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Everaert K, Holm-Larsen T, Bou Kheir G, Rottey S, Weiss JP, Vande Walle J, Kabarriti AE, Dossche L, Hervé F, Spinoit AF, Nørgaard JP, Juul KV. Potential clinical applications of current and future oral forms of desmopressin (Review). Exp Ther Med 2024; 28:303. [PMID: 38873038 PMCID: PMC11170333 DOI: 10.3892/etm.2024.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/06/2024] [Indexed: 06/15/2024] Open
Abstract
Desmopressin is a synthetic analogue of vasopressin and a selective vasopressin receptor 2 agonist. It was first synthesised in 1967 and utilised for its antidiuretic properties. It is also used in bleeding disorders to enhance clotting. Other potential uses of the drug have been reported. The present review aims to provide a broad overview of the literature on potential further uses of oral forms of desmopressin. Key therapeutic areas of interest were identified based on known physiological activities/targets of desmopressin or reports of an effect of desmopressin in the literature. The feasibility of adequate dosing with oral forms of the drug was also considered. Systematic literature searches were carried out using the silvi.ai software for the identified areas, and summaries of available papers were included in tables and discussed. The results of the searches showed that desmopressin has been investigated for its efficacy in a number of areas, including bleeding control, renal colic, the central nervous system and oncology. Evidence suggests that oral desmopressin may have the potential to be of clinical benefit for renal colic and bleeding control in particular. However, further research is needed to clarify its effect in these areas, including randomised controlled studies and studies specifically of oral formulations (and doses). Further research may also yield findings for cancer, cognition and overactive bladder.
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Affiliation(s)
- Karel Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, 9000 Ghent, Belgium
| | - Tove Holm-Larsen
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, 9000 Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sylvie Rottey
- Drug Research Unit and Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jeffrey P. Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, New York City, NY 11203, USA
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Abdo E. Kabarriti
- Department of Urology, State University of New York Downstate Health Sciences University, New York City, NY 11203, USA
| | - Lien Dossche
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Pediatric & Reconstructive Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jens Peter Nørgaard
- Research & Development, Ferring Pharmaceuticals A/S, Ferring International PharmaScience Center, 2770 Copenhagen, Denmark
| | - Kristian Vinter Juul
- Research & Development, Ferring Pharmaceuticals A/S, Ferring International PharmaScience Center, 2770 Copenhagen, Denmark
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Wu H, Zhou H, Zhang W, Jin P, Shi Q, Miao Z, Wang H, Zha Z. Three birds with one stone: co-encapsulation of diclofenac and DL-menthol for realizing enhanced energy deposition, glycolysis inhibition and anti-inflammation in HIFU surgery. J Nanobiotechnology 2022; 20:215. [PMID: 35524259 PMCID: PMC9074192 DOI: 10.1186/s12951-022-01437-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/25/2022] [Indexed: 01/12/2023] Open
Abstract
Despite attracting increasing attention in clinic, non-invasive high-intensity focused ultrasound (HIFU) surgery still commonly suffers from tumor recurrence and even matastasis due to the generation of thermo-resistance in non-apoptotic tumor cells and adverse therapy-induced inflammation with enhanced secretion of growth factors in irradiated region. In this work, inspired by the intrinsic property that the expression of thermo-resistant heat shock proteins (HSPs) is highly dependent with adenosine triphosphate (ATP), dual-functionalized diclofenac (DC) with anti-inflammation and glycolysis-inhibition abilities was successfully co-encapsulated with phase-change dl-menthol (DLM) in poly(lactic-co-glycolic acid) nanoparticles (DC/DLM@PLGA NPs) to realize improved HIFU surgery without causing adverse inflammation. Both in vitro and in vivo studies demonstrated the great potential of DC/DLM@PLGA NPs for serving as an efficient synergistic agent for HIFU surgery, which can not only amplify HIFU ablation efficacy through DLM vaporization-induced energy deposition but also simultaneously sensitize tumor cells to hyperthermia by glycolysis inhibition as well as diminished inflammation. Thus, our study provides an efficient strategy for simultaneously improving the curative efficiency and diminishing the harmful inflammatory responses of clinical HIFU surgery.
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Affiliation(s)
- Haitao Wu
- School of Food and Biological Engineering, School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Anhui, 230009, Hefei, China
| | - Hu Zhou
- Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Wenjie Zhang
- School of Food and Biological Engineering, School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Anhui, 230009, Hefei, China
| | - Ping Jin
- Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, Guangdong, China.
| | - Qianqian Shi
- School of Food and Biological Engineering, School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Anhui, 230009, Hefei, China
| | - Zhaohua Miao
- School of Food and Biological Engineering, School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Anhui, 230009, Hefei, China
| | - Hua Wang
- Department of Oncology, Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Zhengbao Zha
- School of Food and Biological Engineering, School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Anhui, 230009, Hefei, China.
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Ghafouri HB, Abazarian N, Yasinzadeh M, Modirian E. Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial. PAIN MEDICINE 2020; 21:3437-3442. [PMID: 32797236 DOI: 10.1093/pm/pnaa240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. DESIGN Randomized clinical trial. SETTING This study was conducted in the emergency unit of a university hospital. SUBJECTS Patients referred to the emergency room with renal colic. PRIMARY OUTCOME Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. METHODS In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. RESULTS Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (>3) in the desmopressin group (P < 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (>6). CONCLUSIONS Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.
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Affiliation(s)
- Hamed Basir Ghafouri
- Emergency Medicine, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammadreza Yasinzadeh
- Emergency Medicine, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Modirian
- Emergency Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
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Jalili M, Shirani F, Entezari P, Hedayatshodeh M, Baigi V, Mirfazaelian H. Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial. Am J Emerg Med 2019; 37:1009-1012. [DOI: 10.1016/j.ajem.2018.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022] Open
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Kapila V, Kapila AK, Tailly T, Rappe B, Juul KV, Everaert K. The analgesic action of desmopressin in renal colic. Acta Clin Belg 2017; 72:179-185. [PMID: 27658643 DOI: 10.1080/17843286.2016.1230569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urolithiasis is a frequent problem causing a significant clinical, psychological and socio-economic burden. Analgesia remains the most important element in the medical treatment of renal colic. Nonetheless, both NSAIDs and opiates have a side effect profile which can cause further complications. As such, the use of desmopressin for renal colic has received increased attention in the last two decades. This paper provides an overview of current evidence on the use of desmopressin as an analgesic strategy in renal colic.
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Affiliation(s)
- Vansh Kapila
- Academic Department of Urology, University Hospital Ghent, University of Ghent, Belgium
| | | | - Thomas Tailly
- Academic Department of Urology, University Hospital Ghent, University of Ghent, Belgium
| | - Bernard Rappe
- Department of Urology, General City Hospital of Aalst, Geraardsbergen and Wetteren, Belgium
| | | | - Karel Everaert
- Academic Department of Urology, University Hospital Ghent, University of Ghent, Belgium
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Jalili M, Entezari P, Doosti-Irani A, Masoomi R, Mirfazaelian H. Desmopressin effectiveness in renal colic pain management: Systematic review and meta-analysis. Am J Emerg Med 2016; 34:1535-41. [PMID: 27289437 DOI: 10.1016/j.ajem.2016.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This meta-analysis of trials was conducted to evaluate the impact of desmopressin on renal colic pain relief in comparison to more typically used medications (opioids and nonsteroidal anti-inflammatory drugs [NSAIDs]). METHODS PubMed, EMbase, Scopus, CINHAL, and Cochrane Central Register of Controlled Trials were searched for clinical trials. Pain reduction and need for rescue treatment were the outcomes of interest. RESULTS Ten studies met our inclusion criteria and were analyzed. Pooling of data showed that, on a scale of 1-10, pain reduction after 30 minutes was significantly higher in NSAID in comparison to desmopressin (3.39 with a 95% confidence interval [CI] of 4.62-2.16; P<.01), but this reduction was not significantly different between NSAID and desmopressin-NSAID combination (-0.28 with 95% CI of -0.62 to 0.05; P=.01). Summary of relative risk (RR) for the need for rescue treatment in desmopressin in comparison to NSAID was 0.31 with a 95% CI of 0.13-0.74 and a significant RR (P<.04), but no difference was shown in desmopressin-NSAID combination in comparison to NSAID (0.70 with a 95% CI of 0.49-1.00; P<.19). On this outcome, desmopressin in comparison to opioid showed insignificant RR (1.82 with a 95% CI of 0.36-4.34; P=.72), but this need in desmopressin in comparison to desmopressin-opioid combination was 0.75 with a 95% CI of 0.56-0.99 and a significant RR (P=.042). CONCLUSION In conclusion, the results of this systematic review suggest that, according to the present low-quality studies, desmopressin can be used as an adjuvant therapy in renal colic management in combination with opioids.
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Affiliation(s)
- Mohammad Jalili
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Entezari
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Masoomi
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Emergency Medicine Research Center, Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Pricop C, Branisteanu DD, Orsolya M, Puia D, Matei A, Checherita IA. Sublingual desmopressin is efficient and safe in the therapy of lithiasic renal colic. Int Urol Nephrol 2015; 48:183-9. [PMID: 26676309 DOI: 10.1007/s11255-015-1173-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the effects of newer sublingual desmopressin administration in lithiasic renal colic, alone or combined with a nonsteroidal anti-inflammatory drug (NSAID). METHODS Prospective single-blind study including an initial number of 249 patients with lithiasic renal colic was randomized as follows: group NSAID (71 patients) received ketorolac tromethamine (ketorolac) 30 mg im and sublingual placebo (vitamin C), groups D1 and D2 (57 and 62 patients) received sublingual desmopressin (Minirin Melt), 60 and 120 μg, respectively, whereas group C (59 patients) received a combination of 30 mg im ketorolac and 60 μg sublingual desmopressin. Pain intensity was assessed using the visual analogue scale before and thirty minutes after drug administration. Patients experiencing pain aggravation were rescued and excluded from the study. RESULTS Dropout incidence was higher in the NSAID group than in the groups treated with desmopressin in monotherapy or combined with ketorolac (p < 0.05). Pain intensity was diminished at least as potently by the monotherapy with desmopressin and ketorolac. The higher dose of desmopressin and the combination therapy decreased pain intensity with 56 and 59%, respectively, significantly more than the 47% decrease obtained with ketorolac alone (p < 0.05 and p < 0.001). Mean pain decrease was higher in the combination group (C) than in the NSAID or D1 groups (p < 0.001 and p < 0.05, respectively), suggesting drug additivity. Patients did not experience severe side effects. CONCLUSIONS Sublingual desmopressin is at least as potent as NSAID in the treatment of lithiasic renal colic. The combination of sublingual desmopressin and NSAID has additive analgesic effects.
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Affiliation(s)
- Catalin Pricop
- Department of Urology, "Gr. T. Popa" University of Medicine and Pharmacy Iasi, 16th Universitatii St, 700115, Iasi, Romania
| | - Dumitru D Branisteanu
- Department of Endocrinology, "Gr. T. Popa" University of Medicine and Pharmacy Iasi, 16th Universitatii St, 700115, Iasi, Romania
| | - Martha Orsolya
- Department of Urology, Tg. Mures University of Medicine and Pharmacy, 38th Gheorghe Marinescu St, 540139, Tg Mures, Romania.
| | - Dragos Puia
- Department of Urology, "C.I. Parhon" Clinical Hospital, 50th Carol Bd., 700503, Iasi, Romania
| | - Anca Matei
- Department of Endocrinology, "St. Spiridon" Emergency Hospital, 1st Independentei Bd., 700106, Iasi, Romania
| | - Ionel Alexandru Checherita
- Department of Nephrology and Dialysis, Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu St, Sector 1, 020022, Bucharest, Romania
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Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev 2015; 2015:CD006027. [PMID: 26120804 PMCID: PMC10981792 DOI: 10.1002/14651858.cd006027.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Renal colic is acute pain caused by urinary stones. The prevalence of urinary stones is between 10% and 15% in the United States, making renal colic one of the common reasons for urgent urological care. The pain is usually severe and the first step in the management is adequate analgesia. Many different classes of medications have been used in this regard including non-steroidal anti-inflammatory drugs and narcotics. OBJECTIVES The aim of this review was to assess benefits and harms of different NSAIDs and non-opioids in the treatment of adult patients with acute renal colic and if possible to determine which medication (or class of medications) are more appropriate for this purpose. Clinically relevant outcomes such as efficacy of pain relief, time to pain relief, recurrence of pain, need for rescue medication and side effects were explored. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register (to 27 November 2014) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA Only randomised or quasi randomised studies were included. Other inclusion criteria included adult patients with a clinical diagnosis of renal colic due to urolithiasis, at least one treatment arm included a non-narcotic analgesic compared to placebo or another non-narcotic drug, and reporting of pain outcome or medication adverse effect. Patient-rated pain by a validated tool, time to relief, need for rescue medication and pain recurrence constituted the outcomes of interest. Any adverse effects (minor or major) reported in the studies were included. DATA COLLECTION AND ANALYSIS Abstracts were reviewed by at least two authors independently. Papers meeting the inclusion criteria were fully reviewed and relevant data were recorded in a standardized Cochrane Renal Group data collection form. For dichotomous outcomes relative risks and 95% confidence intervals were calculated. For continuous outcomes the weighted mean difference was estimated. Both fixed and random models were used for meta-analysis. We assessed the analgesic effects using four different outcome variables: patient-reported pain relief using a visual analogue scale (VAS); proportion of patients with at least 50% reduction in pain; need for rescue medication; and pain recurrence. Heterogeneity was assessed using the I² test. MAIN RESULTS A total of 50 studies (5734 participants) were included in this review and 37 studies (4483 participants) contributed to our meta-analyses. Selection bias was low in 34% of the studies or unclear in 66%; performance bias was low in 74%, high in 14% and unclear in 12%; attrition bias was low in 82% and high in 18%; selective reporting bias low in 92% of the studies; and other biases (industry funding) was high in 4%, unclear in 18% and low in 78%.Patient-reported pain (VAS) results varied widely with high heterogeneity observed. For those comparisons which could be pooled we observed the following: NSAIDs significantly reduced pain compared to antispasmodics (5 studies, 303 participants: MD -12.97, 95% CI -21.80 to - 4.14; I² = 74%) and combination therapy of NSAIDs plus antispasmodics was significantly more effective in pain control than NSAID alone (2 studies, 310 participants: MD -1.99, 95% CI -2.58 to -1.40; I² = 0%).NSAIDs were significantly more effective than placebo in reducing pain by 50% within the first hour (3 studies, 197 participants: RR 2.28, 95% CI 1.47 to 3.51; I² = 15%). Indomethacin was found to be less effective than other NSAIDs (4 studies, 412 participants: RR 1.27, 95% CI 1.01 to 1.60; I² = 55%). NSAIDs were significantly more effective than hyoscine in pain reduction (5 comparisons, 196 participants: RR 2.44, 95% CI 1.61 to 3.70; I² = 28%). The combination of NSAIDs and antispasmodics was not superior to NSAIDs only (9 comparisons, 906 participants: RR 1.00, 95% CI 0.89 to 1.13; I² = 59%). The results were mixed when NSAIDs were compared to other non-opioid medications.When the need for rescue medication was evaluated, Patients receiving NSAIDs were significantly less likely to require rescue medicine than those receiving placebo (4 comparisons, 180 participants: RR 0.35, 95% CI 0.20 to 0.60; I² = 24%) and NSAIDs were more effective than antispasmodics (4 studies, 299 participants: RR 0.34, 95% CI 0.14 to 0.84; I² = 65%). Combination of NSAIDs and antispasmodics was not superior to NSAIDs (7 comparisons, 589 participants: RR 0.99, 95% CI 0.62 to 1.57; I² = 10%). Indomethacin was less effective than other NSAIDs (4 studies, 517 participants: RR 1.36, 95% CI 0.96 to 1.94; I² = 14%) except for lysine acetyl salicylate (RR 0.15, 95% CI 0.04 to 0.65).Pain recurrence was reported by only three studies which could not be pooled: a higher proportion of patients treated with 75 mg diclofenac (IM) showed pain recurrence in the first 24 hours of follow-up compared to those treated with 40 mg piroxicam (IM) (60 participants: RR 0.05, 95% CI 0.00 to 0.81); no significant difference in pain recurrence at 72 hours was observed between piroxicam plus phloroglucinol and piroxicam plus placebo groups (253 participants: RR 2.52, 95% CI 0.15 to12.75); and there was no significant difference in pain recurrence within 72 hours of discharge between IM piroxicam and IV paracetamol (82 participants: RR 1.00, 95% CI 0.65 to 1.54).Side effects were presented inconsistently, but no major events were reported. AUTHORS' CONCLUSIONS Although due to variability in studies (inclusion criteria, outcome variables and interventions) and the evidence is not of highest quality, we still believe that NSAIDs are an effective treatment for renal colic when compared to placebo or antispasmodics. The addition of antispasmodics to NSAIDS does not result in better pain control. Data on other types of non-opioid, non-NSAID medication was scarce.Major adverse effects are not reported in the literature for the use of NSAIDs for treatment of renal colic.
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Affiliation(s)
- Kourosh Afshar
- University of British Columbia, British Columbia's Children's HospitalDepartment of UrologyChildren's Ambulatory Care Building, Urology ClinicK0‐134, 4480 Oak StreetVancouverBCCanadaV6H 3V4
| | - Siavash Jafari
- University of British ColumbiaSchool of Population and Public Health5804 Fairview AveVancouverBCCanadaV6T 1Z3
| | - Andrew J Marks
- University of British ColumbiaDepartment of UrologyVancouverBCCanada
| | | | - Andrew E MacNeily
- University of British ColumbiaDepartment of UrologyVancouverBCCanada
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The efficacy of intranasal desmopressin as an adjuvant in the acute renal colic pain management. PAIN RESEARCH AND TREATMENT 2014; 2014:320327. [PMID: 25548665 PMCID: PMC4274909 DOI: 10.1155/2014/320327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare analgesic effect of intramuscular (IM) sodium diclofenac and intranasal desmopressin combination with IM sodium diclofenac alone in patients with acute renal colic. In this randomized double-blind clinical trial, all patients aged 18 to 55 years who were diagnosed as acute renal colic and met the inclusion and exclusion criteria were randomized into two groups to receive 40 μg intranasal desmopressin spray and 75 mg IM sodium diclofenac combination (Group A) or 75 mg IM sodium diclofenac alone (Group B). The pain score of patients was assessed using a visual analogue scale (VAS) at baseline, 15, 30, 45, and 60 minutes after administration. Of all 159 patients who were assessed for eligibility finally, the results of 120 patients were analyzed. There was no significant difference regarding age and gender between two groups. The baseline VAS score was not significantly different between two groups (P = 0.44). The Mean ± SD scores of two groups reduced 15 minutes after drug administration, but this decrease was significantly more in Group A compared with Group B (P = 0.02). This pattern continued in minutes 30, 45, and 60 of drug administration. Our results showed that desmopressin could be used as an effective adjuvant in acute renal colic pain management.
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Intravenous ketamine compared with diclofenac suppository in suppressing acute postoperative pain in women undergoing gynecologic laparoscopy. J Anesth 2012; 26:732-7. [DOI: 10.1007/s00540-012-1399-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Asgari SA, Asli MM, Madani AH, Maghsoudi PA, Ghanaei MM, Shakiba M, Aval HB, Enshaei A, Farzan A, Esmaeili S. Treatment of loin pain suspected to be renal colic with papaverine hydrochloride: a prospective double-blind randomised study. BJU Int 2012; 110:449-52. [DOI: 10.1111/j.1464-410x.2011.10793.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El-Hefnawy AS, Abed A, Shokeir AA. The Management of a Patient with an Acute Stone Problem. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Urolithiasis commonly presents to the emergency department with acute, severe, unilateral flank pain. Patients with a suspected first-time stone or atypical presentation should be evaluated with a noncontrast computed tomography scan to confirm the diagnosis and rule out alternative diagnoses. Narcotics remain the mainstay of pain management but in select patients, nonsteroidal anti-inflammatories alone or in combination with narcotics provide safe and effective analgesia in the emergency department. Whereas most kidney stones can be managed with pain control and expectant management, obstructing kidney stones with a suspected proximal urinary tract infection are urological emergencies requiring emergent decompression, antibiotics, and resuscitation.
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Affiliation(s)
- Autumn Graham
- Department of Emergency Medicine, Washington Hospital Center, Georgetown University, Washington, DC 20007, USA.
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Kallidonis P, Liourdi D, Liatsikos E. Medical Treatment for Renal Colic and Stone Expulsion. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eursup.2011.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Arginine vasopressin (AVP), also known as vasopressin or anti-diuretic hormone, is a neuropeptide produced in the hypothalamus. It is primarily responsible for osmoregulation and thus maintains body fluid homeostasis. It is also a potent vasoconstrictor, may have a role in higher cognitive functions and affects metabolism. All the biological and cellular effects of vasopressin are mediated by the interaction of this hormone with three G-protein-coupled receptors - V(1a), V(1b) and V(2).Urological applications are based on the rationale that V(2) receptors mediate water conservation and increase urine osmolality. Due to their anti-diuretic properties mediated by the V(2) receptors, synthetic vasopressin agonists, such as desmopressin, are now commonly used for the treatment of nocturnal polyuria, central diabetes insipidus and nocturnal enuresis and potentially in urinary incontinence. Desmopressin has been licenced worldwide for haematological indications of haemophilia and von Willebrand disease. Vasopressin receptor antagonists correct hyponatremia by blocking the activation of the V(2) receptor and induce a free water diuresis without an accompanying natriuresis or kaliuresis; an effect termed 'aquaresis'. Interfering with vasopressin signalling by administering vasopressin antagonists may have clinical benefits in acute and chronic heart failure.
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