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McClure EW, Daniels RN. Classics in Chemical Neuroscience: Dextromethorphan (DXM). ACS Chem Neurosci 2023. [PMID: 37290117 DOI: 10.1021/acschemneuro.3c00088] [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: 06/10/2023] Open
Abstract
Dextromethorphan (DXM) was introduced in 1958 as the first non-opioid cough suppressant and is indicated for multiple psychiatric disorders. It has been the most used over-the-counter cough suppressant since its emergence. However, individuals quickly noticed an intoxicating and psychedelic effect if they ingested large doses. DXM's antagonism at N-methyl-d-aspartate receptors (NMDAr) is thought to underly its efficacy in treating acute cough, but supratherapeutic doses mimic the activity of dissociative hallucinogens, such as phencyclidine and ketamine. In this Review we will discuss DXM's synthesis, manufacturing information, drug metabolism, pharmacology, adverse effects, recreational use, abuse potential, and its history and importance in therapy to present DXM as a true classic in chemical neuroscience.
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Affiliation(s)
- Elliot W McClure
- Department of Pharmaceutical Sciences, Lipscomb University College of Pharmacy, Nashville, Tennessee 37204, United States
| | - R Nathan Daniels
- Department of Pharmaceutical Sciences, Union University College of Pharmacy, Jackson, Tennessee 38305, United States
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Ward K, Citrome L. AXS-05: an investigational treatment for Alzheimer's disease-associated agitation. Expert Opin Investig Drugs 2022; 31:773-780. [PMID: 35763451 DOI: 10.1080/13543784.2022.2096006] [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: 11/04/2022]
Abstract
INTRODUCTION Agitation is common in patients with Alzheimer's disease (AD). Although nonpharmacologic de-escalation strategies are recommend as first-line treatment, medication is often needed to treat agitation. Currently, there are no FDA-approved medications for this indication. Psychotropics used to treat agitation include antipsychotics, which are notable for their efficacy but also their potential to cause serious side effects. AXS-05, a combination of dextromethorphan and bupropion, is currently being investigated for this indication. AREAS COVERED This review will discuss the pharmacology of AXS-05 and available clinical trial results from completed Phase I and Phase II/III studies assessing the potential for this compound to treat agitation in patients with AD. Ongoing research investigating AXS-05 for this indication will also be highlighted. Resources used for this review include PubMed, Embase, clinicaltrials.gov, and literature available on the manufacturer's website. EXPERT OPINION Early released clinical trial data indicate that AXS-05 may be a useful option to treat agitation in patients with AD, and that it appears to be generally well tolerated. AXS-05 may be especially helpful for patients with comorbid depression, when considering available data from separate phase III studies assessing the efficacy and safety of this compound in the treatment of depression.
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Affiliation(s)
- Kristen Ward
- Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Leslie Citrome
- Clinical Professor of Psychiatry & Behavioral Sciences, Department of Psychiatry and Behavioral Science, New York Medical College, Valhalla, NY, USA
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Jain V, Sharma MC. Validated RP-HPLC method for determining the levels of bromhexine HCl, chlorpheniramine maleate, dextromethorphan HBr and guaiphenesin in their pharmaceutical dosage forms. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2018. [DOI: 10.1016/j.jtusci.2015.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Vishal Jain
- School of Pharmacy, Devi Ahilya Vishwavidyalaya, Takshashila CampusIndoreM.P. 452001India
| | - Mukesh C. Sharma
- School of Pharmacy, Devi Ahilya Vishwavidyalaya, Takshashila CampusIndoreM.P. 452001India
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KuKanich B, KuKanich K, Black J. The effects of ketoconazole and cimetidine on the pharmacokinetics of oral tramadol in greyhound dogs. J Vet Pharmacol Ther 2017; 40:e54-e61. [DOI: 10.1111/jvp.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- B. KuKanich
- Department of Anatomy and Physiology; Institute of Computational Comparative Medicine; Manhattan KS USA
| | - K. KuKanich
- Department of Clinical Sciences; College of Veterinary Medicine; Kansas State University; Manhattan KS USA
| | - J. Black
- Department of Anatomy and Physiology; Institute of Computational Comparative Medicine; Manhattan KS USA
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Wang L, Chiang C, Liang H, Wu H, Feng W, Quinney SK, Li J, Li L. How to Choose In Vitro Systems to Predict In Vivo Drug Clearance: A System Pharmacology Perspective. BIOMED RESEARCH INTERNATIONAL 2015; 2015:857327. [PMID: 26539530 PMCID: PMC4619875 DOI: 10.1155/2015/857327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/23/2015] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Abstract
The use of in vitro metabolism data to predict human clearance has become more significant in the current prediction of large scale drug clearance for all the drugs. The relevant information (in vitro metabolism data and in vivo human clearance values) of thirty-five drugs that satisfied the entry criteria of probe drugs was collated from the literature. Then the performance of different in vitro systems including Escherichia coli system, yeast system, lymphoblastoid system and baculovirus system is compared after in vitro-in vivo extrapolation. Baculovirus system, which can provide most of the data, has almost equal accuracy as the other systems in predicting clearance. And in most cases, baculovirus system has the smaller CV in scaling factors. Therefore, the baculovirus system can be recognized as the suitable system for the large scale drug clearance prediction.
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Affiliation(s)
- Lei Wang
- Bioinformatics Research Center, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
- Biomedical Engineering Institute, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - ChienWei Chiang
- Center for Computational Biology and Bioinformatics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- School of Informatics and Computing, Indiana University, Indianapolis, IN 46202, USA
| | - Hong Liang
- Bioinformatics Research Center, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
- Biomedical Engineering Institute, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - Hengyi Wu
- Center for Computational Biology and Bioinformatics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- School of Informatics and Computing, Indiana University, Indianapolis, IN 46202, USA
| | - Weixing Feng
- Bioinformatics Research Center, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
- Pattern Recognition and Intelligent System Institute, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - Sara K. Quinney
- Center for Computational Biology and Bioinformatics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Jin Li
- Bioinformatics Research Center, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
- Biomedical Engineering Institute, College of Automation, Harbin Engineering University, Harbin, Heilongjiang 150001, China
| | - Lang Li
- Center for Computational Biology and Bioinformatics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
- Department of Medical and Molecular Genomics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
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Papich MG, Martinez MN. Applying Biopharmaceutical Classification System (BCS) Criteria to Predict Oral Absorption of Drugs in Dogs: Challenges and Pitfalls. AAPS JOURNAL 2015; 17:948-64. [PMID: 25916691 DOI: 10.1208/s12248-015-9743-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/12/2014] [Indexed: 01/29/2023]
Abstract
The Biopharmaceutical Classification System (BCS) has been a prognostic tool for assessing the potential effects of formulation on the human drug oral bioavailability. When used in conjunction with in vitro dissolution tests, the BCS can support the prediction of in vivo product performance and the development of mechanistic models that support formulation assessments through the generation of "what if" scenarios. To date, the applicability of existing human BCS criteria has not been evaluated in dogs, thereby limiting its use in canine drug development. Therefore, we examined 50 drugs for which absolute bioavailability (F) was available both in dogs and humans. The drugs were also evaluated for any potential association between solubility (calculated from the dose number, Do) or lipophilicity (LogP) and F in dogs. In humans, solubility is determined in 250 mL of fluid. However, the appropriate volume for classifying drug solubility in dogs has not been established. In this analysis, the estimated volume of a water flush administered to fasted dogs (6 mL) and a volume of 250 mL scaled to a Beagle dog (35 mL) were examined. In addition, in humans, a Do value greater than 1.0 is used to define a compound as highly soluble and a LogP value greater than 1.72 as high permeability. These same criteria were applied for defining highly soluble and highly permeable in dogs. Whether using 35 or 6 mL to determine Do, the canine solubility classification remained unchanged for all but seven compounds. There were no clear associations between a drug's F in dogs and humans or between the canine value of F and either its human BCS classification, its LogP value, or the canine Do estimate. There was a tendency for those drugs with canine values of F equal to or greater than 80% to have LogP values equal to or greater than 1.0. Exceptions to this observation tended to be those compounds known to be absorbed via mechanisms other than passive diffusion (e.g., via transporters or paracellular transporters). Although there are limitations to the approach used in this study, the results of our assessment strongly suggest that the human BCS classification system requires substantial modification before it can be reliably applied to dogs.
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Affiliation(s)
- Mark G Papich
- College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina, 27607, USA,
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Malek A, Amiri S, Habibi Asl B. The therapeutic effect of adding dextromethorphan to clonidine for reducing symptoms of opioid withdrawal: a randomized clinical trial. ISRN PSYCHIATRY 2013; 2013:546030. [PMID: 23864983 PMCID: PMC3706070 DOI: 10.1155/2013/546030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022]
Abstract
Background. Dextromethorphan is a noncompetitive N-methyl D-aspartate receptor antagonist that is clinically feasible for relieving the opioid withdrawal symptoms. This study compares the efficacy of a combination therapy with dextromethorphan and clonidine to treatment with clonidine alone. Methods and Materials. In this double-blind randomized clinical trial, patients were selected from inpatients of detox and rehabilitation ward of Razi Hospital, Tabriz, Iran. They were randomly allocated to two groups receiving either clonidine (0.4-1.2 mg/day) or clonidine and dextromethorphan (300 mg/day). Withdrawal symptoms were evaluated in the first day of admission and again 24, 48, and 72 hours later. Results. Thirty male patients completed the trial in each group. Withdrawal symptoms began to decrease in the second day in patients receiving dextromethorphan and clonidine while patients receiving clonidine experienced the more severe symptoms in 72 hours. Analysis of variance of the symptom severity score revealed a significant group × time interaction (F = 14.25; P < 0.001), so that patients receiving dextromethorphan plus clonidine had milder symptoms during three days in all of the measurements compared to clonidine group. Conclusion. Combination therapy of dextromethorphan and clonidine would result in milder opioid withdrawal symptoms compared to clonidine alone with a reduction beginning at the second day.
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Affiliation(s)
- Ayyoub Malek
- Clinical Psychiatry Research Center (CPRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahrokh Amiri
- Clinical Psychiatry Research Center (CPRC), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Psychiatry, Razi Psychiatric Hospital, El Goli Boulevard, P.O. Box 5456, Tabriz, Iran
| | - Bohlool Habibi Asl
- Department of Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
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The pathogenetic role of adulterants in 5 cases of drug addicts with a fatal outcome. Forensic Sci Int 2013; 227:74-6. [DOI: 10.1016/j.forsciint.2012.08.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022]
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Zou HY, Wu HL, Li YN, Nie JF, Fu HY, Li SF, Yu RQ. Simultaneous Determination of Dextromethorphan and Quinidine Contents in Biological Fluid Samples Using Excitation-Emission Matrix Fluorescence Coupled with Second-Order Calibration Methods. ANAL LETT 2010. [DOI: 10.1080/00032711003763541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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KuKanich B. Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs. J Vet Pharmacol Ther 2010; 33:15-21. [PMID: 20444020 DOI: 10.1111/j.1365-2885.2009.01098.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the pharmacokinetics of codeine and the active metabolites morphine and codeine-6-glucuronide after i.v. codeine administration and the pharmacokinetics of acetaminophen (APAP), codeine, morphine, and codeine-6-glucuronide after oral administration of combination product containing acetaminophen and codeine to dogs. Six healthy Greyhound dogs were administered 0.734 mg/kg codeine i.v. and acetaminophen (10.46 mg/kg mean dose) with codeine (1.43 mg/kg mean dose) orally. Blood samples were collected at predetermined time points for the determination of codeine, morphine, and codeine-6-glucuronide plasma concentrations by LC/MS and acetaminophen by HPLC with UV detection. Codeine was rapidly eliminated after i.v. administration (T(1/2) = 1.22 h; clearance = 29.94 mL/min/kg; volume of distribution = 3.17 L/kg) with negligible amounts of morphine present, but large amounts of codeine-6-glucuronide (C(max) = 735.75 ng/mL) were detected. The oral bioavailability of codeine was 4%, morphine concentrations were negligible, but large amounts of codeine-6-glucuronide (C(max) = 1952.86 ng/mL) were detected suggesting substantial first pass metabolism. Acetaminophen was rapidly absorbed (C(max) = 6.74 microg/mL; T(max) = 0.85 h) and eliminated (T(1/2) = 0.96 h). In conclusion, the pharmacokinetics of codeine was similar to other opioids in dogs with a short half-life, rapid clearance, large volume of distribution, and poor oral bioavailability. High concentrations of codeine-6-glucuronide were detected after i.v. and oral administration.
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Affiliation(s)
- B KuKanich
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506-5802, USA.
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GRABOWSKI T, JAROSZEWSKI JJ. Bioavailability of veterinary drugsin vivoandin silico. J Vet Pharmacol Ther 2009; 32:249-57. [DOI: 10.1111/j.1365-2885.2008.01034.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liang X, Li Y, Barfield M, Ji QC. Study of dried blood spots technique for the determination of dextromethorphan and its metabolite dextrorphan in human whole blood by LC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:799-806. [DOI: 10.1016/j.jchromb.2009.02.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/06/2009] [Indexed: 10/21/2022]
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Mathews KA. Neuropathic pain in dogs and cats: if only they could tell us if they hurt. Vet Clin North Am Small Anim Pract 2009; 38:1365-414, vii-viii. [PMID: 18954689 DOI: 10.1016/j.cvsm.2008.09.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neuropathic pain is difficult to diagnose in veterinary patients because they are unable to verbalize their pain. By assuming that neuropathic pain may exist based on the history of events that each patient has experienced, a focused client history and neurologic examination may identify a lesion resulting in persistent or spontaneous pain. Once neuropathic pain is diagnosed, a trial analgesic or acupuncture session(s) should be prescribed with instructions for owners to observe behavior. Dosing of the analgesic can be titrated to the patient's needs while avoiding adverse effects. When a particular analgesic may be ineffectual, an alternate class should be tried. As research into the neurobiologic mechanisms of neuropathic pain continues, specific therapies for its management should eventually appear in the human clinical setting and subsequently be investigated for veterinary clinical use.
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Affiliation(s)
- Karol A Mathews
- Emergency and Critical Care Medicine, Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada.
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Rusbridge C, Jeffery ND. Pathophysiology and treatment of neuropathic pain associated with syringomyelia. Vet J 2008; 175:164-72. [PMID: 17317245 DOI: 10.1016/j.tvjl.2006.12.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 11/04/2006] [Accepted: 12/16/2006] [Indexed: 01/04/2023]
Abstract
The pain behaviour expressed by dogs with syringomyelia suggests that they experience neuropathic pain, probably due to disordered neural processing in the damaged dorsal horn. As such it is likely that conventional analgesic medication will be ineffective. In this review, physiological and pathological pain processing through the dorsal horn is summarised and mechanisms by which syringomyelia could result in a persistent pain state are discussed. Finally, current knowledge regarding treatment of Chiari malformation and syringomyelia is reviewed and possible drugs which may give improved pain relief in affected dogs are discussed.
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Affiliation(s)
- Clare Rusbridge
- Stone Lion Veterinary Centre, Wimbledon Village, London SW19 5AU, UK.
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Shiran MR, Proctor NJ, Howgate EM, Rowland-Yeo K, Tucker GT, Rostami-Hodjegan A. Prediction of metabolic drug clearance in humans: in vitro-in vivo extrapolation vs allometric scaling. Xenobiotica 2007; 36:567-80. [PMID: 16864504 DOI: 10.1080/00498250600761662] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previously in vitro-in vivo extrapolation (IVIVE) with the Simcyp Clearance and Interaction Simulator has been used to predict the clearance of 15 clinically used drugs in humans. The criteria for the selection of the drugs were that they are used as probes for the activity of specific cytochromes P450 (CYPs) or have a single CYP isoform as the major or sole contributor to their metabolism and that they do not exhibit non-linear kinetics in vivo. Where data were available for the clearance of the drugs in at least three animal species, the predictions from IVIVE have now been compared with those based on allometric scaling (AS). Adequate data were available for estimating oral clearance (CLp.o.) in 9 cases (alprazolam, sildenafil, caffeine, clozapine, cyclosporine, dextromethorphan, midazolam, omeprazole and tolbutamide) and intravenous clearance in 6 cases (CLi.v.) (cyclosporine, diclofenac, midazolam, omeprazole, theophylline and tolterodine). AS predictions were based on five different methods: (1) simple allometry (clearance versus body weight); (2) correction for maximum life-span potential (CL x MLP); (3) correction for brain weight (CL x BrW); (4) the use of body surface area; and (5) the rule of exponents. A prediction accuracy was indicated by mean-fold error and the Pearson product moment correlation coefficient. Predictions were considered successful if the mean-fold error was <or=2. IVIVE predictions were accurate in 14 of 15 cases (mean-fold error range: 1.02-4.00). All five AS methods were accurate in 13, 11, 10, 10 and 14 cases, respectively. However, in some cases the error of AS exceeded fivefold. On the basis of the current results, IVIVE is more reliable than AS in predicting human clearance values for drugs mainly metabolized by CYP450 enzymes. This suggests that the place of AS methods in pre-clinical drug development warrants further scrutiny.
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Affiliation(s)
- M R Shiran
- Academic Unit of Clinical Pharmacology, Division of Clinical Sciences (South), University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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Martin DD, Martin AL. Pain management and anesthesia in veterinary dermatology. Vet Clin North Am Small Anim Pract 2006; 36:1-14, v. [PMID: 16364775 DOI: 10.1016/j.cvsm.2005.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David D Martin
- Companion Animal Division, Pfizer Animal Health, New York, NY, USA.
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