysis of the study data to investigate how well the ibuprofen/caffeine combination worked in patients with moderate pain and in patients with severe pain. The study found that a single dose of ibuprofen/caffeine was significantly more effective than ibuprofen alone in patients with moderate pain and in those with severe pain. The analgesic effects of ibuprofen/caffeine were more marked in patients with moderate pain than in those with severe pain. This indicates that ibuprofen/caffeine is an effective pain reliever for patients with moderate pain, and to a lesser extent in patients with severe pain.
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Affiliation(s)
| | - Anette Lampert
- Medical Consumer Health Care, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, Germany
| | - Simon Hitier
- Global Medical Consumer Health Care, Sanofi-Aventis Groupe, Gentilly, France
| | - Robert Lange
- Global Medical Affairs, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, Germany
| | - Thomas Weiser
- Medical Consumer Health Care, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, Germany
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20
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Kyselovič J, Koscova E, Lampert A, Weiser T. A Randomized, Double-Blind, Placebo-Controlled Trial of Ibuprofen Lysinate in Comparison to Ibuprofen Acid for Acute Postoperative Dental Pain. Pain Ther 2020; 9:249-259. [PMID: 31912434 PMCID: PMC7203382 DOI: 10.1007/s40122-019-00148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Ibuprofen acid is poorly soluble in the stomach, thus reaching maximum plasma levels at approximately 90 min post-dose. Ibuprofen lysinate has been developed to accelerate absorption of ibuprofen to shorten the time to analgesic efficacy. This study compared analgesic efficacy and onset of effect of a single dose of ibuprofen lysinate or ibuprofen acid in patients undergoing third molar extraction. METHODS Randomized, double-blind, placebo-controlled, multi-center, parallel-group single-dose study. Adults (18-60 years) undergoing extraction of ≥ 1 third molar were randomized 2:2:1 to ibuprofen lysinate, ibuprofen acid, or placebo postoperatively. Pain relief (PAR, 5-point scale, 0 = none to 4 = complete pain relief) and pain intensity (PI, 100 mm visual analog scale) were assessed between 15 and 360 min post-dose. The primary endpoint was the weighted sum of PAR scores at 6 h (TOTPAR). Time to onset of effect, global assessment of efficacy, and adverse events were also assessed. RESULTS Overall, 351 patients received ibuprofen lysinate (N = 141), ibuprofen acid (N = 139), or placebo (N = 71). Both active treatments significantly reduced pain compared with placebo, from 15 min post-dose to 6 h (TOTPAR: ibuprofen lysinate: 19.57; ibuprofen acid: 19.96; placebo: 8.27). Ibuprofen lysinate was significantly more effective than placebo, but non-inferior to ibuprofen acid, at providing pain relief over 6 h. There was no significant difference between ibuprofen lysinate and ibuprofen acid for onset of analgesia. Both ibuprofen formulations were well tolerated; all adverse events were mild to moderate and considered unrelated to treatment. CONCLUSIONS A single dose of ibuprofen lysinate is non-inferior to ibuprofen acid in terms of analgesic efficacy, onset of action, and tolerability in patients who have recently undergone dental surgery. TRIAL REGISTRATION EudraCT No. 2006-006942-33. Plain language summary available for this article.
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Affiliation(s)
- Ján Kyselovič
- Clinical Research Unit, 5th Department of Internal Medicine, Medical Faculty of Comenius University, University Hospital, Bratislava, Slovak Republic
| | - Eva Koscova
- CHC Medical Affairs, Eastern Europe Zone, Sanofi-Aventis Pharma Slovakia s.r.o, Bratislava, Slovak Republic
| | - Anette Lampert
- Medical CHC, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, Germany
| | - Thomas Weiser
- Medical CHC, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, Germany.
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21
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Zamanian-Azodi M, Rezaei-Tavirani M, Rezaei-Tavirani M. Investigating the Effects of Ibuprofen on the Gene Expression Profile in Hippocampus of Mice Model of Alzheimer's Disease through Bioinformatics Analysis. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:352-359. [PMID: 33224242 PMCID: PMC7667553 DOI: 10.22037/ijpr.2019.15485.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are identified as effective in many diseases. One of which is neurodegenerative diseases including Alzheimer disease (AD). In this study gross alteration of gene expression in AD mice by ibuprofen treatment is investigated via Protein-protein interaction network (PPI) analysis. Expression profiling of microarray dataset GSE67306 was retrieved from GEO database and analyzed via GEO2R tool. PPI analysis was performed via Cytoscape 3.7.0. and its plug-ins including Network Analyzer, Gene MANIA, and CluePedia. Numbers of 10 central genes including Htr1a, Sstr2, Drd2, Htr1b, Penk, Pomc, Oprm1, Npy, Sst, and Chrm2 were identified as potential biomarkers. However, the role of Penk gene was highlighted. The finding indicates that ibuprofen changes gene expression level of several genes that are involved in AD.
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Affiliation(s)
- Mona Zamanian-Azodi
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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22
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Pereira GM, Cota LOM, Lima RPE, Costa FO. Effect of preemptive analgesia with ibuprofen in the control of postoperative pain in dental implant surgeries: A randomized, triple-blind controlled clinical trial. J Clin Exp Dent 2020; 12:e71-e78. [PMID: 31976047 PMCID: PMC6969969 DOI: 10.4317/medoral.56171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preemptive analgesia has as its basic principle the administration of analgesics before the onset of painful stimuli, in order to reduce or prevent postoperative pain, but this question is little explored in implantology. Thus, this study was conducted in order to evaluate the clinical efficacy of ibuprofen in pain prevention after unit implant surgery. MATERIAL AND METHODS For this triple-blind, parallel, placebo-controlled and randomized clinical trial, 54 insertion surgeries of unitary implants were performed. Two groups have received two different protocols 1 hour before surgery: Ibuprofen group (IBU) 600 mg of ibuprofen; and (2) placebo group (maize starch). The intensity of the pain was evaluated through the visual analogue scale (VAS) in 6 times (1, 6, 12, 24, 48 and 72 hours after the surgery). Patients were instructed to take 750 mg of paracetamol as rescue medication, if necessary. The occurrence and the intensity of pain were analyzed by means of an analysis of variance ANOVA with repeated measurements using the general linear model procedure. RESULTS The IBU group had significantly lower VAS scores overall (IBU = 0.30, ± 0.57; placebo = 1.14, ± 1.07; p<0.001) and at all times in the intra, intergroup comparisons and time/group interaction than the placebo group (p<0.001). The use of rescue medication was significantly lower and the postoperative time was longer in the IBU group compared to placebo (p = 0.002). CONCLUSIONS The single use of ibuprofen was found to be significantly superior in reducing pain after unit implant surgery compared to placebo. Key words:Analgesia, dental implants, pain, surgery, oral.
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Affiliation(s)
- Gustavo-Mattos Pereira
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís-Otávio-Miranda Cota
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael-Paschoal-Esteves Lima
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando-Oliveira Costa
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Predel HG, Ebel-Bitoun C, Lange R, Weiser T. A randomized, placebo- and active-controlled, multi-country, multi-center parallel group trial to evaluate the efficacy and safety of a fixed-dose combination of 400 mg ibuprofen and 100 mg caffeine compared with ibuprofen 400 mg and placebo in patients with acute lower back or neck pain. J Pain Res 2019; 12:2771-2783. [PMID: 31576162 PMCID: PMC6765100 DOI: 10.2147/jpr.s217045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background Ibuprofen is a well-established analgesic for acute pain symptoms. In several acute pain models, caffeine has demonstrated an analgesic adjuvant effect. This randomized trial (NCT03003000) was designed to compare the efficacy of a fixed-dose combination of ibuprofen and caffeine with ibuprofen or placebo for the treatment of acute lower back/neck pain. Methods Patients with acute lower back/neck pain resulting in pain on movement (POM) ≥5 on a 10-point numerical rating scale were randomized 2:2:1 to receive orally, three times daily for 6 days, 400 mg ibuprofen+100 mg caffeine, 400 mg ibuprofen or placebo, respectively. The primary endpoint was change in POMWP (POM triggering highest pain score at baseline [worst procedure]) between baseline and the morning of day 2. Key secondary endpoints included POMWP area under curve (AUC) between baseline and the morning of day 4 (POMWPAUC72h) and day 6 (POMWPAUC120h). Results In total, 635 patients were randomized (256 ibuprofen + caffeine: 253 ibuprofen: 126 placebo). Active treatments exhibited similar reductions in POMWP, with an adjusted mean reduction of 1.998 (standard error [SE]: 0.1042) between baseline and day 2 for ibuprofen, 1.869 (SE: 0.1030) for ibuprofen + caffeine and 1.712 (SE: 0.1422) for placebo. Similar results were observed for POMWPAUC72h and POMWPAUC120h. Safety and tolerability was as expected. Conclusion A decrease in lower back/neck pain, indicated by reduced POMWP, was shown in all active treatment arms; however, treatment effects were small versus placebo. Ibuprofen plus caffeine was not superior to ibuprofen alone or placebo for the treatment of acute lower back/neck pain in this setting.
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Affiliation(s)
- Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Caty Ebel-Bitoun
- Consumer Health Care, Global Medical Head, Sanofi-Aventis, Paris, France
| | - Robert Lange
- Consumer Health Care, Global Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Thomas Weiser
- Consumer Health Care, Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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Weiser T, Schepers C, Mück T, Lange R. Pharmacokinetic Properties of Ibuprofen (IBU) From the Fixed-Dose Combination IBU/Caffeine (400/100 mg; FDC) in Comparison With 400 mg IBU as Acid or Lysinate Under Fasted and Fed Conditions-Data From 2 Single-Center, Single-Dose, Randomized Crossover Studies in Healthy Volunteers. Clin Pharmacol Drug Dev 2019; 8:742-753. [PMID: 30897305 PMCID: PMC6767367 DOI: 10.1002/cpdd.672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/26/2019] [Indexed: 02/05/2023]
Abstract
Rapid onset of analgesic action is linked with rapid absorption of analgesics (high maximum concentration [Cmax] and short time to maximum concentration [tmax]). After overnight fasting, ibuprofen lysinate reaches higher peak plasma levels (Cmax) earlier than ibuprofen acid (tmax) with comparable exposure (area under the plasma concentration–time curve [AUC]); however, subjects usually take ibuprofen with or within a short time of a meal. Therefore, pharmacokinetic (PK) studies under fed conditions may better characterize properties under real‐life conditions. We investigated a new fixed‐dose combination (FDC) of ibuprofen acid 400 mg and caffeine 100 mg in 2 single‐dose, randomized, crossover PK studies in healthy subjects (both N = 36). The FDC was compared with ibuprofen 400 mg as acid and as lysinate after an overnight fast in Study 1, and with ibuprofen lysinate after a meal in Study 2. After fasting, results for ibuprofen in the FDC were comparable with those from ibuprofen acid alone. Caffeine did not affect the Cmax, tmax, and AUC. As expected, a higher Cmax and shorter tmax were observed with ibuprofen lysinates vs the FDC. Compared with administration after fasting, Cmax and tmax for ibuprofen lysinate administered postprandially were markedly different, while with FDC, these parameters were less sensitive to food intake. Taken after a meal, ibuprofen in the FDC reached tmax earlier than ibuprofen lysinate (median 1.25 vs 1.63 hours), and Cmax was approximately 13% higher, with comparable AUC, suggesting that the profile of ibuprofen was in favor of the FDC compared with ibuprofen lysinate. Thus, under real‐life conditions, ibuprofen lysinate had no PK advantage over the FDC. All preparations were well tolerated.
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Affiliation(s)
- Thomas Weiser
- Consumer Health Care, Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Cornelia Schepers
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Frankfurt am Main, Germany
| | - Tobias Mück
- Consumer Health Care, Medical Affairs, Germany, Switzerland, Austria, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Robert Lange
- Consumer Health Care, Global Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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Weiser T, Weigmann H. Effect of Caffeine on the Bioavailability and Pharmacokinetics of an Acetylsalicylic Acid-Paracetamol Combination: Results of a Phase I Study. Adv Ther 2019; 36:597-607. [PMID: 30758744 PMCID: PMC6824350 DOI: 10.1007/s12325-019-0891-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Caffeine is used as an adjuvant in analgesic combinations to enhance their efficacy. The present study aimed to determine the effect of caffeine on the pharmacokinetics of acetylsalicylic acid (ASA) and paracetamol when used as a fixed-dose ASA/paracetamol/caffeine combination. METHODS In this single-centre, two-way, cross-over phase I study, volunteers fasted overnight (≥ 12 h) and randomly received single oral doses of 250 mg ASA/200 mg paracetamol (reference) or 250 mg ASA/200 mg paracetamol/50 mg caffeine (test). Blood samples were collected before and up to 24 h after dosing. The primary end points were the area under the concentration-time curve from zero to infinity (AUC0-∞) and maximum plasma concentration (Cmax) for ASA, salicylic acid (SA) and paracetamol from the two combinations. The main secondary end points were AUC0-∞ and Cmax of caffeine and time to reach Cmax (tmax) of all drugs. RESULTS Eighteen healthy male volunteers (32.5 ± 10.5 years) participated in the study. The geometric means of Cmax for ASA, SA and paracetamol were similar in the test (3.71, 15.8 and 2.42 µg/ml, respectively) and reference groups (3.89, 15.8, 2.42 µg/ml, respectively). The geometric mean of AUC0-∞ for ASA, SA and paracetamol from the test combination was 2.86, 60.5 and 7.68 µg h/ml, respectively, and that for the reference was 2.96, 59.1 and 7.77 µg h/ml, respectively. The medians of tmax for ASA, SA and paracetamol were similar between the two groups. The point estimates for the ratios of AUC0-∞ and Cmax for test versus reference regarding ASA, SA and paracetamol were within the predefined equivalence limits. The two treatments were well tolerated. CONCLUSION Caffeine did not affect the pharmacokinetics of ASA and paracetamol when used as an adjuvant in ASA/paracetamol fixed-dose combination under fasting conditions, suggesting that caffeine enhances the analgesic efficacy of these drugs by pharmacodynamic rather than pharmacokinetic interactions. FUNDING Sanofi-Aventis Deutschland GmbH.
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Affiliation(s)
- Thomas Weiser
- Medical Affairs CHC, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt am Main, Germany.
| | - Harald Weigmann
- Medical Affairs CHC, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt am Main, Germany
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Selected Literature Watch. J Caffeine Adenosine Res 2018. [DOI: 10.1089/caff.2018.29009.slw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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