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Zhao X, Wang N, Zhu M, Qiu X, Sun S, Liu Y, Zhao T, Yao J, Shan G. Application of Transmission Raman Spectroscopy in Combination with Partial Least-Squares (PLS) for the Fast Quantification of Paracetamol. Molecules 2022; 27:molecules27051707. [PMID: 35268808 PMCID: PMC8911717 DOI: 10.3390/molecules27051707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
In recent years, transmission Raman spectroscopy (TRS) has emerged as a potent new tool for rapid, nondestructive quantitation in pharmaceutical manufacturing. In order to expand the applicability of TRS and enhance its use in product quality monitoring during drug production, we aimed, in the present study, to apply partial least-squares (PLS) approaches to build a model consisting of 150 handmade tablets and covering 15 levels through the use of a multifactor orthogonal design of experiment (DOE), which was used to predict concentrations of validation tablets made by hand. The difference between results according to HPLC and TRS were negligible. The model was used to predict the active pharmaceutical ingredient (API) content in four random commercial paracetamol tablets, and corrected with the spectra of the commercial tablets to obtain four corresponding models. The results show that the content relative error in the model’s predictions after correction with commercially available tablets was significantly lower than that before correction. The corrected model was used to make predictions for 20 tablets from the brand Panadol. Compared with the HPLC results, the prediction relative error was basically less than 4.00%, and the relative standard deviation (RSD) of the content was 0.86%.
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Affiliation(s)
- Xuejia Zhao
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Ning Wang
- College of Life Science and Technology, Beijing University of Chemical Technology, North Third Ring Road 15, Beijing 100029, China;
| | - Minghui Zhu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Xiaodan Qiu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Shengnan Sun
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Yitong Liu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Ting Zhao
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
| | - Jing Yao
- China National Institutes for Food and Drug Control, No. 2, Tian Tan Xi Li, Beijing 100050, China
- Correspondence: (J.Y.); (G.S.)
| | - Guangzhi Shan
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Tian Tan Xi Li, Beijing 100050, China; (X.Z.); (M.Z.); (X.Q.); (S.S.); (Y.L.); (T.Z.)
- Correspondence: (J.Y.); (G.S.)
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Cooper SA, Desjardins PJ, Bertoch T, Paredes-Diaz A, Troullos E, Tajaddini A, Centofanti R, An R, Morella D. Analgesic efficacy of naproxen sodium versus hydrocodone/acetaminophen in acute postsurgical dental pain: a randomized, double-blind, placebo-controlled trial. Postgrad Med 2021; 134:463-470. [PMID: 34878953 DOI: 10.1080/00325481.2021.2008180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Opioid/acetaminophen combinations may be overly prescribed in many post-surgical situations where a non-steroidal anti-inflammatory drug with equal or greater efficacy, fewer central nervous system side effects, and no risk for opioid abuse could be substituted. We compared a single, non-prescription dose of naproxen sodium 440 mg (NapS) against hydrocodone plus acetaminophen 10/650 mg (HYD+APAP) in post-impaction surgery pain. METHODS Single-center, randomized, double-blind, placebo-controlled study in moderate-severe pain after surgical removal of impacted third molars (ClinicalTrials.gov: NCT04307940). Patients (n = 212) received NapS, HYD+APAP, or placebo and were assessed over 12 hours. Primary endpoint: summed pain intensity difference from 0 to 12 hours (SPID0-12). Secondary endpoints: pain intensity, pain relief, time to rescue medication, duration of pain at least half gone. Others: onset of pain relief, global assessment of treatment, adverse events. RESULTS All 221 randomized patients formed the safety population and were included in the intention-to-treat sensitivity analysis. Nine patients discontinued treatment or had protocol violations, and 212 patients were included in the per-protocol, primary efficacy population. Both active treatments were significantly more effective than placebo. NapS was significantly more effective than HYD+APAP regarding SPID0-12 (p = 0.01; primary endpoint), total pain relief (0-6 and 0-12 hours; p < 0.05), time to rescue medication (p < 0.001), and duration of pain at least half gone (p < 0.001). HYD+APAP was not statistically superior to NapS for any endpoint. More adverse events were reported with HYD+APAP (n = 63) than NapS (n = 2) and placebo (n = 20), including nausea, vomiting, and dizziness. CONCLUSION In moderate-to-severe postsurgical dental pain, a single dose of NapS was at least as effective as HYD+APAP in the early hours, significantly more effective at reducing pain intensity and providing greater pain relief over 12 hours, and was better tolerated. When not contraindicated, NapS should be considered a preferred alternative to opioid combinations for acute pain. (ClinicalTrials.gov, Identifier: NCT04307940; https://clinicaltrials.gov/ct2/show/NCT04307940).
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Affiliation(s)
| | | | - Todd Bertoch
- CenExcel, JBR Clinical Research, Salt Lake City, UT, USA
| | | | | | | | - Robert Centofanti
- Bayer Healthcare, Consumer Health, Clinical Development, Morristown, NJ, USA
| | - Robert An
- Bayer Healthcare, Consumer Health, Clinical Development, Morristown, NJ, USA
| | - Donna Morella
- Bayer Healthcare, Consumer Health, Clinical Development, Morristown, NJ, USA
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Yuan H, Chang QY, Chen J, Wang YT, Gan ZJ, Wen S, Li TT, Xiong LL. A retrospective analysis of the effects of different analgesics on the pain of patients with traumatic thoracolumbar fractures in the peri-treatment period. J Orthop Surg Res 2021; 16:268. [PMID: 33865404 PMCID: PMC8052732 DOI: 10.1186/s13018-021-02401-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To analyze and compare the effects of peri-treatment analgesics on acute and chronic pain and postoperative functional recovery of patients with thoracolumbar fractures, so as to guide the clinical drug use. METHODS Seven hundred nineteen patients with thoracolumbar fractures were collected and divided into acetaminophen dihydrocodeine, celecoxib, and etoricoxib groups. The main indicators were the degree of postoperative pain (visual analog scale (VAS)), the incidence of chronic pain and postoperative functional recovery (Oswestry dysfunction index (ODI) and Japanese Orthopedics Association score (JOA)), which were continuously tracked through long-term telephone follow-up. The correlation analysis of ODI-pain score, peri-treatment VAS score, and ODI index was performed, and bivariate regression analysis was conducted to understand the risk factors for chronic pain. RESULTS Regression analysis showed that severe spinal cord injury and peri-treatment use of acetaminophen dihydrocodeine were both one of the risk factors for postoperative chronic pain. But there were no statistically conspicuous differences in basic characteristics, preoperative injury, and intraoperative conditions. Compared with the other two groups, patients in the acetaminophen dihydrocodeine group had longer peri-therapeutic analgesic use, higher pain-related scores (VAS 1 day preoperatively, VAS 1 month postoperatively, and ODI-pain 1 year postoperatively), higher VAS variation, higher incidence of chronic pain 1 year after surgery, and higher ODI index. And other ODI items and JOA assessments showed no statistically significant differences. In addition, the correlation analysis showed that the peri-treatment pain score was correlated with the severity of postoperative chronic pain. CONCLUSION Although the peri-treatment analgesic effect of acetaminophen dihydrocodeine is good, it is still necessary to combine analgesics with different mechanisms of action for patients with severe preoperative pain of thoracolumbar fracture, so as to inhibit the incidence of postoperative chronic pain and improve the quality of postoperative rehabilitation.
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Affiliation(s)
- Hao Yuan
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Quan-Yuan Chang
- Institute of Neurological Disease, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610044, China
- Department of Anesthesiology, Southwest Medical University, Luzhou, 646000, China
| | - Jie Chen
- Institute of Neurological Disease, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610044, China
- Department of Anesthesiology, Southwest Medical University, Luzhou, 646000, China
| | - Ya-Ting Wang
- Institute of Neurological Disease, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610044, China
- Department of Anesthesiology, Southwest Medical University, Luzhou, 646000, China
| | - Zong-Jin Gan
- Institute of Neurological Disease, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610044, China
- Department of Anesthesiology, Southwest Medical University, Luzhou, 646000, China
| | - Song Wen
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Ting-Ting Li
- Institute of Neurological Disease, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610044, China.
| | - Liu-Lin Xiong
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Li H, Bunrit A, Li N, Wang F. Heteroatom-participated lignin cleavage to functionalized aromatics. Chem Soc Rev 2020; 49:3748-3763. [DOI: 10.1039/d0cs00078g] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Heteroatom-containing reagents triggered the catalytic cleavage of lignin linkages and functionalization of products simultaneously.
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Affiliation(s)
- Hongji Li
- State Key Laboratory of Catalysis (SKLC)
- Dalian National Laboratory for Clean Energy (DNL)
- Dalian Institute of Chemical Physics (DICP)
- Dalian 116023
- China
| | - Anon Bunrit
- State Key Laboratory of Catalysis (SKLC)
- Dalian National Laboratory for Clean Energy (DNL)
- Dalian Institute of Chemical Physics (DICP)
- Dalian 116023
- China
| | - Ning Li
- State Key Laboratory of Catalysis (SKLC)
- Dalian National Laboratory for Clean Energy (DNL)
- Dalian Institute of Chemical Physics (DICP)
- Dalian 116023
- China
| | - Feng Wang
- State Key Laboratory of Catalysis (SKLC)
- Dalian National Laboratory for Clean Energy (DNL)
- Dalian Institute of Chemical Physics (DICP)
- Dalian 116023
- China
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5
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García-Román R, Francés R. Acetaminophen-Induced Liver Damage in Hepatic Steatosis. Clin Pharmacol Ther 2019; 107:1068-1081. [PMID: 31638270 DOI: 10.1002/cpt.1701] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
One of the most used painkillers is acetaminophen (APAP), which is safe at the right dose. However, several studies have described populations susceptible to APAP-induced liver damage, mainly in livers with steatosis. Thus, clinicians should consider the presence of obesity and other chronic liver diseases like nonalcoholic fatty liver disease (NAFLD) when indicating treatment with APAP. Liver damage from this drug is generated through its metabolite N-acetyl-p-benzoquinone imine, which is detoxified with glutathione (GSH). Prior depletion of GSH in steatotic hepatocytes plays a key role in APAP-induced hepatotoxicity in people with obesity and NAFLD. The knowledge about the damage to the liver or APAP in susceptible people like the obese and those with NAFLD is of great relevance for the sanitary sector because it would imply strategies of different therapeutic approach in such patients. This paper reviews the role of APAP in liver damage in the presence of obesity, NAFLD, and nonalcoholic steatohepatitis.
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Affiliation(s)
| | - Rubén Francés
- Liver and Intestinal Immunobiology Group, Department of Clinical Medicine, Miguel Hernández University, San Juan Alicante, Spain.,ISABIAL-FISABIO Foundation, General University Hospital of Alicante, Alicante, Spain.,CIBERehd, Health Institute Carlos III, Madrid, Spain
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Sripirom J, Sim WC, Khunkaewla P, Suginta W, Schulte A. Simple and Economical Analytical Voltammetry in 15 μL Volumes: Paracetamol Voltammetry in Blood Serum as a Working Example. Anal Chem 2018; 90:10105-10110. [PMID: 30091360 DOI: 10.1021/acs.analchem.8b01135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Reported is a three-electrode mini-cell for voltammetry in 15 μL solutions. The key device component is a rolled platinum foil of an inverted omega-shaped cross section, which functions as both the electrolyte container and the counter-electrode. The analytical assembly was completed with properly sized working and reference electrodes in the two terminals of the quasi-tubular Pt trough. Its applicability in electrochemical assays of 15 μL solutions was verified by redox mediator voltammetry at graphite and noble metal sensors and by trace lead stripping voltammetry. Real sample analysis was adequate for drug detection in a volunteer's blood, drawn before and 1 or 4 h after ingestion of paracetamol. In line with its known pharmacokinetics, lack of drug as well as drug presence and clearance were proven correctly in the three samples. The mini-cell here is easy to assemble and operate, indefinitely reusable, and offers valuable economy in chemical usage and minimal waste. This is primarily a versatile device for electrochemical laboratory analysis of samples that are available only in small quantities, and cost-effective quantitative screens for expensive high-molecular-weight compounds, products of microsynthesis, physiological microdialysis collections, and finger-prick blood sampling are seen as feasible targets.
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Affiliation(s)
- Jiyapa Sripirom
- School of Chemistry, Biochemistry - Electrochemistry Research Unit - Institute of Science , Suranaree University of Technology (SUT) , Nakhon Ratchasima 30000 , Thailand
| | - Wei Chung Sim
- School of Chemistry, Biochemistry - Electrochemistry Research Unit - Institute of Science , Suranaree University of Technology (SUT) , Nakhon Ratchasima 30000 , Thailand
| | - Panida Khunkaewla
- School of Chemistry, Biochemistry - Electrochemistry Research Unit - Institute of Science , Suranaree University of Technology (SUT) , Nakhon Ratchasima 30000 , Thailand
| | - Wipa Suginta
- School of Chemistry, Biochemistry - Electrochemistry Research Unit - Institute of Science , Suranaree University of Technology (SUT) , Nakhon Ratchasima 30000 , Thailand
| | - Albert Schulte
- School of Biomolecular Science and Engineering , Vidyasirimedhi Institute of Science and Technology (VISTEC) , Rayong 21210 , Thailand
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Pratiwi R, Suherman SE, Poongan RAL, Mutakin M, Hasanah AN. Design of Optical Sensor Membrane Based on Polymer Poly(methyl methacrylate) for Paracetamol Detection in Traditional Herbal Medicine. Int J Anal Chem 2018; 2018:8918329. [PMID: 29977296 PMCID: PMC6011087 DOI: 10.1155/2018/8918329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/10/2018] [Indexed: 01/11/2023] Open
Abstract
Generally, regulation states that herbal medicines are remedies containing plants or preparation of plants as active ingredients only. Paracetamol is one of the drugs that is frequently added in herbal medicine to enhance the effect as an analgesic. The government regulation disallows chemical drugs contained in herbal medicine due to the toxic effect of uncontrolled consumption. On this study, the optical sensor membrane from polymer poly(methyl methacrylate) (PMMA) was synthesized by phase inversion method and was used to detect paracetamol in herbal medicine. PMMA was made in three different concentrations 5%, 7.5%, and 10% and was mixed with ferric chloride (FeCl3), Folin-Ciocalteu, and Nessler reagent as specific colorimetric reagents for paracetamol detection, with a ratio of solvent:reagent was 6:4; 7:3; and 8:2. The result of the experiment shows that PMMA-FeCl3 7.5% (7:3), PMMA-Folin 5% (6:4), and PMMA-Nessler 5% (6:4) give the best performance for paracetamol detection. Real herbal medicine samples were analyzed to confirm the practical application of this sensor, and the result shows good agreement with UV-Vis data. The results show that optical sensor membrane which has been developed can be used as new detection method of paracetamol for community application.
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Affiliation(s)
- Rimadani Pratiwi
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Shelvy Elizabeth Suherman
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Rajkannah A. L. Poongan
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Mutakin Mutakin
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Aliya Nur Hasanah
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
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Ahmad ST, Arjumand W, Nafees S, Seth A, Ali N, Rashid S, Sultana S. Hesperidin alleviates acetaminophen induced toxicity in Wistar rats by abrogation of oxidative stress, apoptosis and inflammation. Toxicol Lett 2011; 208:149-61. [PMID: 22093918 DOI: 10.1016/j.toxlet.2011.10.023] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 10/28/2011] [Accepted: 10/31/2011] [Indexed: 01/05/2023]
Abstract
Acetaminophen (APAP) is a widely used analgesic and antipyretic drug, but at high dose it leads to undesirable side effects, such as hepatotoxicity and nephrotoxicity. The present study demonstrates the comparative hepatoprotective and nephroprotective activity of hesperidin (HD), a naturally occurring bioflavonoid against APAP induced toxicity. APAP induces hepatotoxicity and nephrotoxicity as was evident by abnormal deviation in the levels of antioxidant enzymes. Moreover, APAP induced renal damage by inducing apoptotic death and inflammation in renal tubular cells, manifested by an increase in the expression of caspase-3, caspase-9, NFkB, iNOS, Kim-1 and decrease in Bcl-2 expression. These results were further supported by the histopathological examination of kidney. All these features of APAP toxicity were reversed by the co-administration of HD. Therefore, our study favors the view that HD may be a useful modulator in alleviating APAP induced oxidative stress and toxicity.
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Affiliation(s)
- Shiekh Tanveer Ahmad
- Section of Molecular Carcinogenesis and Chemoprevention, Department of Medical Elementology and Toxicology, Faculty of Science, Jamia Hamdard-Hamdard University, Hamdard Nagar, New Delhi 110062, India
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Li S, Dou W, Tang Y, Goorha S, Ballou LR, Blatteis CM. Acetaminophen: antipyretic or hypothermic in mice? In either case, PGHS-1b (COX-3) is irrelevant. Prostaglandins Other Lipid Mediat 2008; 85:89-99. [PMID: 18083054 PMCID: PMC2329595 DOI: 10.1016/j.prostaglandins.2007.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 10/25/2007] [Accepted: 10/26/2007] [Indexed: 01/17/2023]
Abstract
Acetaminophen (AC) reduces the core temperatures (T(c)) of febrile and non-febrile mice alike. Evidence has been adduced that the selectively AC-sensitive PGHS isoform, PGHS-1b (COX-3), mediates these effects. PGHS-1b, however, has no catalytic potency in mice. To resolve this contradiction, AC was injected intravenously (i.v.) into conscious PGHS-1 gene-sufficient (wild-type (WT)) and -deficient (PGHS-1(-/-)) mice 60 min before or after pyrogen-free saline (PFS) or E. coli LPS (10 microg/kg) i.v. T(c) was monitored continuously; brain and plasma PGE(2) levels were determined hourly. AC at <160 mg/kg did not affect T(c) when given before PFS or LPS; at 160 mg/kg, it caused a approximately 2.5 degrees C T(c) fall in 60 min. LPS given after AC (all doses) induced a approximately 1 degrees C fever, not different from that in AC-untreated mice. But this rise was insufficient to overcome the hypothermia of the 160 mg/kg-treated mice; their T(c) culminated 1 degrees C below baseline. LPS given before AC similarly elevated T(c) approximately 1 degrees C. This rise was reduced to baseline in 30 min by 80 mg AC/kg; T(c) rebounded to its febrile level over the next 30 min. At 160 mg/kg, AC reduced T(c) to 4 degrees C below baseline in 60 min, where it remained until the end of the experiment. WT and PGHS-1(-/-) mice responded similarly to all the treatments. The basal brain and plasma PGE(2) levels of PFS mice and the elevated plasma levels of LPS mice were unchanged by AC at 160 mg/kg; but the latter's brain levels were reduced at 1h, then recovered. Thus, AC could exert an anti-PGHS-2 effect when this enzyme is upregulated in the brain of febrile mice. The hypothermia it induces in non-febrile mice, therefore, is due to another mechanism. PGHS-1b is not involved in either case.
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Affiliation(s)
- Shuxin Li
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS DRUG REVIEWS 2007; 12:250-75. [PMID: 17227290 PMCID: PMC6506194 DOI: 10.1111/j.1527-3458.2006.00250.x] [Citation(s) in RCA: 348] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Paracetamol (acetaminophen) is one of the most popular and widely used drugs for the treatment of pain and fever. It occupies a unique position among analgesic drugs. Unlike NSAIDs it is almost unanimously considered to have no antiinflammatory activity and does not produce gastrointestinal damage or untoward cardiorenal effects. Unlike opiates it is almost ineffective in intense pain and has no depressant effect on respiration. Although paracetamol has been used clinically for more than a century, its mode of action has been a mystery until about one year ago, when two independent groups (Zygmunt and colleagues and Bertolini and colleagues) produced experimental data unequivocally demonstrating that the analgesic effect of paracetamol is due to the indirect activation of cannabinoid CB(1) receptors. In brain and spinal cord, paracetamol, following deacetylation to its primary amine (p-aminophenol), is conjugated with arachidonic acid to form N-arachidonoylphenolamine, a compound already known (AM404) as an endogenous cannabinoid. The involved enzyme is fatty acid amide hydrolase. N-arachidonoylphenolamine is an agonist at TRPV1 receptors and an inhibitor of cellular anandamide uptake, which leads to increased levels of endogenous cannabinoids; moreover, it inhibits cyclooxygenases in the brain, albeit at concentrations that are probably not attainable with analgesic doses of paracetamol. CB(1) receptor antagonist, at a dose level that completely prevents the analgesic activity of a selective CB(1) receptor agonist, completely prevents the analgesic activity of paracetamol. Thus, paracetamol acts as a pro-drug, the active one being a cannabinoid. These findings finally explain the mechanism of action of paracetamol and the peculiarity of its effects, including the behavioral ones. Curiously, just when the first CB(1) agonists are being introduced for pain treatment, it comes out that an indirect cannabino-mimetic had been extensively used (and sometimes overused) for more than a century.
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Affiliation(s)
- Alfio Bertolini
- Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Modena, Italy.
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Ayoub SS, Botting RM, Goorha S, Colville-Nash PR, Willoughby DA, Ballou LR. Acetaminophen-induced hypothermia in mice is mediated by a prostaglandin endoperoxide synthase 1 gene-derived protein. Proc Natl Acad Sci U S A 2004; 101:11165-9. [PMID: 15263079 PMCID: PMC503757 DOI: 10.1073/pnas.0404185101] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acetaminophen is a widely used antipyretic analgesic, reducing fever caused by bacterial and viral infections and by clinical trauma such as cancer or stroke. In rare cases in humans, e.g., in febrile children or HIV or stroke patients, acetaminophen causes hypothermia while therapeutic blood levels of the drug are maintained. In C57/BL6 mice, acetaminophen caused hypothermia that was dose related and maximum (>2 degrees C below normal) with a dose of 300 mg/kg. The reduction and recovery of body temperature was paralleled by a fall of >90% and a subsequent rise of prostaglandin (PG)E(2) concentrations in the brain. In cyclooxygenase (COX)-2(-/-) mice, acetaminophen (300 mg/kg) produced hypothermia accompanied by a reduction in brain PGE(2) levels, whereas in COX-1(-/-) mice, the hypothermia to this dose of acetaminophen was attenuated. The brains of COX-1(-/-) mice had approximately 70% lower levels of PGE(2) than those of WT animals, and these levels were not reduced further by acetaminophen. The putative selective COX-3 inhibitors antipyrine and aminopyrine also reduced basal body temperature and brain PGE(2) levels in normal mice. We propose that acetaminophen is a selective inhibitor of a COX-1 variant and this enzyme is involved in the continual synthesis of PGE(2) that maintains a normal body temperature. Thus, acetaminophen reduces basal body temperature below normal in mice most likely by inhibiting COX-3.
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Affiliation(s)
- Samir S Ayoub
- Experimental Pathology Group, Queen Mary University of London, St. Bartholomew's and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom
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Janbaz KH, Gilani AH. Potentiation of paracetamol and carbon tetrachloride-induced hepatotoxicity in rodents by the food additive vanillin. Food Chem Toxicol 1999; 37:603-7. [PMID: 10478828 DOI: 10.1016/s0278-6915(99)00039-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The potential of vanillin to potentiate the paracetamol and carbon tetrachloride (CCl4)-induced hepatotoxicity was investigated in rats. Vanillin when given alone (15 mg/kg, orally), did not modify liver function in rats as the values of serum enzymes of alkaline phosphatase (ALP) and aminotransaminases (AST and ALT) were found similar to those in the normal animals. However, when given repeatedly before the administration of the subtoxic dose of paracetamol (500 mg/kg) or CCl4 (1 ml/kg), vanillin caused liver damage, as manifested by the significant increase in the serum levels of hepatic enzymes. When tested for its possible interaction with pentobarbital (75 mg/kg, i.p.) and strychnine (0.9 mg/kg, i.p.), it caused reduction in pentobarbital-induced sleep in mice as well as preventing the animals against the lethal effect of strychnine, suggestive of an induction of microsomal drug metabolizing enzymes. These results indicate that vanillin potentiates the hepatotoxic potential of paracetamol and CCl4 in rats probably through an enzyme induction process.
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Affiliation(s)
- K H Janbaz
- Department of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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13
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Paracetamol Pharmacokinetics in Pregnancy. Clin Drug Investig 1993. [DOI: 10.1007/bf03259739] [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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14
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Abstract
1. Paracetamol is one of the most common drugs that children accidentally ingest. Unlike the situation in adults, death and hepatotoxicity in children from paracetamol poisoning are exceedingly uncommon events. A review of the literature has revealed only seven deaths and fourteen cases of hepatotoxicity in children, with most of the cases resulting from chronic poisoning and not acute poisoning. 2. Children may be less prone to paracetamol hepatotoxicity because of developmental differences in the drug's metabolism and its pathways of detoxification. In the therapeutic setting of treatment of fever and pain in children, paracetamol is regarded as a drug with a higher therapeutic index, and as such, there seems to be little concern with strict adherence to dosage regimes. 3. Scrutiny of the above paediatric cases associated with chronic paracetamol poisoning suggests that the margin of safety of frequent therapeutic doses of paracetamol in infants and young children to be a lot lower than previously appreciated. This review highlights the need to re-evaluate the safety of paracetamol in the context of chronic therapy in infants and young children.
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Affiliation(s)
- A Penna
- Paediatric Pharmacology Unit, Westmead Hospital, Sydney, Australia
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15
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Baraka OZ, Truman CA, Ford JM, Roberts CJ. The effect of propranolol on paracetamol metabolism in man. Br J Clin Pharmacol 1990; 29:261-4. [PMID: 2306420 PMCID: PMC1380095 DOI: 10.1111/j.1365-2125.1990.tb03631.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ten healthy volunteers were treated for 4 days with 160 mg propranolol HCl and placebo in random order. At the end of each treatment salivary antipyrine kinetics and the plasma kinetics and urinary excretion of paracetamol and its major metabolites were measured following a 1500 mg oral dose. Propranolol prolonged the half-life of antipyrine by 11 +/- 5% (mean +/- s.e. mean) and lowered its clearance by 14 +/- 3% (P less than 0.05). Propranolol increased the half-life of paracetamol by 25 +/- 12% (P less than 0.05) and lowered its clearance by 14 +/- 3% (P less than 0.05). Propranolol decreased the partial clearance of paracetamol to its cysteine and mercapturate derivatives by 16 +/- 3% (P less than 0.05) and 32 +/- 7% (P less than 0.05), respectively. The partial clearance to the glucuronide conjugate was decreased by 27 +/- 6% (P less than 0.05), whereas that to sulphate was not changed significantly. Propranolol inhibits paracetamol metabolism predominantly through inhibition of the oxidation and glucuronidation pathways.
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Affiliation(s)
- O Z Baraka
- Department of Medicine, Bristol Royal Infirmary
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16
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Dupin JP, Gravier D, Casadebaig F, Boisseau MR, Bernard H. In vitro antiaggregant activity of paracetamol and derivatives. Thromb Res 1988; 50:437-47. [PMID: 3134743 DOI: 10.1016/0049-3848(88)90273-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The in vitro antiaggregating action of paracetamol and ten of its derivatives was studied by observing their action on collagen, adenosine-5 diphosphate (ADP) and arachidonic acid-induced platelet aggregation. It is established that in vitro activity appears not only with paracetamol but also with its positional isomers and its isosteric derivatives; this involves the replacement of oxygen by sulfur and that of the NH group of oxygen. Paracetamol and its derivatives also have an inhibiting effect on the serotonin release and the thromboxane synthesis of collagen-stimulated platelets.
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Affiliation(s)
- J P Dupin
- Département d'Hémostase, Université de Bordeaux II, France
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17
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Tee LB, Davies DS, Seddon CE, Boobis AR. Species differences in the hepatotoxicity of paracetamol are due to differences in the rate of conversion to its cytotoxic metabolite. Biochem Pharmacol 1987; 36:1041-52. [PMID: 3566800 DOI: 10.1016/0006-2952(87)90412-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The cytotoxicity of paracetamol and of its putative toxic metabolite, N-acetyl-p-benzo-quinoneimine (NABQI) have been investigated in hepatocytes from hamster, mouse, rat and human liver. Whereas paracetamol readily caused cell blebbing and a loss of viability in hepatocytes from mouse and hamster, human and rat hepatocytes were much more resistant to these effects. In marked contrast, there were no significant differences in the sensitivity of the cells from any species to the toxic effects of NABQI. Glutathione depletion by NABQI and paracetamol correlated very well with the toxic effects of these compounds. It is concluded that species differences in sensitivity to the hepatotoxicity of paracetamol are due almost entirely to differences in the rate of formation of NABQI, and not to any intrinsic differences in sensitivity or in any difference in the fate of NABQI once formed. Further, man appears to be relatively resistant to the hepatotoxic effects of paracetamol, and the results in hepatocytes were confirmed by both in vitro and in vivo analyses.
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Boobis AR, Tee LB, Hampden CE, Davies DS. Freshly isolated hepatocytes as a model for studying the toxicity of paracetamol. Food Chem Toxicol 1986; 24:731-6. [PMID: 3781426 DOI: 10.1016/0278-6915(86)90172-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The toxicity of paracetamol has been investigated in freshly isolated hamster hepatocytes. Two phases of toxicity have been identified. In phase 1, metabolic activation of paracetamol occurs with depletion of glutathione. In phase 2, there is progressive morphological damage, leading ultimately to cell death. This occurs even in the absence of further exposure to paracetamol. The thiol reductant, dithiothreitol, added at the start of phase 2, prevents and reverses the toxicological damage that would otherwise occur. Thus, it is most likely that paracetamol causes hepatotoxicity through oxidation of SH groups in key enzymes. N-Acetylcysteine, but not methionine, has an effect similar to that of dithiothreitol. This difference is probably due to oxidation of the enzymes involved in the conversion of methionine to cysteine, whereas N-acetylcysteine can still serve as a precursor of glutathione. The glutathione can act both by adduct formation with the metabolite of paracetamol and as a thiol reductant. Species differences in sensitivity to paracetamol toxicity were shown to be due to differences in the rate of oxidation of the drug to its toxic metabolite. Most people are relatively poor activators of paracetamol, but in few subjects the reaction proceeds quite rapidly, rendering such individuals more sensitive to the hepatotoxic effects of the drug.
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Abstract
Since their synthesis in the late 1800s paracetamol (acetaminophen) and phenacetin have followed divergent pathways with regard to their popularity as mild analgesic/antipyretic drugs. Initially, paracetamol was discarded in favour of phenacetin because the latter drug was supposedly less toxic. Today the opposite is true, and paracetamol, along with aspirin, has become one of the two most popular 'over-the-counter' non-narcotic analgesic agents. This marked increase in the wide approval attained by paracetamol has been accompanied by the virtual commercial demise of phenacetin because of its role, albeit somewhat circumstantial, in causing analgesic nephropathy. Both paracetamol and phenacetin are effective mild analgesics, suitable for treating mild to moderate pain, and their actions are broadly comparable with those of aspirin and related salicylates, although they do not appear to possess significant anti-inflammatory activity. Since a major portion of a dose of phenacetin is rapidly metabolised to paracetamol, it seems possible that phenacetin owes some of its therapeutic activity to its main metabolite, paracetamol, whereas its most troublesome side effect (methaemoglobinaemia) is due to another metabolite, p-phenetidine. The mechanism of action of paracetamol is poorly defined, although it has been speculated that it may selectively inhibit prostaglandin production in the central nervous system, which would account for its analgesic/antipyretic properties. The lack of any significant influence on peripheral cyclooxygenase would explain the absence of anti-inflammatory activity. At therapeutic doses paracetamol is well tolerated and produces fewer side effects than aspirin. The most frequently reported adverse effect associated with paracetamol is hepatotoxicity, which occurs after acute overdosage (usually doses greater than 10 to 15g are needed) and, very rarely, during long term treatment with doses at the higher levels of the therapeutic range. Paracetamol damages the liver through the formation of a highly reactive metabolite which is normally inactivated by conjugation with glutathione. Overdoses of paracetamol exhaust glutathione stores, thus allowing the accumulation of this toxic metabolite which covalently binds with vital cell elements and can result in liver necrosis. Glutathione precursors (notably intravenous N-acetylcysteine) have proved remarkably successful in treating paracetamol overdose, as long as treatment is initiated within 10 hours.(ABSTRACT TRUNCATED AT 400 WORDS)
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Abstract
The first cases of fulminant hepatic failure due to paracetamol poisoning were reported in 1966, and in the United Kingdom this condition is now responsible for more cases of acute hepatic failure than any other cause. Adults account for the majority of serious and fatal cases of paracetamol poisoning and it is extremely rare for young children to ingest sufficient paracetamol to cause more than minimal liver damage. A single measurement of the plasma paracetamol concentration is an accurate predictor of liver damage provided that it is taken not earlier than 4 hours after ingestion of the overdose. Peak disturbance of liver function occurs 2 to 4 days after the overdose, often accompanied by mild jaundice, after which recovery is usually rapid and complete. In a few patients, fulminant hepatic failure, manifested by increasing jaundice and encephalopathy, may develop by the third to fifth day. Acute renal failure may complicate paracetamol poisoning, often in the context of severe liver damage. Renal failure, which is often non-oliguric, typically becomes apparent 24 to 72 hours after overdosage. The treatment of paracetamol intoxication should include gastric lavage, which has been shown to be of value for up to 6 hours after ingestion of a paracetamol overdose. Further general treatment may include parenteral fluid replacement and a prophylactic infusion of dextrose (5-10%) in patients at risk of hepatic failure. Specific protective agents in those patients at risk of paracetamol-induced liver damage include N-acetylcysteine and methionine which are most effective if given within 8 to 10 hours of ingestion of the overdose. Hepatic and renal failure should be managed conventionally. In recent years in the United Kingdom there has been a gradual decline in the number of hospital admissions and the number of deaths from aspirin poisoning. Salicylates in overdose directly stimulate the respiratory centre and so cause a respiratory alkalosis. Metabolic acidosis occurs in severe poisoning because of impairment of the oxidative metabolism of energy substrates. At very high salicylate concentrations respiratory depression may occur, possibly associated with neuroglycopenia, adding respiratory acidosis to the worsening metabolic acidosis. In addition to a mixed acid-base disturbance, hypokalaemia and hypoglycaemia may be present. Nausea and vomiting increase the fluid deficit. If dehydration is sufficiently severe, decreasing cardiac output may hasten development of lactic acidosis and acute renal failure.(ABSTRACT TRUNCATED AT 400 WORDS)
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Jackson CH, MacDonald NC, Cornett JW. Acetaminophen: a practical pharmacologic overview. CANADIAN MEDICAL ASSOCIATION JOURNAL 1984; 131:25-32, 37. [PMID: 6733646 PMCID: PMC1483338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acetaminophen is an effective analgesic and antipyretic agent with few adverse effects when used in recommended dosages. The drug is metabolized mainly in the liver, and the several end products have no harmful effects. An intermediate compound in a minor metabolic pathway, however, is toxic; it is normally inactivated by glutathione. In the case of an acetaminophen overdose the hepatic stores of glutathione seem to become depleted, leaving the toxic intermediate free to damage liver tissue. Such damage is unlikely to occur unless the plasma concentration of acetaminophen peaks above 150 micrograms/mL--a level far in excess of the 5 to 20 micrograms/mL achieved with therapeutic doses of the drug. Long-term therapeutic use of acetaminophen does not appear to be associated with liver damage, although some case reports suggest the possibility. Acetaminophen poisoning follows an acute overdose and, if untreated, is manifested clinically by an initial phase of nonspecific signs and symptoms, a latent period in which the liver transaminase levels rise and then, 3 to 5 days after the ingestion, signs of more serious hepatic dysfunction. Most patients do not progress beyond the first or second phase. They and those who survive the third phase recover with no residual injury to the liver. Appropriate antidotal therapy markedly reduces the severity of the initial damage.
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Skoglund LA, Skjelbred P. Comparison of a traditional paracetamol medication and a new paracetamol/paracetamol-methionine ester combination. Eur J Clin Pharmacol 1984; 26:573-7. [PMID: 6468471 DOI: 10.1007/bf00543487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The SUR 2647 combination is a sachet formulation containing free paracetamol and its N-acetyl-methionate ester (SUR 2647). In a randomized, single-blind, between-patient study the onset of analgesia, duration and efficacy of the SUR 2647 combination vs paracetamol was investigated in out-patients after oral surgery. One group (n = 27) received sachets of SUR 2647 combination 2 b.i.d. (equivalent to 2 g paracetamol X 2) on the day of operation, and one sachet b.i.d. (equivalent to 1 g paracetamol X 2) for the following two days. The other group (n = 26) received paracetamol tablets 2 q.i.d. on the day of operation (1 g X 4) and one tablet q.i.d. (0.5 g X 4) for the following two days. Several objective and subjective assessments, including pain score on a visual analogue scale, were recorded for comparison of the postoperative courses. Median onset of analgesia for both groups was less than or equal to 0.5 h. The duration after SUR 2647 combination was greater than or equal to 5.5 h as compared to greater than or equal to 2.5 h for paracetamol. Mean pain scores showed that the SUR 2647 combination regime reduced pain significantly more than the paracetamol regime from 0.5 to 3.0 h after initiation of medication. The mean pain scores did not show a significant difference during the remaining observation period. Mild to moderate drowsiness was reported in both treatment groups, but it was more common in subjects given SUR 2647 combination.
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McGuinness BW. A double-blind comparison in general practice of a combination tablet containing orphenadrine citrate and paracetamol ('Norgesic') with paracetamol alone. J Int Med Res 1983; 11:42-5. [PMID: 6219903 DOI: 10.1177/030006058301100109] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A double-blind trial of a combination tablet containing orphenadrine and paracetamol, 'Norgesic', was carried out to assess the value of this product compared with paracetamol alone. All three symptomatic parameters which were measured: pain, spasm and impaired activity, showed a significantly quicker recovery when the combination product was used. Further studies are necessary to evaluate the combination product against orphenadrine citrate alone.
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Lewkonia RM, Pineo GF. Angioedema-like skin lesions associated with lymphoproliferative disease. CANADIAN MEDICAL ASSOCIATION JOURNAL 1982; 127:867-8. [PMID: 6814741 PMCID: PMC1862246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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