[Retrospective analysis of the combined therapy of terazosin with chlormezanone for chronic prostatitis/chronic pelvic pain syndrome]

OBJECTIVE

To investigate the efficacy and safety of the alpha1-receptor inhibitor terazosin combined with chlormezanone in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

METHODS

A total of 168 CPPS patients, aged 20 -50 (mean 32.9) years and with the disease course of 3 months to 7 years (mean 17 months), were equally randomized into a terazosin group (n = 58), a chlormezanone group (n = 38) and a terazosin + chlormezanone (T + C) group (n = 72), and treated accordingly for 4 weeks. All the patients were scored on NIH-CPSI (National Institute of Health-Chronic Prostatitis Symptom Index) after the treatment and the therapeutic effects were compared among the three groups.

RESULTS

Of the total number of patients, 159 completed the treatment and were evaluated, including 55 of the terazosin group, 35 of the chlormezanone group and 69 of the T + C group. After the treatment, the NIH-CPSI scores of the three groups decreased from 24.05 +/- 3.02 to 16.15 +/- 3.25 (mean 7.90), from 23.43 +/- 3.58 to 17.51 +/- 3.08 (mean 5.92), and from 23.93 +/- 3.30 to 15.01 +/- 3.08 (mean 8.92), respectively, with statistically significant differences from pretreatment (P < 0.05) as well as between the combined therapy group and the other two (P < 0.05). The adverse events included postural hypotension (17.1% in the terazosin group and 15.4% in the T + C group), dysspermatism (3.4% in the terazosin group only), lassitude, fatigue and anorexia (18.5% in the chlormezanone group and 12.6% in the T + C group). Nine of the patients failed to accomplish the treatment because of adverse events, 3 (5.2%) in the terazosin group, 3 (7.9%) in the chlormezanone group and 3 (12.6%) in the T + C group.

CONCLUSION

Both terazosin and chlormezanone can relieve the symptoms in CP/CPPS patients and improve their life quality, but their combined use may produce a better efficacy than either terazosin or chlormezanone used alone.

Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial

Following introduction of the compulsory use of seat belts in cars, whiplash injuries of the cervical spine have become common in everyday practice. Current treatment approaches lead to resolution of the symptoms within a short time in most cases but cannot prevent a small proportion of patients developing persistent health problems. The effects of adjuvant treatment with laser acupuncture on the acute symptoms and the results one year after the injury were studied in this prospective, randomized, placebo-controlled single-blind study. One group of patients (n = 23) were treated with laser acupuncture (5 mW HeNe laser on 22 acupuncture points for 15 s each) plus cervical collar and a combination of paracetamol and chlormezanone; a second group (n = 22) received the same treatments but with the use of a placebo laser. The treatment was given three times per week until the patient was asymptomatic. No statistically significant advantage of the laser acupuncture treatment was found in the acute phase (mobility in all three planes, duration of pain and duration of use of a cervical collar) or the chronic phase (drug use and the incidences of chronic recurrent problems such as myofascial pain, headaches, vertigo and tinnitus).

CONCLUSION

Adjuvant laser acupuncture with a 5 mW HeNe laser and an irradiation time of 15 s appears to be ineffective in the management of whiplash injuries.

[Undesired drug effects after taking chlormezanone (Muscle Trancopal) with lethal results]

HISTORY AND CLINICAL FINDINGS

A 34-year-old woman was admitted for treatment of toxic epidermolysis of the skin and mucosa. 16 days previously she had started to take chlormezanone (Muskel Trancopal) and some other medications for pain in the shoulder and neck. On admission she had a fever of 39 degrees C and, in addition to the epidermolysis, diffuse abdominal pain on pressure and blood-streaked stool.

INVESTIGATIONS

Liver enzyme activities (GOT 979 U/I, GPT 1496 U/I, gamma GT 201 U/I) alkaline phosphatase 515 U/I), bilirubin (3.9 mg/dl) and pancreatic enzyme activities were raised. Sonography was nondiagnostic, computed tomography demonstrated only a small amount of ascites.

TREATMENT AND COURSE

The epidermolytic lesions, cholestatic hepatitis and pancreatitis markedly regressed under aseptic wound treatment, antibiotics and parenteral nutrition. Persistent blood-streaked stools and bilateral pneumonia with progressive respiratory failure developed. Despite intensive medical care the patient died after 14 days from protracted sepsis with multi-organ failure. Autopsy additionally revealed adult respiratory distress syndrome and complete loss of colonic mucosa.

CONCLUSION

The severe course of a toxic epidermal necrosis with fatal outcome is the first such case reported in Germany that very probably was caused by chlormezanone. 4 weeks after this case was reported to the German Doctors' Drug Commission, the manufacturers of the drug withdrew it from the market.

Chlormezanone in primary fibromyalgia syndrome: a double blind placebo controlled study

Primary fibromyalgia syndrome (PFS) is a common condition that often proves resistant to health interventions. Chlormezanone combines corrective effects on disturbed sleep with muscle-relaxant properties, and therefore could be of potential benefit in PFS. Forty-two female patients with PFS (mean age 49, range 24-72 years) were randomly and blindly allocated either chlormezanone 400 mg nocte or placebo. Patients were assessed by single observer at 0, 3 and 6 weeks of treatment; assessments included sleep quality, inactivity and morning stiffness, morning alertness, tender point score, mood change and global opinion (patient and observer). No beneficial therapeutic effect could be attributed to chlormezanone. Although there are problems in assessing severity of a predominantly subjective condition, this essentially negative finding is of interest in respect to the pathogenesis of PFS.

Recurrent tension headache in adolescents treated with self-help relaxation training and a muscle relaxant drug

Forty-eight adolescents suffering from recurrent tension headache participated in a controlled trial conducted in a high school setting. During the first treatment phase self-help relaxation training was compared with a waiting-list group. Following this phase a pharmacological regimen consisting of a muscle relaxant (chlormezanone) and placebo was superimposed on relaxation therapy in a double-blind crossover design. Each treatment phase encompassed a 5-week period. In addition to the evaluation of headache complaints, psychological distress among students was measured with respect to their experience of somatic complaints, depressive, anxiety and stress symptoms. Although self-help relaxation training significantly decreased the severity and annoyance of adolescents' headache besides their somatic complaints, the clinical improvement of headache was modest. The addition of chlormezanone did not help those who were nonresponders to self-help relaxation training. Finally, a set of pretreatment variables consisting of baseline headache severity and annoyance, experience of anxiety and daily life stress among adolescents could predict outcome of self-help relaxation therapy.

[Effectiveness of chlormezanone and flunitrazepam in treatment of difficult children]

Out of a total of 366 preschoolers, aged 3-5 years old, from the urban area of Curacautín, a sample of 46 children is selected using a behavioral classification to choose those children difficult to manage. A double-blind type investigation is realized using a posology of the drugs: Chlormezanone and Flunitrazepam as well as a placebo. The distribution of the doses is in accordance with the so called "Latin Table". The results obtained indicate that both drugs are effective, with a 90.6% success rate case of Chlormezanone and 92.8% effectiveness in the case of Flunitrazepam. In terms of the placebo, the success rate was 15% with a higher rate in the third medication, possibly due to better psychological predisposition on the child's part.

Toxic epidermal necrolysis with extensive mucosal erosions of the gastrointestinal and respiratory tracts

Toxic epidermal necrolysis with epidermal shedding over almost the entire body occurred in a patient with classical rheumatoid arthritis treated with sulindac, penicillamine and a combination analgesic containing paracetamol and chlormezanone. Erosions in the lower respiratory tract and the intestine contributed to a lethal outcome of the disease and showed a microscopical picture similar to that of the skin involved. The histopathological picture of these extracutaneous lesions have been only briefly reported previously.

[Drug-induced hepatitis with cholestasis following therapy with chlormezanone]

The history of a 46 years old female patient is reported who suffered from rheumatoid arthritis. During therapy with chlormezanon and paracetamol symptoms of cholestatic liver disease developed. We believe that this was a side-effect of chlormezanon.

Treatment of sleep disturbance in arthritis with chlormezanone

A double-blind, crossover study was carried out in 31 patients with rheumatoid arthritis or osteoarthritis who suffered from insomnia which was considered to be caused primarily by their disease. Patients received 7-day courses of 400 mg chlormezanone, 200 mg chlormezanone and placebo in a pre-determined random order. Patients rated chlormezanone significantly (p less than 0.025) more effective than placebo in overcoming sleep disturbance and preferred the 400 mg dose. There was also a trend towards better quality of sleep with chlormezanone, although this did not attain statistical significance in this relatively small study. Daytime alertness was similar for both active and placebo treatment periods. Chlormezanone, therefore, would seem to be a useful addition to antirheumatic therapy when there is related insomnia.

Hypnotics and hangovers: a pilot study of chlormezanone in general practice

Ten patients were included in this pilot study of chlormezanone, assessing its effects on duration and quantity of sleep and daytime performance using a pursuit rotor and a digit symbol test. Comparisons of the sleep assessments favoured chlormezanone, although the differences were not statistically significant. There was no evidence of any reduction in daytime performance after chlormezanone. The comparison of chlormezanone and placebo on the pursuit rotor test and the visual analogue assessment of hangover both slightly favoured the drug, but there were no significant differences. The study has demonstrated that it is feasible to evaluate hypnotic drugs more exactly in general practice.

Chlormezanone in the treatment of migraine attacks: a double blind comparison with diazepam and placebo

One hundred and fifty patients treated for an acute migraine attack all received a standard regimen consisting of metoclopramide 10 mg i.m. and--20 min later--paracetamol 1 g orally. Simultaneous trial medication was given. This consisted of placebo, diazepam 5 mg as tablets, or chlormezanone 400 mg as capsules given in a double dummy fashion. A successful treatment result was defined as a decrease of two or three steps on a four-point verbal pain report scale, and no need for further treatment. Patients with severe pain (all three treatment groups together) showed significantly better treatment results (p less than 0.001) than patients with pain of medium severity. In the group with severe pain there was no significant difference between diazepam, chlormezanone or placebo. In the group with pain of medium severity there was a significant (p less than 0.01) effect of chlormezanone, but no significant effect of diazepam. Chlormezanone may possibly be a valuable addition to antiemetic and analgesic therapy of migraine attacks.

Four-week tolerance study of chlormezanone for the treatment of insomnia in the elderly

A 4-week study of chlormezanone was carried out in thirty-two patients admitted to a geriatric ward and requiring regular night sedation. Two patients required 400 mg nightly, the remainder only 200 mg nightly. The duration and quality of sleep, and frequency of awaking refreshed, all improved during chlormezanone therapy. There was no deterioration in mental agility test performance. There were no serious side-effects, no significant changes in blood urea or liver function tests, and no evidence of drug accumulation. It is concluded that chlormezanone appears to be a well tolerated drug for elderly patients with sleep disturbance meriting further controlled evaluation.

Successful treatment of anxiety with a single night-time dose of chlormezanone: double-blind comparison with diazepam

A multi-centre, double-blind trial was carried out in general practice in 44 patients with symptoms of neurotic anxiety to compare the effects of treatment with either 400 mg chlormezanone at night or 5 mg diazepam 3-times daily for 4 weeks. The results indicated tht there were similar improvements in anxiety, duration and quality of sleep, and frequency of waking refreshed with both drugs. There was no significant difference in overall effectiveness of the treatments, as rated by both the patients and physicians. It is suggested, therefore, that chlormezanone could serve as a substitute for the benzodiazepine with the advantage of only once-daily dosage.

Two-dose comparison of chlormezanone in sleep disturbance due to anxiety

A double-blind, crossover, multi-centre study was carried out in general practice on 76 patients with mild neurotic anxiety and associated sleep disturbance to compare the effectiveness of chlormezanone given as a single night-time dose of 200 mg or 400 mg, each given for a period of 1 week. There was a significant improvement in the quality and duration of sleep with both dosages, and this was significantly greater with the higher dose. Both doses produced a similarly significant improvement in the frequency of awakening refreshed, and reduction in anxiety rating. The higher dose was considered overall more effective, and significantly more patients preferred it.

A comparison of chlormezanone and temazepam in sleep disturbance

Fifty-five patients complaining of insomnia entered a single-blind general practice study and were treated with either 400 mg chlormezanone or 20 mg temazepam at night for 2 weeks. There was a significant increase from baseline for both treatments in average duration of sleep, quality of sleep and frequency of waking refreshed. There was no significant difference between the treatments, with overall effectiveness rated similarly. It is concluded that chlormezanone is at least as useful as temazepam in treating insomnia.

The treatment of anxiety states by drugs and other means

The place of pharmacotherapy, behaviour therapy and biofeedback techniques in the general strategy of treating anxiety states is critically discussed. The dangers and disadvantages of barbiturates are described and the value and limitations of other drugs are considered. Beta-adrenergic receptor blocking drugs have a limited but valuable role in some patients, neuroleptics have a strictly limited place in treatment, and the role of antidepressants of various kinds is considered when anxiety is part of a depressive illness. The benzodiazepines are the most important group of drugs available for the treatment of anxiety states. The differences between various benzodiazepines are presented, with particular reference to their onset of action, half-life and the relevance of active metabolites of some of these drugs. A knowledge of the pharmacokinetics of the benzodiazepine drugs is of practical importance to the clinician. Emphasis is placed on the doctor-patient relationship and psychotherpeutic management in which drugs and other treatment serve as tactical aids in the general strategy of care.

Chlormezanone in the treatment of insomnia due to rheumatic stiffness

An open assessment of chlormezanone in the treatment of rheumatic sleep disturbances was carried out in general practice. Sixty-one patients received 400 mg chlormezanone (2 tablets) each night for 2 weeks. Patients' nightly sleep assessment showed a steady improvement over the 2-week period, and overall effectiveness was rated as good or excellent by 75% of patients. Only 1 patient stopped treatment because of side-effects. It was concluded that chlormezanone could prove a useful alternative to current therapy for treatment sleeplessness in rheumatic patients.

Treatment of anxiety-related insomnia with chlormezanone

Twenty-nine patients seen in general practice suffering from sleep disturbance due to mild neurotic anxiety were treated with 400 mg chlormezanone per night for 2 weeks. Patients' and doctors' assessments of quality of sleep and Hamilton anxiety rating scores were carried out initially and after 1 and 2 weeks. Patients also completed a daily record card assessing their sleep. The results suggest that chlormezanone produced prompt improvement within 2 nights of the start of treatment, and by the end of the study period only 2 (7%) patients still reported their sleep as being poor compared with 80% initially, and 19 (66%) rated their sleep as good or excellent. There was a steady reduction in anxiety rating scores throughout treatment. Only 1 patient reported a transient mild side-effect.

A controlled study of Trancopal in sleep disturbances due to rheumatic disease

A placebo controlled, double-blind study was carried out in six centres in general practice to assess the effectiveness of Trancopal in treating sleep disturbances due to rheumatic disorders. Eighty-five patients received a usual dose of two tablets of Trancopal or matching placebo at night for two weeks. Patients were assessed weekly and kept a daily record of the quality of sleep. All ratings showed that patients slept significantly better on Trancopal than on placebo. Day-time rheumatic stiffness however was not significantly reduced. Six patients receiving Trancopal reported side-effects chiefly drowsiness (five patients) which was controlled by dose reduction. It was concluded that for rheumatic patients Trancopal offers an acceptable alternative to current hypnotics over which it may prove to have some advantages, particularly for the elderly.

A controlled study of Trancopal in the treatment of sleep disturbances due to anxiety

Sixty-eight patients presenting with sleep disturbances due to mild neurotic anxiety were treated for two weeks with a single night-time dose of 400 mg trancopal or matching placebo under double-blind conditions. Patients kept a daily record of the quality of their sleep and the observer carried out a weekly rating of anxiety using a modified Hamilton scale. By Day 7 patients receiving Trancopal had a significantly better rating for sleep and mean Hamilton scores for day-time anxiety than the placebo group. Side-effects were minimal. It was concluded that for patients with sleep disturbances due to neurotic anxiety Trancopal is a well tolerated and effective alternative to the hypnotics.

A controlled study comparing a three times daily dose of chlordiazepoxide with a single night-time dose of Trancopal in the control of anxiety, using a double-blind, double-dummy technique

A double-blind, double-dummy between-patient study in general practice was carried out to compare the effectiveness of a single, night-time dosage of Trancopal and a three times daily dose of chlordiazepoxide in controlling neurotic anxiety. Ninety-three patients received either 400 mg of Trancopal at night and a chlordiazepoxide placebo capsule three times daily or 10 mg of chlordiazepoxide three times daily and one or two Trancopal placebo tablets at night. Each was treated for four weeks. Three assessments were made using a physicians' rating scale (modified Hamilton Scale). A visual analogue scale was completed by patients initially and at weekly intervals and physicians' and patients' global assessments were made at Weeks 2 and 4.

Each treatment group improved considerably over the period of the study both for sleep and anxiety ratings. A statistically significant correlation was found between improvement in day-time fatigue and loss of energy and improvement in sleep disturbance only in the Trancopal group. Loss of concentration was analyzed separately in patients over 40 years old and there was a significant improvement in the physicians' rating in the Trancopal group.

There was a very close correlation throughout between the physician's and patient's own assessment of improvement. Few side-effects not already reported at the start of the trial were reported on either treatment. It was concluded that Trancopal at a usual dosage of 400 mg at night offers an effective alternative to a divided dose of chlordiazepoxide. Not only is the beneficial effect on symptoms of anxiety similar but there is some suggestion of a greater improvement in sleep and less interference with day-time functioning.

[Gustatory disturbances as sideeffect of medical treatment (author's transl)]

A review of the pharmacological induced taste disorders is given. Many patients complain only of a spontaneous metallic, bitter or salty sensation in their mouths. More serious is the development of a dissociated hypogeusia or even an ageusia. 7 cases with gustatory disturbances caused by orally given medicine are presented. The phenylbutazone, oxyphedrine, carbamazepine, Muskel-Trancopal comp. (Chlormezanon, Paracetamol) and Lioresal (baclofen) were accused to have caused a partial or complete loss of taste. After the treatment had been discontinued it took weeks or even months for a complete recovery.

[Muscle relaxants in the treatment of idiopathic trigeminal neuralgia (author's transl)]

In 195 patients with idiopathic trigeminal neuralgias, atypical facial neuralgia or zoster neuralgia in the face it was shown that, in the initial stages of these diseases, the efficacy of the always satisfactory medicinal treatment with an anticonvulsant (hydantoin or carbamezathine) can be increased by combination with a muscle relaxant (especially chlormezanone). Medicinal therapy is then still frequently possible without side effects and operative treatment (Frazier-Spiller's retrogasserian neurotomy) can be postponed.

A controlled clinical trial of chlormezanone, orphenadrine, orphenadrine/paracetamol and placebo in the treatment of painful skeletal muscle spasms

Four hundred patients with painful muscle spasm caused by five common musculoskeletal diseases were included in a double-blind controlled trial of chlormezanone, orphenadrine, orphenadrine/paracetomol and placebo. Patients were treated for one week and then asked for their subjective assessment of the treatment. Fifty-three per cent improved on placebo, 57 percent on chlormezanone, 66 percent on orphenadrine and 71 percent on orphenadrine/paracetamol. There was no significant difference between chlormezanone and placebo, but orphenadrine appeared to have a beneficial effect, presumably because of its muscle relaxant activity.