Pharmacokinetics of paracetamol in patients with chronic pancreatitis

Evidence-based clinical practice guidelines for chronic pancreatitis 2021

BACKGROUND

Chronic pancreatitis (CP) is defined according to the recently proposed mechanistic definition as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress.

METHODS

The clinical practice guidelines for CP in Japan were revised in 2021 based on the 2019 Japanese clinical diagnostic criteria for CP, which incorporate the concept of a pathogenic fibro-inflammatory syndrome in the pancreas. In this third edition, clinical questions are reclassified into clinical questions, background questions, and future research questions.

RESULTS

Based on analysis of newly accumulated evidence, the strength of evidence and recommendations for each clinical question is described in terms of treatment selection, lifestyle guidance, pain control, treatment of exocrine and endocrine insufficiency, and treatment of complications. A flowchart outlining indications, treatment selection, and policies for cases in which treatment is ineffective is provided. For pain control, pharmacological treatment and the indications and timing for endoscopic and surgical treatment have been updated in the revised edition.

CONCLUSIONS

These updated guidelines provide clinicians with useful information to assist in the diagnosis and treatment of CP.

Rapid synthesis of a hybrid of rGO/AuNPs/MWCNTs for sensitive sensing of 4-aminophenol and acetaminophen simultaneously

In this work, a hybrid of multiwalled carbon nanotubes, nanogold, and reduced graphene (rGO/AuNPs/MWCNTs) was synthesized rapidly with an easy method, and then combined with chitosan (CS), which was fixed on a glassy carbon electrode (GCE) to construct a new kind of electrochemical sensor to simultaneously determine 4-aminophenol (4-AP) and acetaminophen (AC). When detecting 4-AP and AC simultaneously, the linear range is 0.12~12 μM for acetaminophen and 0.05~25 μM for 4-aminophenol; the detection limit is 42 nM for acetaminophen and 2.95 nM for 4-aminophenol. Compared with previously related reports, the proposed sensor has an excellent electrocatalytic performance for the redox of 4-AP and AC, which can effectively determine 4-AP and AC simultaneously in actual samples and has potential application prospect. Graphical abstract.

Simultaneous voltammetric determination of rizatriptan and acetaminophen using a carbon paste electrode modified with NiFe2O4 nanoparticles

Nickel-ferrite nanoparticles (NiFe₂O₄) were synthesized by a hydrothermal method. They were used to modify a carbon paste electrode (CPE) and to prepare an electrochemical sensor for simultaneous determination of rizatriptan benzoate (RZB) and acetaminophen (AC). The structure and morphology of the bare CPE and modified CPE were studied using field emission scanning electron microscopy, while the structural characterization of NiFe₂O₄ was performed via X-ray diffraction. In the potential range 0.2-1.2 V, AC and RZB were detected at potentials of 0.5 V and 0.88 V (vs. Ag/AgCl saturated KCl 3 M), respectively. Both calibration plots are linear in the 1 to 90 μM concentration range. The limits of detection (at 3σ) of AC and RZB are 0.49 and 0.44 μM, respectively. The performance of the modified CPE was evaluated by quantifying the two drugs in spiked urine and in tablets. Graphical abstract The modified electrode consist of Nickel-ferrite and graphite by differential pulse voltammetry methods are schematically presented for simultaneous detection of acetaminophen (a painkiller drug) and rizatriptan benzoate (an antimigraine drug) in human urine and tablet samples.

Simultaneous detection of acetaminophen and 4-aminophenol with an electrochemical sensor based on silver–palladium bimetal nanoparticles and reduced graphene oxide

Simultaneous detection of acetaminophen and 4-aminophenol with a highly sensitive electrochemical sensor based on silver–palladium bimetal nanoparticles and reduced graphene oxide.

Simultaneous voltammetric determination of acetaminophen and dopamine using a glassy carbon electrode modified with copper porphyrin-exfoliated graphene

Graphene nanosheets (GSs) were prepared via liquid-phase non-covalent exfoliation of graphite powder in N,N-dimethylformamide under the assistance of copper(II) meso-tetra(4-carboxyphenyl)porphyrin tetrasodium salt Na₄(CuTCPP). A glassy carbon electrode (GCE) was modified with a film of such GSs which, due to the good electrical conductivity of graphene and the electrocatalytic properties of Na₄(CuTCPP), is capable of simultaneous determination of acetaminophen (AC) and dopamine (DA). The peak currents, best measured at voltage of 0.2 V (for DA) and 0.4 V (for AC; both vs. SCE), increase linearly in the 0.0024-3.6 μM and 0.004-7.6 μM concentration ranges, respectively. The detection limits are 0.8 nM for DA and 0.7 nM for AC. The sensor was successfully applied to the simultaneous determination of AC and DA in pharmaceutical preparations and spiked human serum. The results were in good agreement with those obtained for the same samples by HPLC. Graphical abstract Graphene nanosheets were prepared via a facile liquid-phase exfoliation of graphite with the assistance of copper(II) meso-tetra(4-carboxyphenyl)porphyrin tetrasodium salt. A graphene nanosheet-film modified glassy carbon electrode was fabricated to determine acetaminophen and dopamine through a simple and effective strategy.

Anxiety- and activity-related effects of paracetamol on healthy and neuropathic rats

Paracetamol has recently been suggested to affect emotion processing in addition to alleviating pain in humans. We investigated in adult male Hannover-Wistar rats whether acute intraperitoneally administrated paracetamol affects behavior in tests measuring anxiety, mood, motor activity, and memory. Unoperated rats received saline or a low (50 mg/kg) or high (300 mg/kg) dose of paracetamol, while rats with a spared nerve injury (SNI) model of neuropathy and sham-operated rats received saline or the low dose of paracetamol. Rats were tested on open-field (OFT), elevated plus-maze (EPM), light-dark box (LDB), novel-object recognition (NOR), sucrose preference, rotarod, and monofilament tests. In unoperated rats, both the low and high dose of paracetamol reduced line crossings, and grooming time in the OFT, and novel preference in NOR. The high dose of paracetamol increased the time spent in the closed arm in EPM, reduced the number of rearings and leanings in OFT, the time spent in the light box in LDB, and sucrose preference. Paracetamol had no significant effect on the rotarod test measuring motor activity. The low dose of paracetamol suppressed mechanical pain hypersensitivity in SNI rats, without influencing pain behavior in sham-operated rats. Saline- but not paracetamol-treated SNI rats spent more time than sham-operated rats in the closed arm in the EPM test. Together the results suggest that a high dose of paracetamol increases anxiety-like and anhedonic behavior, and impairs recognition memory in unoperated controls, while in neuropathy, a low dose of paracetamol reduces nerve injury-associated anxiety probably by reducing neuropathic pain.

Medical Management of Pain in Chronic Pancreatitis

The medical management of pain in chronic pancreatitis continues to pose significant challenges for clinicians caring for these patients. There are increasing data, suggesting that pain in chronic pancreatitis is largely due to peripheral and central sensitization that evolves, over time, as a result of nociceptive afferent associated with chronic inflammation and fibrosis of the pancreas. In many instances, patients rapidly progress to requiring opioid analgesics for the adequate treatment of pain despite the unequivocal risks associated with the long-term use of these drugs. Centrally acting drugs, such as gabapentinoids, appear to be effective means of treating pain due to their inhibition of neurotransmitters involved in central sensitization, but side effects limit their use. The present review explores the evidence for various non-pharmacologic and pharmacologic treatments for pain in chronic pancreatitis.