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Filip AB, Berg SE, Mullins ME, Schwarz ES. Fomepizole as an adjunctive therapy for acetaminophen poisoning: cases reported to the toxicology investigators consortium (ToxIC) database 2015-2020. Clin Toxicol (Phila) 2022; 60:1006-1011. [PMID: 35510880 DOI: 10.1080/15563650.2022.2070071] [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: 11/03/2022]
Abstract
INTRODUCTION Fomepizole inhibits formation of toxic acetaminophen (APAP) metabolites and may prevent or reverse mitochondrial toxicity. Given these mechanisms, it may be beneficial in patients with severe APAP toxicity. Current patterns of use for this indication are not well-studied. METHODS This is a secondary analysis of patients enrolled in the Toxicology Investigators Consortium (ToxIC) database from January 2015 to July 2020. We queried cases in which APAP was listed as an ingested agent and fomepizole was also administered. We excluded cases in which APAP was not the primary agent, N-acetylcysteine (NAC) was not administered, or fomepizole was explicitly administered for another indication. Additionally, we sent a survey to each ToxIC site that administered fomepizole for APAP toxicity to better understand when, why, and how they were using it for this indication. RESULTS Twenty-five cases of fomepizole administration following an APAP ingestion met our inclusion criteria. There were one to four cases per year between 2015 and 2019 and eight cases in 2020. Seventeen of 25 (68%) cases were for a known acute ingestion. Eighteen of 25 (72%) patients developed hepatotoxicity (AST or ALT > 1000 IU/L) and 10 of 25 (40%) developed coagulopathy (PT > 15s). This was an ill patient population, with 18 of 25 (72%) developing metabolic acidosis (pH <7.20), 12 of 25 (48%) were intubated, 9 of 25 (36%) receiving vasopressors, and 6 of 25 (24%) receiving continuous renal replacement therapy. Overall, mortality was 24%. CONCLUSION The use of fomepizole is increasing in frequency in a small subset of critically ill and acutely APAP-poisoned patients.
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Affiliation(s)
- Ari B Filip
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sarah E Berg
- The Toxikon Consortium, Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Evan S Schwarz
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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- American College of Medical Toxicology, Phoenix, AZ, USA
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Patterson TG, Beckenkamp P, Ferreira M, Turner J, Gnjidic D, Chen Y, Mesa Castrillion CI, Ferreira P. Deprescribing paracetamol in pain conditions: A scoping review. Res Social Adm Pharm 2021; 18:3272-3283. [PMID: 34911668 DOI: 10.1016/j.sapharm.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine evidence on deprescribing paracetamol in pain conditions and inform future strategies for paracetamol deprescription. DESIGN Scoping review. PARTICIPANTS Adults with pain conditions, taking paracetamol. RESULTS After two independent teams of reviewers screening for titles, abstracts, and then full texts, 16 original articles were included. Deprescribing strategies were grouped into 5 categories: (1) Pharmacological, (2) Psychological, (3) Physiological, (4) Policy, and (5) Combination. We found strategies were predominately consumer-focused, conducted in community settings and involved individuals experiencing musculoskeletal pain (such as low back pain and osteoarthritis). A total of twelve studies investigated interventions targeting dose reduction and four studies examined interventions focusing on discontinuation of paracetamol. The most common strategies used to deprescribe paracetamol in pain conditions were physiological strategies, followed by psychological strategies. All included studies demonstrated some level of effectiveness to deprescribe paracetamol in a pain conditions through dose reduction or discontinuation, although the effectiveness of deprescribing strategies were highly variable, ranging from the majority of participants discontinuing their paracetamol use, to less than 10% reducing their paracetamol use upon the latest follow-up. CONCLUSIONS There are clear opportunities for prospective trials to be designed more purposely and primarily focused to influence reduction and cessation of paracetamol for specific pain conditions where deprescription is appropriate.
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Affiliation(s)
| | - Paula Beckenkamp
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Manuela Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Justin Turner
- Faculty of Pharmacy, University of Montreal, Quebec, Canada.
| | - Danijela Gnjidic
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Yanyu Chen
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | | | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Nie W, Xu P, Hao C, Chen Y, Yin Y, Wang L. Efficacy and safety of over-the-counter analgesics for primary dysmenorrhea: A network meta-analysis. Medicine (Baltimore) 2020; 99:e19881. [PMID: 32384431 PMCID: PMC7220209 DOI: 10.1097/md.0000000000019881] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea. METHODS The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities. RESULTS Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac. CONCLUSION Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.
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Affiliation(s)
| | - Ping Xu
- School of Nursing, Jilin University
| | - Chunyan Hao
- Gynecology and Integrated Care Unit, China-Japan Union Hospital of Jilin University
| | | | - Yanling Yin
- Dean's Office, Second Hospital of Jilin University, Changchun, China
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Eke-Okoro UJ, Raffa RB, Pergolizzi JV, Breve F, Taylor R. Curcumin in turmeric: Basic and clinical evidence for a potential role in analgesia. J Clin Pharm Ther 2018; 43:460-466. [PMID: 29722036 DOI: 10.1111/jcpt.12703] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/29/2018] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Current analgesic pharmacotherapy-opioids, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (paracetamol) and related drugs-is effective for acute pain, but their use is limited by adverse effects on the renal, hepatic, cardiovascular or gastrointestinal systems, or they have potential for abuse. Therefore, alternative options are desired. Compounds used in traditional medicine might offer such alternatives, but the evidence must be based on pharmacologic properties and on clinical trial data. This review summarizes the evidence for one of these: the analgesic properties of turmeric and other curcumins. METHODS The PubMed database and other sources were searched using keywords related to turmeric, curcumin, antinociception and analgesia. Primary sources and reviews of preclinical and clinical studies were identified, assessed and summarized. Bibliographies within these sources provided additional information. RESULTS Turmeric has consistently been demonstrated to produce analgesic and anti-inflammatory effects in animal models and in clinical trials, and appears to have less serious adverse effects than many current analgesics. WHAT IS NEW AND CONCLUSIONS Turmeric (curcumin) appears to be a possible candidate for consideration for use as a stand-alone analgesic, or in analgesic combinations as part of opioid-, NSAID- or paracetamol (acetaminophen)-sparing strategies.
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Affiliation(s)
- U J Eke-Okoro
- Temple University School of Pharmacy, Philadelphia, PA, USA
| | - R B Raffa
- Temple University School of Pharmacy, Philadelphia, PA, USA.,University of Arizona College of Pharmacy, Tucson, AZ, USA
| | | | - F Breve
- Mid Atlantic PharmaTech Consultants LLC, Ventnor City, NJ, USA
| | - R Taylor
- NEMA Research Inc., Naples, FL, USA
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Sundstrup E, Jakobsen MD, Brandt M, Jay K, Ajslev JZN, Andersen LL. Regular use of pain medication due to musculoskeletal disorders in the general working population: Cross-sectional study among 10,000 workers. Am J Ind Med 2016; 59:934-941. [PMID: 27245746 DOI: 10.1002/ajim.22612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND We aimed to determine the association between work, health, and lifestyle with regular use of pain medication due to musculoskeletal disorders in the general working population. METHODS Currently employed wage earners (N = 10,024) replied to questions about health, work, and lifestyle. The odds for regularly using medication for musculoskeletal disorders were modeled using logistic regression controlled for various confounders. RESULTS Pain intensity increased the odds for using pain medication in a dose-response fashion. With seated work as reference, the odds for using pain medication were 1.26 (95%CI: 1.09-1.47) for workers engaged in standing or walking work that is not strenuous and 1.59 (95%CI: 1.39-1.82) for workers engaged in standing or walking work with lifting tasks or heavy and fast strenuous work. CONCLUSIONS Workers with higher levels of physical activity at work are more likely to use pain medication on a regular basis for musculoskeletal disorders, even when adjusting for pain intensity, lifestyle, and influence at work. Am. J. Ind. Med. 59:934-941, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Emil Sundstrup
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - Markus D. Jakobsen
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - Mikkel Brandt
- National Research Centre for the Working Environment; Copenhagen Denmark
- Physical Activity and Human Performance Group, SMI; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Kenneth Jay
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - Jeppe Z. N. Ajslev
- National Research Centre for the Working Environment; Copenhagen Denmark
| | - Lars L. Andersen
- National Research Centre for the Working Environment; Copenhagen Denmark
- Physical Activity and Human Performance Group, SMI; Department of Health Science and Technology; Aalborg University; Aalborg Denmark
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Kreindler G, Attias S, Kreindler A, Hen H, Haj B, Matter I, Ben-Arye E, Schiff E. Treating postlaparoscopic surgery shoulder pain with acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:120486. [PMID: 24864149 PMCID: PMC4017844 DOI: 10.1155/2014/120486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/14/2014] [Accepted: 03/30/2014] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3 P < 0.0001) and general pain (mean reduction 6.4 ± 2.1 P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.
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Affiliation(s)
- Gur Kreindler
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Samuel Attias
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- School of Public Health, University of Haifa, Mount Carmel, 31905 Haifa, Israel
| | - Anna Kreindler
- Faculty of Management, Tel-Aviv University, P.O. Box 39040 , 69978 Tel-Aviv, Israel
| | - Haim Hen
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Bassel Haj
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Ibrahim Matter
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Eran Ben-Arye
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion International School, Mauerberger building, 2nd floor, Technion City, 3200003 Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- Department of Internal Medicine, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- The Department of Complementary/Integrative Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, Israel
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Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol 2014; 7:341-8. [PMID: 24678654 DOI: 10.1586/17512433.2014.904744] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acetaminophen is a commonly-used analgesic in the US and, at doses of more than 4 g/day, can lead to serious hepatotoxicity. Recent FDA and CMS decisions serve to limit and monitor exposure to high-dose acetaminophen. This literature review aims to describe the exposure to and consequences of high-dose acetaminophen among chronic pain patients in the US. Each year in the US, approximately 6% of adults are prescribed acetaminophen doses of more than 4 g/day and 30,000 patients are hospitalized for acetaminophen toxicity. Up to half of acetaminophen overdoses are unintentional, largely related to opioid-acetaminophen combinations and attempts to achieve better symptom relief. Liver injury occurs in 17% of adults with unintentional acetaminophen overdose.
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Affiliation(s)
- Marissa Blieden
- Evidera, 430 Bedford St, Suite 300, Lexington, MA 02420, USA
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Cusack L, de Crespigny C, Wilson C. Over-the-counter analgesic use by urban Aboriginal people in South Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:373-380. [PMID: 23387500 DOI: 10.1111/hsc.12023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 06/01/2023]
Abstract
Despite recent health gains for Australian Aboriginal people their significantly poorer health status compared with that of non-Aboriginal Australians remains significant. Within the context of high levels of mortality and morbidity, research highlights significant barriers to timely health-care, access and safe use of prescribed and over-the-counter medicines. The risks to Aboriginal people's health due to unsafe medication use are preventable. The purpose of this article is to present the findings from qualitative research focused on Aboriginal people's knowledge, use and experience of over-the-counter analgesics. The study was conducted in the north-western metropolitan area of Adelaide, which has the largest urban Aboriginal population in South Australia. The employment of an Aboriginal Elder as Cultural Advisor enabled engagement with Aboriginal participants. Purposive 'snow ball' sampling was used to recruit participants for four focus groups [n = 30] and one participant opting for a personal semi-structured interview. Participants worked with the researchers to develop the findings and formulate recommendations. The 25 women and 6 men, aged 20-80 years reported various chronic medical conditions. Focus groups/interview elicited accounts of critical issues concerning safe selection and use of over-the-counter analgesics. Serious health risks were evident due to limited knowledge about safe analgesic use and over-reliance on information from family, friends and advertising. Extremely poor access was reported by participants to culturally and linguistically appropriate information, education and advice from a range of doctors and other health professionals including Aboriginal health workers.
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Affiliation(s)
- Lynette Cusack
- Faculty of Health Science, School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
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Cavagna L, Caporali R, Trifirò G, Arcoraci V, Rossi S, Montecucco C. Overuse of Prescription and OTC Non-Steroidal Anti-Inflammatory Drugs in Patients with Rheumatoid Arthritis and Osteoarthritis. Int J Immunopathol Pharmacol 2013; 26:279-81. [DOI: 10.1177/039463201302600132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) have been demonstrated to have significant cardiovascular and gastrointestinal toxicity; high dose of intake and concomitant use of multiple compounds or corticosteroids are factors that increase the risk of NSAID toxicity. In this paper we described our experience on NSAIDs misuse (both prescribing and OTC formulations), particularly relevant in the setting of rheumatoid arthritis (39.5% of patients) and osteoarthritis (47% of patients). We also evaluated causes underlying NSAIDs misuse (e.g. not satisfactory pain control, other painful conditions, etc).
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Affiliation(s)
- L. Cavagna
- Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy
| | - R. Caporali
- Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy
| | - G. Trifirò
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy
| | - V. Arcoraci
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy
| | - S. Rossi
- Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy
| | - C. Montecucco
- Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy
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