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Geppetti P, De Cesaris F, Benemei S, Cortelli P, Cevoli S, Pierangeli G, Favoni V, Lisotto C, Usai S, Frediani F, Di Fiore P, D'Arrigo G, Tassorelli C, Sances G, Cainazzo MM, Baraldi C, Sarchielli P, Corbelli I, De Vanna G, Tedeschi G, Russo A. Self-administered subcutaneous diclofenac sodium in acute migraine attack: A randomized, double-blind, placebo-controlled dose-finding pilot study. Cephalalgia 2022; 42:1058-1070. [PMID: 35469478 DOI: 10.1177/03331024221093712] [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: 11/16/2022]
Abstract
BACKGROUND A novel formulation of diclofenac, complexed with hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer, in a prefilled syringe for self-administered subcutaneous injection may overcome the limitations of acute migraine treatments administered by oral, rectal, intramuscular, or intravenous routes. METHODS This multicentre, phase 2, double-blind, randomized, placebo-controlled, dose-finding pilot study evaluated the efficacy, safety and tolerability of three different doses (25/50/75 mg/1 mL) of subcutaneous diclofenac sodium in the treatment of an acute migraine attack in 122 subjects. The primary efficacy endpoint was the percentage of patients pain-free at 2 hours after the study drug injection. RESULTS A significantly higher percentage of patients in the 50 mg diclofenac group 14 (46.7%) were pain-free at 2 hours when compared with placebo: 9 (29.0%) (p = 0.01). The 50 mg dose proved superior to placebo also in the majority of the secondary endpoints. The overall global impression favoured diclofenac vs placebo. There were no adverse events leading to study withdrawal. The majority of treatment-emergent adverse events were mild. CONCLUSIONS The 50 mg dose of this novel formulation of diclofenac represents a valuable self-administered option for the acute treatment of migraine attacks.Trial registration: EudraCT Registration No. 2017-004828-29.
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Affiliation(s)
- Pierangelo Geppetti
- Università degli studi di Firenze, Dipartimento di Scienze della Salute, Florence, Italy.,SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco De Cesaris
- SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Benemei
- SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Sabina Cevoli
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Giulia Pierangeli
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy.,Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale-Centro Cefalee, Presidio Ospedaliero di San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | - Valentina Favoni
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Carlo Lisotto
- Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale-Centro Cefalee, Presidio Ospedaliero di San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | - Susanna Usai
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UO Neurologia 3, Milan, Italy
| | - Fabio Frediani
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Paola Di Fiore
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giacomo D'Arrigo
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cristina Tassorelli
- Headache Science & Neurorehabilitation Center, IRCCS C. Mondino Foundation Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science & Neurorehabilitation Center, IRCCS C. Mondino Foundation Pavia, Pavia, Italy
| | - Maria Michela Cainazzo
- AOU Policlinico di Modena, Struttura Semplice Dipartimentale -Centro Cefalee e Abuso di Farmaci e Tossicologia Medica, Modena, Italy
| | - Carlo Baraldi
- Università degli studi di Modena e Reggio Emilia, Struttura Semplice Dipartimentale Centro Cefalee ed abuso di Farmaci-Tossicologia Medica, Modena, Italy
| | - Paola Sarchielli
- Headache Center, Neurological Clinic, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Headache, Center, Neurological Clinic, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Perugia, Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Science, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gorecki P, Rainsford KD, Taneja P, Bulsara Y, Pearson D, Saund D, Ahmed B, Dietrich T. Submucosal Diclofenac for Acute Postoperative Pain in Third Molar Surgery: A Randomized, Controlled Clinical Trial. J Dent Res 2017; 97:381-387. [PMID: 29202646 DOI: 10.1177/0022034517744207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diclofenac sodium is a widely used nonsteroidal anti-inflammatory drug (NSAID) for relief of inflammatory pain. A recent formulation combines this drug with hydroxypropyl-β-cyclodextrin (HPβCD) to improve its solubility and to enable subcutaneous administration. Previous studies confirmed the efficacy of this combination. This study's aim was to evaluate the efficacy, safety, and local tolerability of diclofenac HPβCD administered as a local submucosal injection prior to lower third molar surgery. We conducted a prospective, randomized, double-blind, placebo-controlled, parallel-group phase II single-center study. Seventy-five patients requiring mandibular third molar surgery were randomized into 1 of 5 groups: 5 mg/1 mL diclofenac HPβCD, 12.5 mg/1 mL diclofenac HPβCD, 25 mg/1 mL diclofenac HPβCD, 50 mg/1 mL diclofenac HPβCD, or 1 mL placebo. The respective study drug was injected into the mucosal tissue surrounding the surgical site prior to surgery following achievement of local anesthesia. The primary outcome measure was the area under the curve (AUC) of cumulative pain scores from end of surgery to 6 h postsurgery. This demonstrated a global treatment effect between the active groups and placebo, hence confirming the study drug's efficacy ( P = 0.0126). Secondary outcome measures included the time until onset of pain and the time until patients required rescue medication, both showing statistical significance of the study drug compared to placebo ( P < 0.0161 and P < 0.0001, respectively). The time until rescue medication ranged between 7.8 h (for 25 mg/1 mL diclofenac HPβCD) and 16 h (for 50 mg/1 mL diclofenac HPβCD). Interestingly, the 5-mg/1-mL solution appeared superior to the 12.5-mg/1-mL and 25-mg/1-mL solutions (time until rescue medication = 12.44 h). A total of 14% of patients experienced minor adverse drug reactions (ADRs), of which 2 cases demonstrated flap necrosis. These resolved without further intervention. The study results overall indicate efficacy, safety, and relative tolerability of diclofenac HPβCD used locally as a submucosal injection prior to third molar surgery (ClinicalTrials.gov NCT01706588).
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Affiliation(s)
- P Gorecki
- 1 The School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - K D Rainsford
- 2 Biomedical Research Centre, Sheffield Hallam University, Sheffield, UK
| | - P Taneja
- 3 Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Y Bulsara
- 1 The School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - D Pearson
- 3 Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - D Saund
- 3 Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - B Ahmed
- 3 Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - T Dietrich
- 1 The School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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3
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Association of inflammatory mediators with pain perception. Biomed Pharmacother 2017; 96:1445-1452. [DOI: 10.1016/j.biopha.2017.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022] Open
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Scavone C, Bonagura AC, Fiorentino S, Cimmaruta D, Cenami R, Torella M, Fossati T, Rossi F. Efficacy and Safety Profile of Diclofenac/Cyclodextrin and Progesterone/Cyclodextrin Formulations: A Review of the Literature Data. Drugs R D 2017; 16:129-40. [PMID: 26939533 PMCID: PMC4875918 DOI: 10.1007/s40268-016-0123-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background According to health technology assessment, patients deserve the best medicine. The development of drugs associated with solubility enhancers, such as cyclodextrins, represents a measure taken in order to improve the management of patients. Different drugs, such as estradiol, testosterone, dexamethasone, opioids, non-steroidal anti-inflammatories (NSAIDs; i.e. diclofenac), and progesterone are associated with cyclodextrins. Products containing the association of diclofenac/cyclodextrins are available for subcutaneous, intramuscular, and intravenous administration in doses that range from 25 to 75 mg. Medicinal products containing the association of progesterone/cyclodextrins are indicated for intramuscular and subcutaneous injection at a dose equal to 25 mg. Objectives and Methods The effects of cyclodextrins have been discussed in the solubility profile and permeability through biological membranes of drug molecules. A literature search was performed in order to give an overview of the pharmacokinetic characteristics, and efficacy and safety profiles of diclofenac/hydroxypropyl-β-cyclodextrin (HPβCD) and progesterone/HPβCD associations. Results The results of more than 20 clinical studies were reviewed. It was suggested that the new diclofenac/HPβCD formulation gives a rapid and effective response to acute pain and, furthermore, has pharmacokinetic and efficacy/safety profiles comparable to other medicinal products not containing cyclodextrins. One of the principal aspects of these new diclofenac formulations is that in lowering the dose (lower than 50 mg) the drugs could be more tolerable, especially in patients with comorbid conditions. Moreover, results of studies investigating the characteristics of progesterone and cyclodextrins showed that the new formulation (progesterone/HPβCD 25 mg solution) has the same bioavailability as other products containing progesterone. It is more rapidly absorbed and allows the achievement of peak plasma concentrations in a shorter time. Finally, the new formulation of progesterone was shown to be safe and not inferior to other products already on the market, with the exception of progesterone administered vaginally. Conclusions As shown by the results of clinical studies presented in this review, the newly approved medicines containing cyclodextrins have been found to be as effective and as well-tolerated as other medicinal products that do not contain cyclodextrins. Moreover, the newly approved lower dose of diclofenac associated with cyclodextrins is consistent with the European Medicines Agency recommendations reported in the revision of the Assessment Report for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Cardiovascular Risk. Finally, the use of cyclodextrins led to significant increases in solubility and bioavailability of drugs, such as diclofenac and progesterone, and improvement in the efficacy and safety of these drugs.
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Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy.
| | - Angela Colomba Bonagura
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy
| | - Sonia Fiorentino
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy
| | - Daniela Cimmaruta
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy
| | - Rosina Cenami
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy
| | - Marco Torella
- Department of Women, Child, General and Specialised Surgery, Second University of Naples, Caserta, Italy
| | | | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine, Second University of Naples, Via De Crecchio, 7, Naples, 80138, Italy
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Julião M, Cunha I, Costa A. Skin Necrosis after Subcutaneous Diclofenac Administration: A Case Report. J Palliat Med 2016; 19:584-5. [PMID: 27182984 DOI: 10.1089/jpm.2016.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miguel Julião
- 1 Faculty of Medicine of the University of Lisbon , Lisbon, Portugal .,2 Hospital da Universidade Fernando Pessoa , Gondomar, Portugal
| | - Isabel Cunha
- 2 Hospital da Universidade Fernando Pessoa , Gondomar, Portugal
| | - Ana Costa
- 2 Hospital da Universidade Fernando Pessoa , Gondomar, Portugal
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Diclofenac sodium injection (Akis®, Dicloin®) in the management of pain: a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rahimi M, Mobedi H, Behnamghader A. In situforming poly(lactic acid-co-glycolic acid) implants containing leuprolide acetate/β-cyclodextrin complexes: preparation, characterization, andin vitrodrug release. INT J POLYM MATER PO 2015. [DOI: 10.1080/00914037.2015.1055633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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D'Arienzo A, Beltrami G, Mancini D, Scoccianti G, Cuomo P, Muratori F, Matera D, Ippolito M, Mondanelli N, Frenos F, Totti F, Capanna R. Pre-operative diclofenac HPβCD for pain control of needle biopsy in musculoskeletal neoplasm: preliminary results. CLINICAL CASES IN MINERAL AND BONE METABOLISM 2015; 12:47-51. [PMID: 26136796 DOI: 10.11138/ccmbm/2015.12.1.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Needle biopsy is the main standard method used for diagnosis of musculoskeletal tumors of the limbs and superficial trunk. Pain control during this procedure is through the use of Local Anaestetic (L.A.). In order to achieve a complete pain control in our cases, recently we started using diclofenac HPβCD 50 mg via s.c. preoperativly. We present the clinical results of a non-randomized study of two eterogeneous groups of patients: "Experimental" Group (1): diclofenac HPβCD 50 mg via s.c. one hour before surgical procedure, local anesthesia and ev. diclofenac HPβCD 50 mg via s.c. 12 hours postoperative; "Conventional" Group (2): local anesthesia and ev. postoperative tramadol 100 mg via oral for pain control. In October 2014, at the Department of Orthopedic Oncology and Reconstructive Surgery of Florence, 37 musculoskeletal biopsies for a bone or a soft tissue lesion were performed. Exclusion criteria for this study were: known allergies to lidocaine, diclofenac, tramadol; known gastric or duodenal ulcers; known gastrointestinal bleed or perforation; refusal of the patients to collaborate. For one or more of these reasons, 6 patients were excluded from this study. In the Group 1, 10 patients (59%) referred no pain during the surgical procedure (8/14 biopsies on soft tissue and 2/3 on bone). In 5 cases (29%) no exacerbation of previous chronic pain, and in 2 cases (12%) a progression of local pain after biopsy (average 1 points higher in the VAS). In Group 2, only 6 patients (42%) did not have any pain during the procedure, 4 (29%) no exacerbation of previous chronic pain and 4 (29%) a progression of local pain (average 2 points higher in the VAS). Despite similar results in both Groups, Group 1 seemed to have a mild better control of perioperative pain. The use of diclofenac HPβCD 50 mg preoperative seems to be a rational approach for minimizing perioperative pain and the preliminary data of our study seem encouraging. Obviously many bias are present in this study (small numbers of cases, heterogeneity of diseases, association with local anesthetic, non-randomized study, comparison between preoperative versus postoperative treatment) and this cannot absolutely be considerate as definitive conclusions.
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Affiliation(s)
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Daniele Mancini
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Pierluigi Cuomo
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Davide Matera
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Massimiliano Ippolito
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Nicola Mondanelli
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Francesca Totti
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic Oncology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
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Abstract
SummaryPatients with difficult venous access or oral intolerance and clinical situations with inadequate response to oral therapy have generated the need for alternative routes of delivery for drugs and fluids.The purpose of this study was to conduct a systematic review examining the evidence for subcutaneous (SC) administration of drugs and/or fluids.We used a broad search strategy using electronic databases CINAHL, EMBASE, PubMed and Cochrane library, key terms and ‘Medical Subject Headings’ (MeSH) such as ‘subcutaneous route’, ‘hypodermoclysis’ and the name/group of the most used drugs via this route (e.g. ‘ketorolac, morphine, ceftriaxone’, ‘analgesics, opioids, antibiotics’).We conclude that the SC route is an effective alternative for rehydration in patients with mild–moderate dehydration and offers a number of potential advantages in appropriately selected scenarios. Experience of administering drugs by this route suggests that it is well tolerated and is associated with minimal side-effects.
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Blair HA, Plosker GL. Diclofenac sodium injection (akis(®), dicloin (®)): a review of its use in the management of pain. Clin Drug Investig 2015; 35:397-404. [PMID: 25989733 DOI: 10.1007/s40261-015-0294-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A novel formulation of diclofenac sodium suitable for subcutaneous or intramuscular injection (Akis(®), Dicloin(®)) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. Clinical trials have demonstrated the analgesic efficacy of diclofenac HPβCD in terms of relieving moderate to severe postoperative pain in patients undergoing dental surgery or minor orthopaedic surgery. Subcutaneous diclofenac HPβCD also effectively relieved moderate to severe neuropathic pain, related to cancer or not. Diclofenac HPβCD was generally well tolerated in clinical trials, with injection-site reactions among the most commonly reported adverse events. The local tolerability of diclofenac HPβCD was consistently rated as 'good' or 'excellent' across all studies. Subcutaneous administration of diclofenac is a valid alternative to intramuscular delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75 mg/mL solution for subcutaneous or intramuscular injection extends the treatment options available for use in the management of pain in adults.
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Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Amato F, Morrone EG, Lacquaniti G. Efficacy, safety and tolerance of subcutaneous injection of high dosages of diclofenac in patients with neuropathic non-cancer pain and neuropathic cancer pain: Data from a clinical setting. EUR J INFLAMM 2015. [DOI: 10.1177/1721727x15576850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diclofenac sodium is widely used for its anti-inflammatory and analgesic effects in the symptomatic treatment of acute and chronic inflammatory and painful conditions. The present observational study was carried out to investigate efficacy, safety, and tolerability of a new subcutaneous (SC) 75 mg/1 mL diclofenac hydroxypropyl-β-cyclodextrin (HPβCD) formulation for the treatment of neuropathic pain both in patients without cancer and in patients with cancer. A total of 105 outpatients and inpatients with moderate to severe neuropathic pain related to cancer (CP) and non-cancer (NCP), were selected if Numeric Rating Scale (NRS) ⩾7 and Pain Detect (PD) >16, and treated with 75 mg/1 mL SC HPβCD, according to a real clinical setting. The analgesic efficacy of the treatment, which was assessed during the study by questionnaire, was expressed in terms of reduction of 30–50% and >50% of baseline pain (NRS), after 1.5 h and 4 h from drug administration; tolerability and safety were assessed as well, and adverse events were recorded by an expert panel. In our study, a significant reduction in pain intensity (PI) after 1.5 h and after 4 h was observed for both groups of patients (CP and NCP). Different from what was detected in the CP group, a further and significant reduction of PI was obtained in the NCP group at 4 h ( P <0.039). With regard to tolerability, while 90% of the patients did not complain of any adverse drug reactions, only 10% reported mild transient adverse reactions. SC administration of HPβCD has been proven effective and safe in the treatment of patients with moderate to severe neuropathic pain related to cancer or not, in a real clinical setting.
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Affiliation(s)
- F Amato
- Hospital Emergency Services, Cosenza, Italy
| | - EG Morrone
- Pain Therapy Study Center, Cosenza, Italy
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Rahimi M, Mobedi H, Behnamghader A. Aqueous stability of leuprolide acetate: effect of temperature, dissolved oxygen, pH and complexation with β-cyclodextrin. Pharm Dev Technol 2014; 21:108-15. [PMID: 25331295 DOI: 10.3109/10837450.2014.971377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the present research, the aqueous stability of leuprolide acetate (LA) in phosphate buffered saline (PBS) medium was studied (pH = 2.0-7.4). For this purpose, the effect of temperature, dissolved oxygen and pH on the stability of LA during 35 days was investigated. Results showed that the aqueous stability of LA was higher at low temperatures. Degassing of the PBS medium partially increased the stability of LA at 4 °C, while did not change at 37 °C. The degradation of LA was accelerated at lower pH values. In addition, complexes of LA with different portions of β-cyclodextrin (β-CD) were prepared through freeze-drying procedure and characterized by Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC) analyses. Studying their aqueous stability at various pH values (2.0-7.4) showed LA/β-CD complexes exhibited higher stability when compared with LA at all pH values. The stability of complexes was also improved by increasing the portion of LA/β-CD up to 1/10.
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Affiliation(s)
- Mehdi Rahimi
- a Department of Biomedical Engineering, Science and Research Branch , Islamic Azad University , Tehran , Iran
| | - Hamid Mobedi
- b Department of Novel Drug Delivery Systems , Iran Polymer and Petrochemical Institute , Tehran , Iran , and
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