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Ryan PM, Scherry H, Pierson R, Wilson CD, Probe RA. NSAID use in orthopedic surgery: A review of current evidence and clinical practice guidelines. J Orthop Res 2024. [PMID: 38273720 DOI: 10.1002/jor.25791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a valuable class of medications for orthopedic surgeons and often play a pivotal role in pain control. However, there are many common stipulations resulting in avoidance of its use in the treatment of musculoskeletal disease. This review summarizes the mechanism of action of NSAIDs as well as provides an overview of commonly used NSAIDs and the differences between them. It provides a concise summary on the osseous effects of NSAIDs with regard to bone healing and heterotopic ossification. Most of all, it serves as a guide or reference for orthopedic providers when counseling patients on the risks and benefits of NSAID use, as it addresses the common stipulations encountered: "It irritates my stomach," "I have a history of bariatric surgery," "I'm already on a blood thinner," "I've had a heart attack," and "I've got kidney problems" and synthesizes both current research and society recommendations regarding safe use and avoidance of NSAIDs.
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Affiliation(s)
| | | | - Ryan Pierson
- Washington University Orthopaedics, Saint Louis, Missouri, USA
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Glover CD, Berkenbosch JW, Taylor MB, Patel NV, Kaelin B, Gibson BHY, Zhong J. A Multi-Center Evaluation of the Pharmacokinetics and Safety of Intravenous Ibuprofen in Infants 1-6 Months of Age. Paediatr Drugs 2023; 25:585-593. [PMID: 37294477 DOI: 10.1007/s40272-023-00576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Enteral ibuprofen was first approved as a prescription drug in 1974 for the US market. An intravenous (IV) ibuprofen formulation is approved for use in children older than 6 months of age, but there are limited studies specifically evaluating the pharmacokinetics and safety in children 1-6 months of age. AIMS The primary purpose of this study was to evaluate the pharmacokinetics of IV ibuprofen in infants younger than 6 months of age. The secondary objective was to evaluate the safety of single and repeated doses of IV ibuprofen in infants younger than 6 months of age. METHODS This was an industry-sponsored multi-center study. Institutional Review Board approval and informed parental consent were obtained prior to enrollment. Hospitalized neonates and infants younger than 6 months of age with fever or expected postoperative pain were eligible. Enrolled patients received 10 mg/kg of IV ibuprofen every 6 h, with up to four doses per day. Patients were randomized to two sparse sampling technique pharmacokinetic sample time groups. Group 1 samples were drawn at 0, 30 min, and 2 h, while group 2 samples were drawn at 0 min, 1, and 4 h after administration. RESULTS A total of 24 children were enrolled in the study, with 15 male patients and 9 female patients. The median age of the cohort was 4.4 months (range 1.1-5.9 months), and the median weight was 5.9 kg (range 2.3-8.8 kg). The arithmetic mean and standard error for peak plasma ibuprofen concentration was 56.28 ± 2.77 µg/mL. Plasma levels declined rapidly with a mean elimination half-life of 1.30 h. Time to peak ibuprofen effect and concentration were similar when compared with older pediatric patients. Clearance and volume of distribution were also similar to those reported in older pediatric patients. No drug-related adverse events were reported. CONCLUSIONS The pharmacokinetic and short-term safety profiles of IV ibuprofen in pediatric patients 1-6 months of age are comparable to those in children older than 6 months of age. TRIAL REGISTRATION Clinicaltrials.gov Trial Registration number and date: NCT02583399-Registered July 2017.
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Affiliation(s)
- Chris D Glover
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030-2399, USA
| | - John W Berkenbosch
- "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY, USA
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, 231 E. Chestnut St, N-97, Louisville, KY, 40202, USA
| | - Mary B Taylor
- Department of Pediatrics, Suzan B. Thames Chair, Pediatric Critical Care and Pediatric Cardiology, Children's of Mississippi, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Nihar V Patel
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030-2399, USA
| | - Byron Kaelin
- Clinical Operations, Cumberland Pharmaceuticals Inc., 1600 West End Avenue, Suite 1300, Nashville, TN, 37203, USA
| | - Breanne H Y Gibson
- Clinical Operations, Cumberland Pharmaceuticals Inc., 1600 West End Avenue, Suite 1300, Nashville, TN, 37203, USA
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health of Dallas, 1935 Medical District Drive, Suite D2085, Dallas, TX, 75235, USA.
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Mojave Yucca ( Yucca Schidigera Roezl) Effects on Female Reproduction a Review. FOLIA VETERINARIA 2018. [DOI: 10.2478/fv-2018-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Yucca is an important source of biologically active substances such as steroidal saponins and stilbenes providing many beneficial effects when administered to humans and other animals. These substances offer a great potential in the prevention and treatment of current civilized diseases as well as to their: antioxidant, hypocholesterolaemic, anti-inflammatory, phytoestrogenic, pro-apoptotic, anti-proliferative, and anti-carcinogenic properties. This review focuses on the roles of two main yucca constituent groups and their ability to modulate ovarian functions and female reproductive performance. Both the biological activity of yucca substances and the mechanisms of their actions on ovaries are still incompletely understood. Thus, the direct effects of yucca extract on ovarian cells in animal models under in vitro conditions, as well as actions after yucca consumption will be discussed.
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Steiner AA, Romanovsky AA. Platelet-activating factor is a potent pyrogen and cryogen, but it does not mediate lipopolysaccharide fever or hypothermia. Temperature (Austin) 2015; 2:535-42. [PMID: 27227073 PMCID: PMC4843927 DOI: 10.1080/23328940.2015.1030540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 12/22/2022] Open
Abstract
We examined whether platelet-activating factor (PAF) and its receptor mediate lipopolysaccharide (LPS)-induced fever and hypothermia in rats. Two highly potent, structurally distinct antagonists of the PAF receptor, CV6209 and WEB2086, were used. At a neutral ambient temperature (Ta) of 30ºC, administration of LPS at a low (10 μg/kg, i.v.) or high (1,000 μg/kg, i.v.) dose resulted in fever. The response to the high dose was turned into hypothermia at a subneutral Ta of 22ºC. Neither LPS-induced fever nor hypothermia was affected by pretreatment with CV6209 (5 mg/kg, i.v.) or WEB2086 (5 mg/kg, i.v.). However, both PAF antagonists were efficacious in blocking the thermoregulatory response caused by PAF (334 pmol/kg/min, 1 h, i.v.), regardless of whether the response was a fever (at 30ºC) or hypothermia (at 22ºC). Additional experiments showed that the thermoregulatory responses to LPS and PAF are also distinct in terms of their mediation by prostaglandins. Neither PAF fever nor PAF hypothermia was affected by pretreatment with the cyclooxygenase-2 inhibitor SC236 (5 mg/kg, i.p.), which is known to abrogate LPS fever. The responses to PAF were also unaffected by pretreatment with the cyclooxygenase-1 inhibitor SC560 (5 mg/kg, i.p.), which is known to attenuate LPS hypothermia. In conclusion, PAF infusion at a picomolar dose causes fever at thermoneutrality but hypothermia in a subthermoneutral environment, both responses being dependent on the PAF receptor and independent of prostaglandins. However, the PAF receptor does not mediate LPS-induced fever or hypothermia, thus challenging the dogma that PAF is an upstream mediator of responses to LPS.
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Affiliation(s)
- Alexandre A Steiner
- Feverlab; Trauma Research; St. Joseph's Hospital and Medical Center; Phoenix, AZ USA; Department of Immunology; Institute of Biomedical Sciences; University of São Paulo; São Paulo, SP Brazil
| | - Andrej A Romanovsky
- Feverlab; Trauma Research; St. Joseph's Hospital and Medical Center ; Phoenix, AZ USA
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Shin YO, Lee JB, Song YJ, Min YK, Yang HM. Oligonol supplementation attenuates body temperature and the circulating levels of prostaglandin E2 and cyclooxygenase-2 after heat stress in humans. J Med Food 2013; 16:318-23. [PMID: 23566058 DOI: 10.1089/jmf.2012.2543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Oligonol, a phenolic production from lychee, has been reported to exhibit anti-oxidative and anti-inflammatory effects. This study investigated the effect of Oligonol supplementation on circulating levels of prostaglandin E2 (PGE2) and cyclooxygenase (COX)-2, as well as body temperature, after heat stress in 17 healthy human male volunteers (age, 21.6±2.1 years). All experiments were performed in an automated climate chamber (26.0°C±0.5°C, relative humidity 60%±3.0%, air velocity less than 1 m/sec) between 2 and 5 p.m. Subjects ingested an Oligonol (100 mg)-containing beverage or placebo beverage before half-body immersion into hot water (42°C±0.5°C for 30 min). Tympanic and skin temperatures were measured and mean body temperatures were calculated. Serum concentrations of PGE2 and COX-2 were analyzed before, immediately after, and 60 min after immersion. Oligonol intake significantly prevented elevation of tympanic (temperature difference: 0.17°C at Post, P<.05; 0.17°C at Re-60, P<.05) and mean body temperatures (temperature difference: 0.18°C at Post, P<.05; 0.15°C at Re-60, P<.05), and lowered concentrations of serum PGE2 (increased by 13.3% vs. 29.6% at Post, P<.05) and COX-2 (increased by 15.6% vs. 21.8% at Post, P<.05), compared to placebo beverage. Our result suggests that Oligonol has the potential to suppress increases in body temperature under heat stress, and this is associated with decreases in serum levels of PGE2 and COX-2.
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Affiliation(s)
- Young Oh Shin
- Department of Healthcare, Global Graduate School, Soonchunhyang University, Asan, Korea
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Kirkby NS, Zaiss AK, Wright WR, Jiao J, Chan MV, Warner TD, Herschman HR, Mitchell JA. Differential COX-2 induction by viral and bacterial PAMPs: Consequences for cytokine and interferon responses and implications for anti-viral COX-2 directed therapies. Biochem Biophys Res Commun 2013; 438:249-56. [PMID: 23850620 PMCID: PMC3759847 DOI: 10.1016/j.bbrc.2013.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 11/24/2022]
Abstract
We report interactions of Toll-like receptors (TLRs) with COX enzymes in vivo. COX-2 was broadly induced by LPS (TLR4) but more locally by poly(I:C) (TLR3). COX-1/2 deletion modified the response to TLR activation in a TLR-specific manner. COX-2 deletion enhanced interferon responses to viral-type TLR3/7/9 ligands. COX-2 inhibition could provide a novel anti-viral therapeutic strategy.
Cyclooxygenase 2 (COX)-2 is induced by bacterial and viral infections and has complex, poorly understood roles in anti-pathogen immunity. Here, we use a knock-in luciferase reporter model to image Cox2 expression across a range of tissues in mice following treatment with the either the prototypical bacterial pathogen-associated molecular pattern (PAMP), LPS, which activates Toll-like receptor (TLR)4, or with poly(I:C), a viral PAMP, which activates TLR3. LPS induced Cox2 expression in all tissues examined. In contrast, poly(I:C) elicited a milder response, limited to a subset of tissues. A panel of cytokines and interferons was measured in plasma of wild-type, Cox1−/− and Cox2−/− mice treated with LPS, poly(I:C), MALP2 (TLR2/6), Pam3CSK4 (TLR2/1), R-848 (TLR7/8) or CpG ODN (TLR9), to establish whether/how each COX isoform modulates specific PAMP/TLR responses. Only LPS induced notable loss of condition in mice (inactivity, hunching, piloerection). However, all TLR agonists produced cytokine responses, many of which were modulated in specific fashions by Cox1 or Cox2 gene deletion. Notably we observed opposing effects of Cox2 gene deletion on the responses to the bacterial PAMP, LPS, and the viral PAMP, poly(I:C), consistent with the differing abilities of the PAMPs to induce Cox2 expression. Cox2 gene deletion limited the plasma IL-1β and interferon-γ responses and hypothermia produced by LPS. In contrast, in response to poly(I:C), Cox2−/− mice exhibited enhanced plasma interferon (IFNα,β,γ,λ) and related cytokine responses (IP-10, IL-12). These observations suggest that a COX-2 selective inhibitor, given early in infection, may enhance and/or prolong endogenous interferon responses, and thereby increase anti-viral immunity.
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Loewen PS. Review of the selective COX-2 inhibitors celecoxib and rofecoxib: focus on clinical aspects. CAN J EMERG MED 2012; 4:268-75. [PMID: 17608990 DOI: 10.1017/s1481803500007508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The selective cyclooxygenase-2 (COX-2) inhibitors celecoxib and rofecoxib were designed to have similar efficacy but less gastrointestinal toxicity than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Their efficacy has been demonstrated in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, postoperative dental pain and dysmenorrhea. These agents produce fewer endoscopic ulcers, symptomatic ulcers and gastrointestinal bleeds than traditional NSAIDs; although the absolute benefit is small and the gastropreserving effect is negated by concurrent use of low-dose aspirin for cardiovascular risk reduction. Nephrotoxicity and hyptertension remain concerns with COX-2 inhibitors, as they are with traditional NSAIDs. COX-2 inhibitors may be safe alternatives to traditional NSAIDs for patients with aspirin-sensitive asthma.
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Affiliation(s)
- Peter S Loewen
- Internal Medicine, Pharmaceutical Sciences Clinical Service Unit, Vancouver Hospital and Health Sciences Centre, Vancouver, British Colubmia, Canada
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Kaur J, Vaish V, Sanyal SN. COX-2 as a molecular target of colon cancer chemoprevention: Promise and reality. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.biomag.2012.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Imanishi J, Morita Y, Yoshimi E, Kuroda K, Masunaga T, Yamagami K, Kuno M, Hamachi E, Aoki S, Takahashi F, Nakamura K, Miyata S, Ohkubo Y, Mutoh S. Pharmacological profile of FK881(ASP6537), a novel potent and selective cyclooxygenase-1 inhibitor. Biochem Pharmacol 2011; 82:746-54. [DOI: 10.1016/j.bcp.2011.06.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 12/26/2022]
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10
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Effect of oligonol intake on cortisol and cytokines, and body temperature after leg immersion into hot water. Food Sci Biotechnol 2011. [DOI: 10.1007/s10068-011-0093-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Schoenfeld DA, Hui Zheng, Finkelstein DM. Bayesian design using adult data to augment pediatric trials. Clin Trials 2010; 6:297-304. [PMID: 19667026 DOI: 10.1177/1740774509339238] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It can be difficult to conduct pediatric clinical trials because there is often a low incidence of the disease in children, making accrual slow or infeasible. In addition, low mortality and morbidity in this population make it impractical to achieve adequate power. In this case, the only evidence for treatment efficacy comes from adult trials. Since pediatric care providers are accustomed to relying on evidence from adult studies, it is natural to consider borrowing information from adult trials. PURPOSE The goal of this article is to propose a Bayesian approach to the design and analysis of pediatric trials to allow borrowing strength from previous or simultaneous adult trials. METHODS We apply a hierarchical model for which the efficacy parameter from the adult trial and that of the pediatric trail are considered to be draws from a normal distribution. The choice of (the variance of) this distribution is guided by discussion with medical experts. We show that with this information, one can calculate the sample size required for the pediatric trial. We discuss how inference of these studies in pediatric populations depends on the parameter that captures the similarity of the treatment efficacy in adults compared to children. RESULTS The Bayesian approach can substantially increase the power of a pediatric clinical trial (or equivalently decrease the number of subjects required) by formally leveraging the data from the adult trial. LIMITATIONS Our method relies on obtaining a value for the inter-study variability, nu, which may be difficult to describe to a clinical investigator. CONCLUSIONS The Bayesian approach has the potential of making pediatric clinical trials feasible because it has the effect of borrowing strength from adult trials, thus requiring a smaller pediatric trial to show efficacy of a drug in children.
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Hörl WH. Nonsteroidal Anti-Inflammatory Drugs and the Kidney. Pharmaceuticals (Basel) 2010; 3:2291-2321. [PMID: 27713354 PMCID: PMC4036662 DOI: 10.3390/ph3072291] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 12/20/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the isoenzymes COX-1 and COX-2 of cyclooxygenase (COX). Renal side effects (e.g., kidney function, fluid and urinary electrolyte excretion) vary with the extent of COX-2-COX-1 selectivity and the administered dose of these compounds. While young healthy subjects will rarely experience adverse renal effects with the use of NSAIDs, elderly patients and those with co-morbibity (e.g., congestive heart failure, liver cirrhosis or chronic kidney disease) and drug combinations (e.g., renin-angiotensin blockers, diuretics plus NSAIDs) may develop acute renal failure. This review summarizes our present knowledge how traditional NSAIDs and selective COX-2 inhibitors may affect the kidney under various experimental and clinical conditions, and how these drugs may influence renal inflammation, water transport, sodium and potassium balance and how renal dysfunction or hypertension may result.
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Affiliation(s)
- Walter H Hörl
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Krudsood S, Tangpukdee N, Wilairatana P, Pothipak N, Duangdee C, Warrell DA, Looareesuwan S. Intravenous ibuprofen (IV-ibuprofen) controls fever effectively in adults with acute uncomplicated Plasmodium falciparum malaria but prolongs parasitemia. Am J Trop Med Hyg 2010; 83:51-5. [PMID: 20595477 PMCID: PMC2912575 DOI: 10.4269/ajtmh.2010.09-0621] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 03/12/2010] [Indexed: 11/07/2022] Open
Abstract
Because some febrile patients are unable to swallow or retain oral antipyretic drugs, we carried out a double-blind, placebo-controlled trial in which intravenous ibuprofen (IV-ibuprofen) was given to adults hospitalized with fever associated with acute uncomplicated falciparum malaria treated with oral artesunate plus mefloquine. Thirty patients received IV-ibuprofen 400 mg and 30 received placebo every 6 hours for 72 hours. Reduction in the area above 37.0 degrees C versus time curve was significantly greater for IV-ibuprofen than for placebo during the first 72 hours after first administration. No patients developed severe malaria; parasite clearance was delayed in the patients whose fevers were controlled by IV-ibuprofen (median 37.3 hours versus 23.7 hours in the placebo group [P = 0.0024]). This difference did not appear to be clinically important Adverse events, none considered severe, occurred equally in both groups. IV-ibuprofen was effective and well tolerated in reducing fever in febrile inpatients with malaria.
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Affiliation(s)
| | | | | | | | | | - David A. Warrell
- Department of Tropical Hygiene, Department of Clinical Tropical Medicine, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Sornchai Looareesuwan
- Department of Tropical Hygiene, Department of Clinical Tropical Medicine, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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Bavbek S, Celik G, Ozer F, Mungan D, Misirligil Z. Safety of Selective COX‐2 Inhibitors in Aspirin/Nonsteroidal Anti‐inflammatory Drug‐Intolerant Patients: Comparison of Nimesulide, Meloxicam, and Rofecoxib. J Asthma 2009; 41:67-75. [PMID: 15046380 DOI: 10.1081/jas-120026063] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intolerance to acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAIDs) is a crucial problem in clinical practice. There is, therefore, a need for safer NSAIDs in patients with analgesic intolerance. OBJECTIVE To assess the safety of nimesulide, meloxicam, and rofecoxib, selective COX-2 inhibitors, in a group of ASA/NSAIDs-intolerant patients. METHOD Tolerances to nimesulide, meloxicam, and rofecoxib were assessed by single-blind placebo-controlled oral challenges. One hundred twenty-seven subjects with history of adverse reaction to ASA/NSAIDs received oral challenges with nimesulide, 61 subjects were challenged with meloxicam, 51 subjects were challenged with rofecoxib, and 37 subjects were challenged with all three drugs. Placebos were given to all patients on the first day of the study. On the second day, one-fourth and three-fourths of the therapeutic doses of the active drugs (nimesulide 100 mg, meloxicam 7.5 mg, or rofecoxib 25 mg) were given at 60-minute intervals. There was at least a 3-day interval between challenge tests. Erythema, pruritus accompanied by erythema, urticaria/angioedema, rhinorrhea, nasal obstruction, sneezing, dyspnea, or cough associated with a decrease of at least 20% in the forced expiratory volume (FEV1) and hypotension were considered as positive reactions. RESULTS Positive reactions to the nimesulide, meloxicam, and rofecoxib challenges were observed in 18/127 (14.3%), 5/61 (8.1%), and 1/51 (2.0%) patients, respectively. In each group of nine patients, there were two patients with asthma and four who developed skin type reactions and asthmatic reactions, respectively, to the nimesulide challenge. Among five patients who reacted to the meloxicam challenge, asthmatic type reactions were detected in two asthmatics. Only one urticarial type reaction was observed with rofecoxib challenge in one patient who presented with anaphylaxis to ASA/NSAIDs. All patients with asthma tolerated rofecoxib without any adverse effects. None of the patients reacted to the placebo. Among 37 patients challenged with all three drugs, 11 reacted to nimesulide, and one patient reacted only to meloxicam. Three patients reacted to more than one of the drugs tested, and one of them reacted to all drugs. CONCLUSION This is the first placebo-controlled report comparing these three drugs. The results indicate that among these alternative drugs for ASA/NSAIDs-intolerant patients, rofecoxib seems to have the most favorable tolerability.
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Affiliation(s)
- Sevim Bavbek
- Department of Allergy, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Patel NSA, Cuzzocrea S, Collino M, Chaterjee PK, Mazzon E, Britti D, Yaqoob MM, Thiemermann C. The role of cycloxygenase-2 in the rodent kidney following ischaemia/reperfusion injury in vivo. Eur J Pharmacol 2007; 562:148-54. [PMID: 17343844 DOI: 10.1016/j.ejphar.2007.01.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 01/18/2007] [Accepted: 01/24/2007] [Indexed: 11/22/2022]
Abstract
The role of cyclooxygenase-2 (COX-2) in the pathophysiology of renal ischaemia/reperfusion injury is still not fully understood. In order to elucidate the role of COX-2 in ischaemia/reperfusion injury of the kidney, we have evaluated the effects of ischaemia/reperfusion on renal dysfunction and injury in (i) rats treated with either vehicle or the selective COX-2 inhibitor parecoxib, and (ii) wild-type mice or mice in which the gene for COX-2 has been deleted (COX-2 knock-out mice or COX-2(-/-)). Rats were subjected to bilateral renal ischaemia (45 min) and reperfusion (6 h), and received parecoxib (20 mg/kg, i.v.) 30 min prior to ischaemia and 3 h after the commencement of reperfusion. Serum urea, serum creatinine, serum aspartate aminotransferase, creatinine clearance and fractional excretion of sodium were all used as indicators of renal dysfunction and injury. Mice (wild-type and COX-2(-/-)) were subjected to bilateral renal ischaemia (30 min) and reperfusion (24 h) after which renal dysfunction (serum urea and creatinine) and renal injury was assessed by histological analysis. Parecoxib significantly augmented the degree of renal dysfunction and injury caused by ischaemia/reperfusion in the rat. In addition, the degree of renal injury and dysfunction caused by ischaemia/reperfusion was also significantly augmented in COX-2(-/-) mice when compared to their wild-type littermates. These findings support the view that metabolites of COX-2 protect the kidney against ischaemia/reperfusion injury, and (ii) that selective inhibitors of COX-2 may worsen renal dysfunction and injury in conditions associated with renal ischaemia.
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Affiliation(s)
- Nimesh S A Patel
- Centre for Experimental Medicine and Nephrology and Critical Care, William Harvey Research Institute, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary - University of London, London, UK.
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Bradford CD, Cotter JD, Thorburn MS, Walker RJ, Gerrard DF. Exercise can be pyrogenic in humans. Am J Physiol Regul Integr Comp Physiol 2007; 292:R143-9. [PMID: 17197641 DOI: 10.1152/ajpregu.00926.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Exercise increases mean body temperature (T̄body) and cytokine concentrations in plasma. Cytokines facilitate PG production via cyclooxygenase (COX) enzymes, and PGE2 can mediate fever. Therefore, we used a COX-2 inhibitor to test the hypothesis that PG-mediated pyrogenicity may contribute to the raised T̄body in exercising humans. In a double-blind, cross-over design, 10 males [age: 23 yr (SD 5), V̇o2 max: 53 ml·kg−1·min−1 (SD 5)] consumed rofecoxib (50 mg/day; NSAID) or placebo (PLAC) for 6 days, 2 wk apart. Exercising thermoregulation was measured on day 6 during 45-min running (∼75% V̇o2 max) followed by 45-min cycling and 60-min seated recovery (28°C, 50% relative humidity). Plasma cytokine (TNF-α, IL-10) concentrations were measured at rest and 30-min recovery. T̄body was similar at rest in PLAC (35.59°C) and NSAID (35.53°C) and increased similarly during running, but became 0.33°C (SD 0.26) lower in NSAID during cycling (37.39°C vs. 37.07°C; P = 0.03), and remained lower throughout recovery. Sweating was initiated at T̄body of ∼35.6°C in both conditions but ceased at higher T̄body in PLAC than NSAID during recovery [36.66°C (SD 0.36) vs. 36.39°C (SD 0.27); P = 0.03]. Cardiac frequency averaged 6·min−1 higher in PLAC ( P < 0.01), whereas exercising metabolic rate was similar (505 vs. 507 W·m−2; P = 0.56). A modest increase in both cytokines across exercise was similar between conditions. COX-2 specific NSAID lowered exercising heat and cardiovascular strain and the sweating (offset) threshold, independently of heat production, indicating that PGE-mediated inflammatory processes may contribute to exercising heat strain during endurance exercise in humans.
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Affiliation(s)
- Carl D Bradford
- School of Physical Education, University of Otago, P.O. Box 56, Dunedin, New Zealand
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17
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Mitchell JA, Warner TD. COX isoforms in the cardiovascular system: understanding the activities of non-steroidal anti-inflammatory drugs. Nat Rev Drug Discov 2006; 5:75-86. [PMID: 16485347 DOI: 10.1038/nrd1929] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the formation of prostanoids by the enzyme cyclooxygenase (COX). Work in the past 15 years has shown that COX exists in two forms: COX1, which is largely associated with physiological functions, and COX2, which is largely associated with pathological functions. Heated debate followed the introduction of selective COX2 inhibitors around 5 years ago: do these drugs offer any advantages over the traditional NSAIDs theywere meant to replace, particularly in regard to gastrointestinal and cardiovascular side effects? Here we discuss the evidence and the latest recommendations for the use of selective inhibitors of COX2 as well as the traditional NSAIDs.
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Affiliation(s)
- Jane A Mitchell
- Cardiothoracic Pharmacology, Unit of Critical Care Medicine, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK.
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Abstract
To provide optimal pain control for their patients, emergency physicians should have an in-depth understanding of analgesic drugs and how to use and combine them effectively. The purpose of this article is to describe the pharmacology and use of analgesic agents that are most useful in the management of acute pain in the emergency department.
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Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine, Providence Health Care and St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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19
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Abstract
Cyclooxygenase (COX)-2 inhibitors are as efficacious as nonselective nonsteroidal anti-inflammatory drugs for the treatment of postoperative pain but have the advantages of a better gastrointestinal side-effect profile as well as a lack of antiplatelet effects. There have been recent concerns regarding the cardiovascular side effects of COX-2 inhibitors. Nonetheless, they remain a valuable option for postoperative pain management. The pharmacology of these agents and available studies are reviewed.
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Affiliation(s)
- Noor M Gajraj
- Baylor Center for Pain Management, Baylor University Medical Center, 5575 Warren Parkway # 220, Frisco, TX 75034, USA.
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Archana P, Tandan SK, Chandra S, Lal J. Antipyretic and analgesic activities ofCaesalpinia bonducella seed kernel extract. Phytother Res 2005; 19:376-81. [PMID: 16106383 DOI: 10.1002/ptr.1339] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ethanolic extract (70%) of Caesalpinia bonducella seed kernel has been subjected for its antipyretic and antinociceptive activities in adult albino rats or mice of either sex at 30, 100 and 300 mg/kg orally. The extract demonstrated marked antipyretic activity against Brewer's yeast-induced pyrexia in rats. The extract had significant central analgesic activity in hot plate and tail flick methods. It also exhibited marked peripheral analgesic effect in both acetic acid-induced writhing test in mice and Randall-Selitto assay in rats. It also significantly inhibited the formalin-induced hind paw licking in mice. In conclusion, the present study suggests that the ethanolic extract of Caesalpinia bonducella seed kernel possesses potent antipyretic and antinociceptive activities and thus, validates its use in the treatment of pain and pyretic disorders.
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Affiliation(s)
- P Archana
- Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, Izatnagar, India
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Abstract
The beneficial actions of nonsteroidal anti-inflammatory drugs (NSAIDs) have been linked to their ability to inhibit inducible COX-2 at sites of inflammation, and their side effects (e.g., gastric damage) to inhibition of constitutive COX-1. Selective inhibitors of COX-2, such as celecoxib, etoricoxib, lumiracoxib, rofecoxib, and valdecoxib have been developed and the greatest recent growth in our knowledge in this area has been come from the clinical use of these compounds. Although clinical data indicate that COX-2 selectivity is associated with a reduction in severe gastrointestinal events, they also reveal there are roles for constitutive COX-2 within tissues such as the brain, kidney, pancreas, intestine, and blood vessels. We now better understand the roles of COX-1 and COX-2 in functions as disparate as the perception of pain and the progression of cancers. Clinical use of COX-2-selective compounds has ignited strong debates regarding potential side effects, most notably those within the cardiovascular system such as myocardial infarctions, strokes, and elevation in blood pressure. This review will discuss how the latest studies help us understand the roles of COX-1 and COX-2 and what clinically proven benefits the newer generation of COX-2-selective inhibitors offer
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Affiliation(s)
- Timothy D Warner
- The William Harvey Research Institute, Barts & the London, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
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Simmons DL, Botting RM, Hla T. Cyclooxygenase Isozymes: The Biology of Prostaglandin Synthesis and Inhibition. Pharmacol Rev 2004; 56:387-437. [PMID: 15317910 DOI: 10.1124/pr.56.3.3] [Citation(s) in RCA: 1160] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) represent one of the most highly utilized classes of pharmaceutical agents in medicine. All NSAIDs act through inhibiting prostaglandin synthesis, a catalytic activity possessed by two distinct cyclooxygenase (COX) isozymes encoded by separate genes. The discovery of COX-2 launched a new era in NSAID pharmacology, resulting in the synthesis, marketing, and widespread use of COX-2 selective drugs. These pharmaceutical agents have quickly become established as important therapeutic medications with potentially fewer side effects than traditional NSAIDs. Additionally, characterization of the two COX isozymes is allowing the discrimination of the roles each play in physiological processes such as homeostatic maintenance of the gastrointestinal tract, renal function, blood clotting, embryonic implantation, parturition, pain, and fever. Of particular importance has been the investigation of COX-1 and -2 isozymic functions in cancer, dysregulation of inflammation, and Alzheimer's disease. More recently, additional heterogeneity in COX-related proteins has been described, with the finding of variants of COX-1 and COX-2 enzymes. These variants may function in tissue-specific physiological and pathophysiological processes and may represent important new targets for drug therapy.
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Affiliation(s)
- Daniel L Simmons
- Department of Chemistry and Biochemistry, E280 BNSN, Brigham Young University, Provo, UT 84604, USA.
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23
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Lin CM, Neeru S, Doufas AG, Liem E, Shah YM, Wadhwa A, Lenhardt R, Bjorksten A, Sessler DI, Kurz A. Dantrolene Reduces the Threshold and Gain for Shivering. Anesth Analg 2004; 98:1318-24, table of contents. [PMID: 15105208 PMCID: PMC1454474 DOI: 10.1213/01.ane.0000108968.21212.d7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Dantrolene is used for treatment of life-threatening hyperthermia, yet its thermoregulatory effects are unknown. We tested the hypothesis that dantrolene reduces the threshold (triggering core temperature) and gain (incremental increase) of shivering. Healthy volunteers were evaluated on 2 random days: control and dantrolene (approximately 2.5 mg/kg plus a continuous infusion). In Study 1, 9 men were warmed until sweating was provoked and then cooled until arteriovenous shunt constriction and shivering occurred. Sweating was quantified on the chest using a ventilated capsule. Absolute right middle fingertip blood flow was quantified using venous-occlusion volume plethysmography. A sustained increase in oxygen consumption identified the shivering threshold. In Study 2, 9 men were given cold lactated Ringer's solution i.v. to reduce core temperature approximately 2 degrees C/h. Cooling was stopped when shivering intensity no longer increased with further core cooling. The gain of shivering was the slope of oxygen consumption versus core temperature regression. In Study 1, sweating and vasoconstriction thresholds were similar on both days. In contrast, shivering threshold decreased 0.3 +/- 0.3 degrees C, P = 0.004, on the dantrolene day. In Study 2, dantrolene decreased the shivering threshold from 36.7 +/- 0.2 to 36.3 +/- 0.3 degrees C, P = 0.01 and systemic gain from 353 +/- 144 to 211 +/- 93 mL.min(-1).degrees C(-1), P = 0.02. Thus, dantrolene substantially decreased the gain of shivering, but produced little central thermoregulatory inhibition. IMPLICATIONS Dantrolene substantially decreases the gain of shivering but produces relatively little central thermoregulatory inhibition. It thus seems unlikely to prove more effective than conventional muscle relaxants for treatment of life-threatening hyperthermia.
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Affiliation(s)
- Chun-Ming Lin
- Research Fellow, Outcomes Research™ Institute, University of Louisville
| | - Sharma Neeru
- Research Fellow, Department of Anesthesia, Washington University
| | - Anthony G. Doufas
- Assistant Professor, Outcomes Research™ Institute and Department of Anesthesiology, University of Louisville
| | - Edwin Liem
- Assistant Professor, Outcomes Research™ Institute and Department of Anesthesiology, University of Louisville
| | - Yunus Muneer Shah
- Research Fellow, Outcomes Research™ Institute, University of Louisville
| | - Anupama Wadhwa
- Research Fellow, Outcomes Research™ Institute, University of Louisville
| | - Rainer Lenhardt
- Assistant Director, Outcomes Research™ Institute; Assistant Professor, Department of Anesthesiology, University of Louisville
| | - Andrew Bjorksten
- Clinical Research Scientist, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
| | - Daniel I. Sessler
- Associate Dean for Research, Director Outcomes Research™ Institute, Lolita and Samuel Weakley Distinguished University Research Chair, Professor of Anesthesiology and Pharmacology, University of Louisville
| | - Andrea Kurz
- Professor and Chair, Department of Anesthesia, University of Bern; Associate Professor, Department of Anesthesia, Washington University; Professor and Associate Director, Outcomes Research™ Institute, University of Louisville
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25
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Ahuja N, Singh A, Singh B. Rofecoxib: an update on physicochemical, pharmaceutical, pharmacodynamic and pharmacokinetic aspects. J Pharm Pharmacol 2003; 55:859-94. [PMID: 12906745 DOI: 10.1211/0022357021387] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Rofecoxib (MK-966) is a new generation non-steroidal anti-inflammatory agent (NSAID) that exhibits promising anti-inflammatory, analgesic and antipyretic activity. It selectively inhibits cyclooxygenase (COX)-2 isoenzyme in a dose-dependent manner in man. No significant inhibition of COX-1 is observed with rofecoxib up to doses of 1000 mg. The pharmacokinetics of rofecoxib has been found to be complex and variable. Mean oral bioavailability after single dose of rofecoxib (12.5, 25 or 50 mg) is 93% with t(max) varying widely between 2 and 9 h. It is highly plasma-protein bound and is metabolized primarily by cytosolic reductases to inactive metabolites. Rofecoxib is eliminated predominantly by hepatic metabolism with a terminal half-life of approximately 17 h during steady state. Various experimental models and clinical studies have demonstrated rofecoxib to be superior, or at least equivalent, in anti-inflammatory, analgesic and antipyretic efficacy to comparator nonselective NSAIDs in osteoarthritis, rheumatoid arthritis and other pain models. Emerging evidence suggests that rofecoxib may also find potential use as supportive therapy in various pathophysiologic conditions like Alzheimer's disease, and in various malignant tumours and polyps, where COX-2 is overly expressed. Rofecoxib is generally well-tolerated. Analysis of data pooled from several trials suggests that rofecoxib is associated with fewer incidences of clinically symptomatic gastrointestinal ulcers and ulcer complications vis-à-vis conventional NSAIDs. However, this gastropreserving effect may be negated by concurrent use of low-dose aspirin for cardiovascular risk reduction. Rofecoxib tends to show similar tolerability for renal and cardiothrombotic events as compared with nonnaproxen nonselective NSAIDs. No clinically significant drug interaction has been reported for rofecoxib except with diuretics, where it reverses their salt-wasting effect and thus can be clinically exploited in electrolyte-wasting disorders. There is only modest information about the physicochemical and pharmaceutical aspects of rofecoxib. Being poorly water soluble, its drug delivery has been improved using varied formulation approaches. Although it is stable in solid state, rofecoxib is photosensitive and base-sensitive in solution form with its degradation mechanistics elucidated. Analytical determinations of rofecoxib and its metabolites in biological fluids employing HPLC with varied types of detectors have been reported. Isolated studies have also been published on the chromatographic and spectrophotometric assay of rofecoxib and its degradants in bulk samples and pharmaceutical dosage forms. The current article provides an updated overview on the physicochemical, pharmaceutical, pharmacokinetic and pharmacodynamic vistas of rofecoxib.
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Affiliation(s)
- Naveen Ahuja
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160 014, India
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26
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Affiliation(s)
- Noor M Gajraj
- Eugene McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, U.T. Southwestern Medical Center, Dallas, Texas
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27
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Rosa P, Peiró J, Campebell R, Valadão C, Bechara G. Effects of diclofenac and dexamethasone on horse experimental endotoxemia. ARQ BRAS MED VET ZOO 2003. [DOI: 10.1590/s0102-09352003000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fifteen healthy Mangalarga horses, aged two to three years were used to evaluate the possible beneficial effects of dexamethasone and sodium diclofenac administration during experimental endotoxemia in horses. They were divided into three groups with five animals each: control (C), sodium diclofenac (SD) and dexamethasone (DM). All groups were given 0.1µg of Escherichia coli O55:B5 endotoxin/kg of body weight, intravenous, over 15 minutes, and one of the following preparations: group C - 20ml of 0.9% saline intravenous, 30 minutes before endoxin infusion; group SD - 2.2mg/kg, per os, 60 minutes before endotoxin infusion and group DM - 1.1 mg/kg, intravenous, 30 minutes before endotoxin infusion. No increase in rectal temperature was observed in the SD or DM treated groups. SD did not prevent the significant leukopenia, neutropenia and lymphopenia induced three hours after LPS injection, but DM attenuated these changes. No significant changes in plasma and peritoneal fluid total protein, inorganic phosphorus or glucose concentrations and in total nucleated cell count in peritoneal fluid were observed. SD was effective to prevent the fever and changes in intestinal borborygmi and DM blocked the cellular changes induced by experimental endotoxemia.
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28
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Affiliation(s)
- Harvey Kayman
- Advice and Appointment Call Center, Kaiser Permanente Medical Care Program, Vallejo, California, USA
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29
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Abstract
Fever is a common response to sepsis in critically ill patients. Fever occurs when either exogenous or endogenous pyrogens affect the synthesis of prostaglandin E2 in the pre-optic nucleus. Prostaglandin E2 slows the rate of firing of warm sensitive neurons and results in increased body temperature. The febrile response is well preserved across the animal kingdom, and experimental evidence suggests it may be a beneficial response to infection. Fever, however, is commonly treated in critically ill patients, usually with antipyretics, without good data to support such a practice. Fever induces the production of heat shock proteins (HSPs), a class of proteins critical for cellular survival during stress. HSPs act as molecular chaperones, and new data suggest they may also have an anti-inflammatory role. HSPs and the heat shock response appear to inhibit the activation of NF-kappabeta, thus decreasing the levels of proinflammatory cytokines. The anti-inflammatory effects of HSPs, coupled with improved survival of animal models with fever and infection, call into question the routine practice of treating fever in critically ill patients.
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Affiliation(s)
- Michael Ryan
- Fellow, Brown Medical School/Rhode Island Hospital, Pulmonary/Critical Care Division, Providence, Rhode Island, USA
| | - Mitchell M Levy
- Associate Professor, Brown Medical School/Rhode Island Hospital and Medical Director of MICU, Rhode Island Hospital, Pulmonary/Critical Care Division, Providence, Rhode Island, USA
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30
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Abstract
Aspirin, arguably the world's favourite drug, has been around since the late nineteenth century, but it wasn't until the late 1970s that its ability to inhibit prostaglandin production by the cyclooxygenase enzyme was identified as the basis of its therapeutic action. Early hints of a second form of the cyclooxygenase that was differentially sensitive to other aspirin-like drugs ultimately ushered in an exciting era of drug discovery, culminating in the introduction of an entirely new generation of anti-inflammatories. This article reviews the story of this discovery and looks at the future of cyclooxygenase pharmacology.
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Affiliation(s)
- Rod J Flower
- Department of Biochemical Pharmacology, The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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31
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Butters DE, Whitehouse MW. Treating inflammation: some (needless) difficulties for gaining acceptance of effective natural products and traditional medicines. Inflammopharmacology 2003; 11:97-110. [PMID: 15035737 DOI: 10.1163/156856003321547149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The quality of so-called 'natural medicines' is extraordinarily variable. Lack of resolute pharmacological assays contributes to this hiatus. More stringent evaluation of anti-inflammatory and anti-pyretic activities in rats can help resolve some of the uncertainties surrounding (a) preparations of some herbal products including so-called 'nature's aspirin' (e.g. willowbark, ginger), cat's claw, celery seed, etc., and (b) some animal lipids (e.g. Lyprinol(R) (NZ Mussel), emu and fish oils). These animal products can be a remarkable resource for supplementing conventional/allopathic therapy for inflammatory disease, e.g. providing lipoxygenase inhibitors. Beyond the verifiable science, the healing professions and the general public still need to examine more carefully criteria for QUALITY(S) in any alternative medicine-to ensure the good (= both reputations and products) are not destroyed by the bad-in essence counteracting Gresham's Law which states: the bad tends to displace the good.
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Affiliation(s)
- D E Butters
- Therapeutics Research Unit, Dept. of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld. 4102, Australia
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32
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Castaldo RS, Mato A, Kaul AF, Gorski H, Bosch RJ. A Retrospective Analysis of Cyclooxygenase-II Inhibitor Response Patterns. J Pharm Technol 2002. [DOI: 10.1177/875512250201800602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To summarize responses to cyclooxygenase-II (COX-II) medication use and describe physicians' reasons for switching or discontinuing therapy in the management of osteoarthritis. Methods: This retrospective medical record review evaluated all patients in a private clinical practice setting with a diagnosis of osteoarthritis who had been prescribed the COX-II inhibitor rofecoxib. Results: Of 144 evaluable patients, 81 had previously experienced treatment failure with celecoxib. Sixty-three patients had received rofecoxib as their first COX-II agent. A total of 101 of 144 patients remained on rofecoxib through the time of follow up. Patients starting celecoxib as their first COX-II agent discontinued therapy significantly earlier than those initiating treatment with rofecoxib (p < 0.001). Kaplan–Meier estimates of the median time to discontinuation were 17 weeks for celecoxib and 45 weeks for rofecoxib. There was no significant difference in the time to discontinuation in the first 6 months of therapy with a second COX-II agent between the groups. Conclusions: The majority of patients demonstrating therapeutic failure with 1 COX-II inhibitor may successfully be treated with another COX-II agent.
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Affiliation(s)
- Richard S Castaldo
- RICHARD S CASTALDO MD, Director, Buffalo Managed Care Group,
Tonawanda, NY
| | - Anthony Mato
- ANTHONY MATO MD, at time of writing, Medical Student, State
University of New York at Buffalo; now, Internal Medicine Resident, Hospital at
the University of Pennsylvania
| | - Alan F Kaul
- ALAN F KAUL RPh MSc MBA FCCP, President, Medical Outcomes Management,
Inc., Foxborough, MA; Adjunct Professor of Pharmacy, Univesity of Rhode Island,
Kingston, RI
| | - Heather Gorski
- HEATHER GORSKI MPP, Programming Coordinator, Harvard School of Public
Health, Boston, MA
| | - Ronald J Bosch
- RONALD J BOSCH PhD, Senior Research Scientist, Harvard School of
Public Health
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Engblom D, Ek M, Andersson IM, Saha S, Dahlström M, Jakobsson PJ, Ericsson-Dahlstrand A, Blomqvist A. Induction of microsomal prostaglandin E synthase in the rat brain endothelium and parenchyma in adjuvant-induced arthritis. J Comp Neurol 2002; 452:205-14. [PMID: 12353217 DOI: 10.1002/cne.10380] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although central nervous symptoms such as hyperalgesia, fatigue, malaise, and anorexia constitute major problems in the treatment of patients suffering from chronic inflammatory disease, little has been known about the signaling mechanisms by which the brain is activated during such conditions. Here, in an animal model of rheumatoid arthritis, we show that microsomal prostaglandin E-synthase, the inducible terminal isomerase in the prostaglandin E(2)-synthesizing pathway, is expressed in endothelial cells along the blood-brain barrier and in the parenchyma of the paraventricular hypothalamic nucleus. The endothelial cells but not the paraventricular hypothalamic cells displayed a concomitant induction of cyclooxygenase-2 and expressed interleukin-1 type 1 receptors, which indicates that the induction is due to peripherally released cytokines. In contrast to cyclooxygenase-2, microsomal prostaglandin E synthase had very sparse constitutive expression, suggesting that it could be a target for developing drugs that will carry fewer side effects than the presently available cyclooxygenase inhibitors. These findings, thus, suggest that immune-to-brain communication during chronic inflammatory conditions involves prostaglandin E2-synthesis both along the blood-brain barrier and in the parenchyma of the hypothalamic paraventricular nucleus and point to novel avenues for the treatment of the brain-elicited disease symptoms during these conditions.
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Affiliation(s)
- David Engblom
- Department of Biomedicine and Surgery, Division of Cell Biology, Faculty of Health Sciences, University of Linköping, S-581 85 Linköping, Sweden
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Chandrasekharan NV, Dai H, Roos KLT, Evanson NK, Tomsik J, Elton TS, Simmons DL. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A 2002; 99:13926-31. [PMID: 12242329 PMCID: PMC129799 DOI: 10.1073/pnas.162468699] [Citation(s) in RCA: 1165] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2002] [Accepted: 08/05/2002] [Indexed: 12/22/2022] Open
Abstract
Two cyclooxygenase isozymes, COX-1 and -2, are known to catalyze the rate-limiting step of prostaglandin synthesis and are the targets of nonsteroidal antiinflammatory drugs. Here we describe a third distinct COX isozyme, COX-3, as well as two smaller COX-1-derived proteins (partial COX-1 or PCOX-1 proteins). COX-3 and one of the PCOX-1 proteins (PCOX-1a) are made from the COX-1 gene but retain intron 1 in their mRNAs. PCOX-1 proteins additionally contain an in-frame deletion of exons 5-8 of the COX-1 mRNA. COX-3 and PCOX mRNAs are expressed in canine cerebral cortex and in lesser amounts in other tissues analyzed. In human, COX-3 mRNA is expressed as an approximately 5.2-kb transcript and is most abundant in cerebral cortex and heart. Intron 1 is conserved in length and in sequence in mammalian COX-1 genes. This intron contains an ORF that introduces an insertion of 30-34 aa, depending on the mammalian species, into the hydrophobic signal peptide that directs COX-1 into the lumen of the endoplasmic reticulum and nuclear envelope. COX-3 and PCOX-1a are expressed efficiently in insect cells as membrane-bound proteins. The signal peptide is not cleaved from either protein and both proteins are glycosylated. COX-3, but not PCOX-1a, possesses glycosylation-dependent cyclooxygenase activity. Comparison of canine COX-3 activity with murine COX-1 and -2 demonstrates that this enzyme is selectively inhibited by analgesic/antipyretic drugs such as acetaminophen, phenacetin, antipyrine, and dipyrone, and is potently inhibited by some nonsteroidal antiinflammatory drugs. Thus, inhibition of COX-3 could represent a primary central mechanism by which these drugs decrease pain and possibly fever.
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Affiliation(s)
- N V Chandrasekharan
- Department of Chemistry and Biochemistry, E280 Benson Science Building, Brigham Young University, Provo, UT 84602, USA
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Abstract
The discovery of two isoforms of the cyclooxygenase enzyme, COX-1 and COX-2, and the development of COX-2-specific inhibitors as anti-inflammatories and analgesics have offered great promise that the therapeutic benefits of NSAIDs could be optimized through inhibition of COX-2, while minimizing their adverse side effect profile associated with inhibition of COX-1. While COX-2 specific inhibitors have proven to be efficacious in a variety of inflammatory conditions, exposure of large numbers of patients to these drugs in postmarketing studies have uncovered potential safety concerns that raise questions about the benefit/risk ratio of COX-2-specific NSAIDs compared to conventional NSAIDs. This article reviews the efficacy and safety profiles of COX-2-specific inhibitors, comparing them with conventional NSDAIDs.
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Souza FR, Souza VT, Ratzlaff V, Borges LP, Oliveira MR, Bonacorso HG, Zanatta N, Martins MAP, Mello CF. Hypothermic and antipyretic effects of 3-methyl- and 3-phenyl-5-hydroxy-5-trichloromethyl-4,5-dihydro-1H-pyrazole-1-carboxyamides in mice. Eur J Pharmacol 2002; 451:141-7. [PMID: 12231383 DOI: 10.1016/s0014-2999(02)02225-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effect of novel pyrazolines, 3-methyl-5-hydroxy-5-trichloromethyl-4,5-dihydro-1H-pyrazole-1-carboxyamide (MPCA) and 3-phenyl-5-hydroxy-5-trichloromethyl-4,5-dihydro-1H-pyrazole-1-carboxyamide (PPCA) on body temperature and endotoxin-induced fever was investigated in mice. The subcutaneous (s.c.) administration of 1.5 mmol/kg dipyrone, MPCA or PPCA and the intracerebroventricular (i.c.v.) administration of 225 nmol dipyrone reduced basal rectal temperature. Intracerebroventricular administration of 225 nmol MPCA or PPCA did not alter basal rectal temperature. The administration of 0.15 mmol/kg (s.c.) or 25 nmol (5 microl) dipyrone (i.c.v.), MPCA or PPCA had no effect on basal rectal temperature, but reversed lipopolysaccharide-induced fever. These results suggest that MPCA and PPCA cause antipyresis, which is similar to that caused by dipyrone, and may be useful antipyretic agents.
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Affiliation(s)
- Fabiane R Souza
- Laboratório de Neurotoxicidade, Departamento de Química, Centro de Ciências Naturais e Exatas, Campus Universitário-Camobi, Universidade Federal de Santa Maria, Santa Maria, 97105-900, RS, Brazil
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37
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Dogan MD, Ataoglu H, Akarsu ES. Effects of selective cyclooxygenase enzyme inhibitors on lipopolysaccharide-induced dual thermoregulatory changes in rats. Brain Res Bull 2002; 57:179-85. [PMID: 11849824 DOI: 10.1016/s0361-9230(01)00739-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effects of selective cyclooxygenase-1 and cyclooxygenase-2 inhibitors (valeryl salicylate and SC-58236, respectively) on Escherichia coli O111:B4 lipopolysaccharide (LPS)-induced dual thermoregulatory changes and serum tumor necrosis factor-alpha elevation were investigated in rats. LPS (50 microg/kg, intraperitoneal) produced an initial hypothermia that was then followed by fever. Serum tumor necrosis factor-alpha levels elevated at the initial phase of hypothermia. Valeryl salicylate injections (20, 40, and 80 mg/kg, subcutaneous [s.c.]) completely inhibited hypothermia without any effect on the elevated serum tumor necrosis factor-alpha levels and on the subsequent fever. On the other hand, SC-58236 injections (10, 20, and 40 mg/kg, s.c.) only partially abolished the hypothermia. SC-58236 had no effect on the initiation of fever, however completely inhibited the maintenance of fever. The serum tumor necrosis factor-alpha elevation was not reduced by SC-58236 treatment. The combination of valeryl salicylate and SC-58236 also failed to inhibit the initiation of fever. These findings suggest that cycloxygenase-1 may have a predominant role for the development of LPS-induced hypothermia, but cyclooxygenase-1 does not seem to be involved in the mediation of LPS-induced fever. Meanwhile, cyclooxgenase-2 may be critical for the late phase rather than the initiation of the fever response in rats.
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Affiliation(s)
- M Devrim Dogan
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Sihhiye 06100 Ankara, Turkey
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Matheson AJ, Figgitt DP. Rofecoxib: a review of its use in the management of osteoarthritis, acute pain and rheumatoid arthritis. Drugs 2001; 61:833-65. [PMID: 11398914 DOI: 10.2165/00003495-200161060-00019] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rofecoxib is a selective cyclo-oxygenase (COX)-2 inhibitor which has little or no effect on the COX-1 isoenzyme at doses up to 1000 mg/day. Rofecoxib has greater selectivity for COX-2 than celecoxib, meloxicam, diclofenac and indomethacin. In well-controlled clinical trials, rofecoxib 12.5 to 500 mg/day has been evaluated for its efficacy in the treatment of osteoarthritis, acute pain and rheumatoid arthritis [lower dosages (5 to 125 mg/day) were generally used in the chronic pain indications]. In the treatment of patients with osteoarthritis, rofecoxib was more effective in providing symptomatic relief than placebo, paracetamol (acetaminophen) and celecoxib and was similar in efficacy to ibuprofen, diclofenac, naproxen and nabumetone. Overall, both the physician's assessment of disease status and the patient's assessment of response to therapy tended to favour rofecoxib. In patients with postsurgical dental pain, pain after spinal fusion or orthopaedic surgery, or primary dysmenorrhoea, rofecoxib provided more rapid and more sustained pain relief and reduced requirements for supplemental morphine use after surgery than placebo. Rofecoxib was more efficacious than celecoxib in patients with acute dental pain and pain after spinal fusion surgery, although celecoxib may have been used at a subtherapeutic dose. In comparison with traditional nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen, diclofenac and naproxen sodium, rofecoxib was similar in efficacy in the treatment of acute pain. Although naproxen sodium provided more rapid pain relief than rofecoxib in patients with primary dysmenorrhoea, the reverse was true after orthopaedic surgery: rofecoxib provided more rapid pain relief and less supplemental morphine was needed. Rofecoxib was as effective as naproxen in providing symptomatic relief for over 8700 patients with rheumatoid arthritis. Compared with traditional NSAID therapy, rofecoxib had a significantly lower incidence of endoscopically confirmed gastroduodenal ulceration and, in approximately 13,000 patients with osteoarthritis and rheumatoid arthritis, a lower incidence of gastrointestinal (GI) adverse events. Rofecoxib was generally well tolerated in all indications with an overall tolerability profile similar to traditional NSAIDs. The most common adverse events in rofecoxib recipients were nausea, dizziness and headache. In conclusion, rofecoxib is at least as effective as traditional NSAID therapy in providing pain relief for both chronic and acute pain conditions. Rofecoxib provides an alternative treatment option to traditional NSAID therapy in the management of symptomatic pain relief in patients with osteoarthritis. Initial data from patients with primary dysmenorrhoea and postoperative pain are promising and further trials may confirm its place in the treatment of these indications. Rofecoxib has also shown promising results in patients with rheumatoid arthritis and is likely to become a valuable addition to current drug therapy for this patient population. Importantly, rofecoxib is associated with a lower incidence of GI adverse events than traditional NSAIDs making it a primary treatment option in patients at risk of developing GI complications or patients with chronic conditions requiring long term treatment.
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Affiliation(s)
- A J Matheson
- Adis International Limited, Mairangi Bay, Auckland, New Zealand.
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39
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Abstract
Fever is a complex physiologic response triggered by infectious or aseptic stimuli. Elevations in body temperature occur when concentrations of prostaglandin E(2) (PGE(2)) increase within certain areas of the brain. These elevations alter the firing rate of neurons that control thermoregulation in the hypothalamus. Although fever benefits the nonspecific immune response to invading microorganisms, it is also viewed as a source of discomfort and is commonly suppressed with antipyretic medication. Antipyretics such as aspirin have been widely used since the late 19th century, but the mechanisms by which they relieve fever have only been characterized in the last few decades. It is now clear that most antipyretics work by inhibiting the enzyme cyclooxygenase and reducing the levels of PGE(2) within the hypothalamus. Recently, other mechanisms of action for antipyretic drugs have been suggested, including their ability to reduce proinflammatory mediators, enhance anti-inflammatory signals at sites of injury, or boost antipyretic messages within the brain. Although the complex biologic actions of antipyretic agents are better understood, the indications for their clinical use are less clear. They may not be indicated for all febrile conditions because some paradoxically contribute to patient discomfort, interfere with accurately assessing patients receiving antimicrobials, or predispose patients to adverse effects from other medications. The development of more selective fever-relieving agents and their prudent use with attention to possible untoward consequences are important to the future quality of clinical medicine.
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Affiliation(s)
- D M Aronoff
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, 23rd Avenue at Pierce, Nashville, TN 37232-6603, USA
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40
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Nakamura H. [Cyclooxygenase (COX)-2 selective inhibitors: aspirin, a dual COX-1/COX-2 inhibitor, to COX-2 selective inhibitors]. Nihon Yakurigaku Zasshi 2001; 118:219-30. [PMID: 11577463 DOI: 10.1254/fpj.118.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aspirin was developed as a non-steroidal anti-inflammatory drug (NSAID) in 1899. During the century after that, aspirin has been found to show its anti-inflammatory, analgesic and anti-pyretic activities by reducing prostaglandins biosynthesis through inhibition of cyclooxygenase (COX); and then COX was found to be constituted of two isoforms, constitutive COX-1 and inducible COX-2. Currently, novel NSAIDs, acting through selective inhibition of COX-2, that have efficacy as excellent as aspirin with significantly lower incidence of gastrointestinal adverse effects are available in America and some other countries, but not in Japan. Physiological and pathophysiological roles of COX-1 and COX-2 have been explained from studies in experimental animals, but there are many differences in species and diseases between animals and humans. Thus, physiological and pathophysiological roles of COX-2 were considered from the standpoint of clinical effects of the two latest COX-2 selective inhibitors, celecoxib and rofecoxib, on inflammation, pain, fever and colorectal cancer together with their adverse effects on gastrointestinal, renal and platelet functions; and the usefulness and limits of COX-2-selective inhibitors were discussed with the trends of new NSAIDs development.
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Affiliation(s)
- H Nakamura
- Center of Pharmacovigilance & Regulatory Affairs, Dainippon Pharmaceutical Co., Ltd., 2-6-8 Dosho-machi, Chuo-ku, Osaka 541-0045, Japan.
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41
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Affiliation(s)
- A S Nies
- Department of Clinical Sciences, Merck Research Laboratories, Merck & Co., Inc., Rahway, New Jersey, USA
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Mazario J, Gaitan G, Herrero JF. Cyclooxygenase-1 vs. cyclooxygenase-2 inhibitors in the induction of antinociception in rodent withdrawal reflexes. Neuropharmacology 2001; 40:937-46. [PMID: 11378164 DOI: 10.1016/s0028-3908(01)00020-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Non-steroidal antiinflammatory drugs (NSAIDs) inhibit the cyclooxygenase (COX) enzyme and so they are effective analgesic, antiinflammatory and antipyretic drugs. The discovery of COX-2 led to the search for new NSAIDs with a selective action over this isoenzyme. The experiments performed to date have shown either more, less or no different efficacy of new COX-2 selective NSAIDs when compared to the non-selective inhibitors, probably because the comparison has not been performed under similar conditions. We have therefore compared the analgesic activity of six NSAIDs with different selectivity for the COX isoenzymes. The experiments were performed using the recording of spinal cord nociceptive reflexes in anaesthetised rats and in awake mice. The non-selective COX inhibitors, such as dexketoprofen trometamol, were effective in reducing nociceptive responses both in normal and monoarthritic rats (ED50s: 0.31 and 3.97 micromol/kg, respectively), and in mice with paw inflammation (12.5 micromol/kg, p < 0.01). The COX-1 selective inhibitor SC-58560 showed efficacy in normal rats (ED50: 0.8 micromol/kg) and in mice with paw inflammation (15 micromol/kg, p < 0.05), but not in monoarthritic rats. The COX-2 selective inhibitors celecoxib (105 micromol/kg) and rofecoxib (128 micromol/kg) however, were not effective in any of the groups studied. We conclude that inhibition of both COX isoenzymes is needed to achieve an effective analgesia in inflammation.
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Affiliation(s)
- J Mazario
- Departamento de Fisiología, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, Alcala de Henares 28871, Madrid, Spain
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43
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Abstract
Conventional nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). The clinical efficacy of NSAIDs is primarily related to the inhibition of COX-2 activity, whereas much of the toxicity, particularly gastrointestinal toxicity, is related to COX-1 inhibition. In vitro and in vivo assays indicate that both COX-2-specific inhibitors and conventional NSAIDs are equally effective in inhibiting COX-2, suggesting that the clinical efficacy of COX-2-specific inhibitors should be similar to that of conventional NSAIDs. Multiple studies in patients with osteoarthritis, rheumatoid arthritis, and acute pain have now confirmed that the clinical efficacy of COX-2-specific inhibitors is similar to that of conventional NSAIDs.
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Affiliation(s)
- G W Cannon
- Veterans Affairs Medical Center, and the Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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44
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Abstract
Cyclooxygenase metabolizes arachidonic acid to a family of bioactive fatty acids designated prostaglandins. Two isoforms of cyclooxygenase exist, designated COX1 and COX2. These isoforms are expressed in distinct but important areas of the kidney. COX1 predominates in vascular smooth muscle and collecting ducts, whereas COX2 predominates in the macula densa and nearby cells in the cortical thick ascending limb. COX2 is also highly expressed in medullary interstitial cells. Whereas COX1 expression does not exhibit dynamic regulation, COX2 expression is subject to regulation by several environmental conditions, including salt intake, water intake, medullary tonicity, growth factors, cytokines, and adrenal steroids. Recently, COX2-selective non-steroidal anti-inflammatory drugs have become widely available. Many of the renal effects of non-selective non-steroidal anti-inflammatory drugs (including sodium retention, decreased glomerular filtration rate, and effects on renin-angiotensin levels) appear to be mediated by the inhibition of COX2 rather than COX1. Therefore, in contrast to the gastrointestinal-sparing effects of COX2-selective non-steroidal anti-inflammatory drugs, when considering the kidney, the same caution must be applied when using COX2-selective inhibitors as has been used with traditional non-selective non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- M D Breyer
- Department of Medicine, Veterans Administration Medical Center and Vanderbilt University, Nashville, Tennessee, USA.
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Schwartz JI, De Smet M, Larson PJ, Verbesselt R, Ebel DL, Lins R, Lens S, Porras AG, Gertz BJ. Effect of rofecoxib on the pharmacokinetics of digoxin in healthy volunteers. J Clin Pharmacol 2001; 41:107-12. [PMID: 11144988 DOI: 10.1177/00912700122009755] [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: 11/16/2022]
Abstract
The authors examined the effect of the cyclooxygenase-2 (COX-2) inhibitor, rofecoxib, at steady state on the pharmacokinetics of digoxin following a single dose in healthy subjects. Each healthy subject (N = 10) received rofecoxib (75 mg once daily) or placebo for 11 days in a double-blind, randomized, balanced, two-period crossover study. A single 0.5 mg oral dose of digoxin elixir was administered on the 7th day of each 11-day period. Each treatment period was separated by 14 to 21 days. Samples for plasma and urine immunoreactive digoxin concentrations were collected through 120 hours following the digoxin dose. No statistically significant differences between treatment groups were observed for any of the calculated digoxin pharmacokinetic parameters. For digoxin AUC(0-infinity), AUC(0-24), and Cmax, the geometric mean ratios (90% confidence interval) for (rofecoxib + digoxin/placebo + digoxin) were 1.04 (0.94, 1.14), 1.02 (0.94, 1.09), and 1.00 (0.91, 1.10), respectively. The digoxin median tmax was 0.5 hours for both treatments. The harmonic mean elimination half-life was 45.7 and 43.4 hours for rofecoxib + digoxin and placebo + digoxin treatments, respectively. Digoxin is eliminated renally. The mean (SD) cumulative urinary excretion of immunoreactive digoxin after concurrent treatment with rofecoxib or placebo was 228.2 (+/- 30.8) and 235.1 (+/- 39.1) micrograms/120 hours, respectively. Transient and minor adverse events occurred with similar frequency on placebo and rofecoxib treatments, and no treatment-related pattern was apparent. Rofecoxib did not influence the plasma pharmacokinetics or renal elimination of a single oral dose of digoxin.
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Affiliation(s)
- J I Schwartz
- Merck Research Laboratories, Rahway, New Jersey, USA
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46
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Blain H, Jouzeau JY, Netter P, Jeandel C. [Non-steroidal anti-inflammatory agents with selective inhibitory activity on cyclooxygenase-2. Interest and future prospects]. Rev Med Interne 2000; 21:978-88. [PMID: 11109595 DOI: 10.1016/s0248-8663(00)00254-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the production of primary prostanoids by blocking the access of arachidonic acid to the active site of the cyclooxygenases (COXs). Because the prostanoids produced by COX-1 appear to play a physiological role (protection of the gastric mucosa, platelet aggregation, vascular homeostasis, maintenance of renal sodium-water balance) while those produced by COX-2 seem mainly to intervene in the inflammatory response and in certain processes associated with cell proliferation, the hypothesis has been put forward that the NSAIDs that are selective COX-2 inhibitors should theoretically be capable of maintaining NSAID therapeutic properties but also have fewer adverse side effects due to the maintenance of prostaglandin production at normal physiological levels. CURRENT KNOWLEDGE AND KEY POINTS The hypothesis of COX isoenzyme selectivity has led to a proposed classification for COX inhibitors: 1) COX-1 selective inhibitors (low-dosage aspirin); 2) COX non-selective inhibitors (the majority of classified NSAIDs, which when administered over the long term, e.g., in cases of rheumatoid arthritis, cause duodenal ulcers in 20% of cases and gastric hemorrhage in 1-4% of cases/year); 3) COX-2 preferential inhibitors (meloxicam and nimesulide, which have fewer gastric side effects than standard NSAIDs, but which are not risk-free at high doses); 4) COX-2 selective inhibitors (celecoxib and rofecoxib). Preliminary clinical studies have shown that COX-2 selective inhibitors are as efficient as standard NSAIDs and have fewer adverse digestive side effects, thereby confirming the interest of this proposed classification. In the UK, the aforementioned studies have led to the commercialization of rofecoxib for the treatment of pain and osteoarthritis, while celecoxib has been introduced in medical practice in the USA and other countries for the treatment of rheumatoid arthritis and osteoarthritis. FUTURE PROSPECTS AND PROJECTS Various epidemiological and laboratory studies have indicated that NSAIDs may be able to reduce the risk of cancer (colorectal cancer in particular) and Alzheimer's disease due to their inhibitory activity on COXs, especially COX-2. The therapeutic contribution of COX-2 specific inhibitors has to be more fully evaluated, particularly as these agents could delay the healing of duodenal ulcers and interfere with several COX-2-induced physiological functions. It is therefore suggested that until further information becomes available, this new class of NSAIDs should be used with caution in certain patient populations.
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Affiliation(s)
- H Blain
- Service de médecine interne C et gérontologie clinique, centre Antonin-Balmes, CHU, Montpellier, France
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47
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Simmons DL, Wagner D, Westover K. Nonsteroidal anti-inflammatory drugs, acetaminophen, cyclooxygenase 2, and fever. Clin Infect Dis 2000; 31 Suppl 5:S211-8. [PMID: 11113025 DOI: 10.1086/317517] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used antipyretic agents that most probably exert their antifever effect by inhibiting cyclooxygenase (COX)-2. Thus, COX-2-selective drugs or null mutation of the COX-2 gene reduce or prevent fever. Acetaminophen is antipyretic and analgesic, as are NSAIDs, but it lacks the anti-inflammatory and anticoagulatory properties of these drugs. This has led to the speculation that a COX variant exists that is inhibitable by acetaminophen. An acetaminophen-inhibitable enzyme is inducible in the mouse J774.2 monocyte cell line. Induction of acetaminophen-inhibitable prostaglandin E(2) synthesis parallels induction of COX-2. Thus, inhibition of pharmacologically distinct COX-2 enzyme activity by acetaminophen may be the mechanism of action of this important antipyretic drug.
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Affiliation(s)
- D L Simmons
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA.
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48
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis via the cyclooxygenase (COX) enzyme, the key to both therapeutic benefits and toxicity. COX enzyme exists in 2 isoforms, COX-1 and COX-2. COX-1 enzyme is thought to mediate "housekeeping" or homeostatic functions, and COX-2 is considered an inducible enzyme in response to injury or inflammation. COX-2 inhibitors are the "next-generation" NSAIDs that may selectively block the COX-2 isoenzyme without affecting COX-1 function. This may result in control of pain and inflammation with a lower rate of adverse effects compared with older nonselective NSAIDs. Rapidly evolving evidence suggests that COX-2 enzyme has a diverse physiologic and pathologic role. This article addresses the role of COX-2 enzyme in health and disease as well as the potential therapeutic value and safety issues related to COX-2 inhibition.
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Affiliation(s)
- N S Buttar
- Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, Minn. 55905, USA
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49
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Abstract
Fever is frequently managed outside the purview of medical professionals, and antipyretic therapy, on the whole, is generally considered safe. However, each of the drugs used in the management of fever has significant toxicities. The purpose of this review is to examine the relative safety of such agents with a focus on the nonsteroidal anti-inflammatory drugs and acetaminophen. Toxicity to the gastrointestinal, renal, and hepatic systems are considered; the comparative safety profile of acetaminophen and ibuprofen as antipyretics are highlighted; and specific recommendations to improve the safe use of these therapies are advanced.
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Affiliation(s)
- K I Plaisance
- University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
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50
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Payne R. Limitations of NSAIDs for pain management: Toxicity or lack of efficacy? THE JOURNAL OF PAIN 2000; 1:14-8. [PMID: 14622838 DOI: 10.1054/jpai.2000.16611] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of arthritis and acute and chronic pain of many etiologies, including cancer-related pain. These drugs are indicated for use as single agents in mild to moderate pain and in combination with opioid analgesics or adjuvant analgesic drugs in severe pain. NSAIDs, which nonselectively inhibit the cyclooxygenase enzymes (isoenzymes 1 and 2), pose a potentially serious risk of gastrointestinal toxicity with acute and chronic use, hematologic toxicity with acute use, and nephrotoxicity with chronic use. Patients experiencing acute and chronic pain associated with serious and even life-threatening medical illness such as cancer and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) fall into a high-risk group with respect to the use of NSAIDs. This is so because the occurrence of gastrointestinal bleeding and the masking of opportunistic infections related to the antipyretic effects of NSAIDs pose particular risk and might even cause lethal complications in patients who are neutropenic, thrombocytopenic, or otherwise immuno-compromised.
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Affiliation(s)
- R Payne
- Pain & Palliative Care Service, Department of Neurology, Memorial Sloan-Ketting Cancer Center, New York, NY 10021, USA.
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