|
|
|
Thank you for entrusting in the compounding services at MD Custom Rx to help meet the unique medication needs of your patients. We are excited to share with you our monthly newsletter and look forward to continuing to be your medication problem solvers. Please don't ever hesitate to let us know how we can be of further assistance to you and your practice.
Sincerely,
John, Dan and Monica |
Topical Amitriptyline and Ketamine for Neuropathic Pain
Efficacy of different agents for peripheral neuropathic pain conditions is less than optimal. The administration of topical analgesics might be an option, due to the potential for reduced adverse effects and increased patient compliance. Topical analgesics have the potential to be a valuable additional approach for the management of peripheral neuropathic pain. Topical amitriptyline-ketamine combination (AK) is a promising agent for peripheral neuropathic pain conditions. Efficacy may depend on many factors, including the choice of vehicle, method of compounding, concentration, site of pain, and specific diseases.
|
|
Evaluation of Analgesic Activities of Compounded Topical Creams and Voltaren® Gel in Chronic Non-cancer Pain
Pharmacologic treatment of chronic pain is challenging. Oral therapy may require multiple medications; each has side effects, dose limitations, and limited efficacy. Compounded topical formulations have evolved as potential treatment options. The objective of a study conducted at the American Institute of Therapeutics, Lake Bluff, IL, was to evaluate the efficacy of 2 compounded topical creams, "Cream I" and "Cream II," in patients with chronic extremity, joint, musculoskeletal, neuropathic, or other chronic pain conditions and compare their efficacy with Voltaren® gel. The primary efficacy outcome was the change in visual numeric pain intensity score from pretreatment to posttreatment. Cream I contained flurbiprofen 20%, tramadol 5%, clonidine 0.2%, cyclobenzaprine 4%, and bupivacaine 3%. Cream II contained flurbiprofen 20%, baclofen 2%, clonidine 0.2%, gabapentin 10%, and lidocaine 5%. The Voltaren® gel contained 1% diclofenac sodium. A total of 2177 patients were evaluated, 826 males and 1351 females. During their medical treatment, 1141 patients received Cream I, 527 patients received Cream II, and 509 patients received Voltaren® gel. After treatment, the pain intensity score decreased by 37% with Cream I, by 35% with Cream II, and by 19% with Voltaren® gel. Cream I and Cream II did not differ significantly in efficacy, and both were significantly more effective than Voltaren® gel. |
|
Topical Clonidine for Neuropathic Pain
Clonidine is a presynaptic alpha-2-adrenergic receptor agonist used for many years to treat hypertension and other conditions, including chronic pain. Adverse events associated with systemic use of the drug have limited its application. Topical use of drugs is currently gaining interest, as it may limit adverse events without loss of analgesic efficacy. Topical clonidine (TC) formulations have been investigated recently in clinical trials.
Two randomized, double-blind studies of at least two weeks' duration with a total of 344 participants compared topical clonidine 0.1% versus placebo or other active treatment in patients with chronic neuropathic pain. One drug manufacturer supported both studies. TC was applied in gel form to the painful area two to three times daily. Evidence indicated slight improvement after the drug was used in study participants with painful diabetic neuropathy (PDN). A greater number of participants in the TC group had at least 30% reduction in pain compared with placebo. The rate of adverse events did not differ between groups.
Limited evidence from a small number of studies of moderate to low quality suggests that TC may provide some benefit in peripheral diabetic neuropathy. The drug may be useful in situations for which no better treatment options are available because of lack of efficacy, contraindications or adverse events.
|
|
Topical Tranexamic Acid After Reduction Mammoplasty:
a model to assess reduction of postoperative bleeding
The anti-fibrinolytic drug tranexamic acid is currently being rediscovered for both trauma and major surgery. When fibrinolysis exceeds coagulation, unwanted surgical bleeding may occur despite adequate hemostasis. Tranexamic acid is the most commonly used medication to prevent fibrinolysis. It acts by blocking the lysine-binding sites on plasminogen, thereby preventing the activation of plasminogen to plasmin. Tranexamic acid can be administered orally or intravenously, but topical use is increasingly reported. Intravenous administration reduces the need for blood transfusion and postoperative bleeding by about one-third, but routine administration in surgery is not yet advocated owing to concerns regarding thromboembolic events. The aim of this study was to investigate whether topical application of tranexamic acid to a wound surface reduces postoperative bleeding.
Topical application of tranexamic acid provides a high drug concentration at the site of the wound and a low systemic concentration. Studies from cardiac and orthopedic surgery have shown an equal or superior effect of topical compared with intravenous tranexamic acid on both bleeding and transfusion requirement. Topical treatment is cost-effective, and adverse effects drug interactions have not been reported.
Whereas most topical hemostatic agents can cover only a small surface area, tranexamic acid diluted in saline can moisten large areas, such as after massive weight loss surgery, or in patients with burns. The aim of a randomized double-blind placebo-controlled trial on 30 consecutive women undergoing bilateral reduction mammoplasty was to investigate whether moistening a wound surface with tranexamic acid reduces bleeding. On one side the wound surfaces were moistened with 25 mg/ml tranexamic acid before closure, and placebo (saline) was used on the other side. Drain fluid production was measured for 24 hours after surgery, and pain was measured after 3 and 24 hours. Postoperative complications including infection, seroma, re-bleeding and suture reactions were recorded. Bilateral reduction mammoplasty provides two almost identical wounds in an ordinary clinical setting where effects of intervention on one breast can be evaluated by comparison with the other. A small study can thus provide adequate statistical power. Topical application of diluted tranexamic acid solution reduced bleeding in this model. Adverse effects were not observed. There were no significant differences in postoperative pain scores or complications.
Topical application of tranexamic acid significantly reduced wound drainage after reduction mammoplasty. Drain production was 39% lower during the first 24 hours in breasts treated topically with tranexamic acid 2.5% solution, compared with breasts treated with placebo.
Your questions are welcome. We work together with physicians and their patients to improve outcomes.
|
|
|
|
|
