Matching articles for "pain"

Intravenous Acetaminophen/Ibuprofen (Combogesic IV)

   
The Medical Letter on Drugs and Therapeutics • April 29, 2024;  (Issue 1701)
The FDA has approved Combogesic IV (Hikma), an IV solution containing acetaminophen and ibuprofen, to treat mild to moderate pain (alone) or moderate to severe pain (in combination with an opioid) in...
The FDA has approved Combogesic IV (Hikma), an IV solution containing acetaminophen and ibuprofen, to treat mild to moderate pain (alone) or moderate to severe pain (in combination with an opioid) in adults when IV analgesia is considered clinically necessary. Single-drug IV solutions containing ibuprofen (Caldolor) and acetaminophen have been available in the US for years.
Med Lett Drugs Ther. 2024 Apr 29;66(1701):68-9 | Show Full IntroductionHide Full Introduction

Opioids for Pain

   
The Medical Letter on Drugs and Therapeutics • December 12, 2022;  (Issue 1665)
A new CDC guideline for prescribing opioids for pain recently became available. Nonopioid drugs for pain were reviewed in a previous...
A new CDC guideline for prescribing opioids for pain recently became available. Nonopioid drugs for pain were reviewed in a previous issue.
Med Lett Drugs Ther. 2022 Dec 12;64(1665):193-200 | Show Full IntroductionHide Full Introduction

Comparison Table: Some Oral/Transdermal Opioid Analgesics (online only)

   
The Medical Letter on Drugs and Therapeutics • December 12, 2022;  (Issue 1665)
...
View the Comparison Table: Some Oral/Transdermal Opioid Analgesics
Med Lett Drugs Ther. 2022 Dec 12;64(1665):e199-202 | Show Full IntroductionHide Full Introduction

Tramadol/Celecoxib (Seglentis) for Pain

   
The Medical Letter on Drugs and Therapeutics • April 18, 2022;  (Issue 1648)
The FDA has approved Seglentis (Esteve/Kowa), an oral combination of tramadol hydrochloride, a weak opioid agonist and weak serotonin and norepinephrine reuptake inhibitor (SNRI), and celecoxib, a...
The FDA has approved Seglentis (Esteve/Kowa), an oral combination of tramadol hydrochloride, a weak opioid agonist and weak serotonin and norepinephrine reuptake inhibitor (SNRI), and celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), for use in adults with acute pain that is severe enough to require an opioid and for which alternative treatment options are inadequate.
Med Lett Drugs Ther. 2022 Apr 18;64(1648):58-60 | Show Full IntroductionHide Full Introduction

Comparison Table: Some Nonopioid Analgesics for Pain (online only)

   
The Medical Letter on Drugs and Therapeutics • March 7, 2022;  (Issue 1645)
...
View the Comparison Table: Some Nonopioid Analgesics for Pain
Med Lett Drugs Ther. 2022 Mar 7;64(1645):e40-3 | Show Full IntroductionHide Full Introduction

Nonopioid Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • March 7, 2022;  (Issue 1645)
Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. For severe pain, especially severe chronic cancer pain, use of opioids may be necessary....
Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. For severe pain, especially severe chronic cancer pain, use of opioids may be necessary. Noninvasive nonpharmacologic treatments, including physical and psychological therapies, have been shown to improve pain and function in patients with some common chronic pain conditions and are unlikely to cause serious harms. A multimodal approach to analgesic therapy can increase pain control while reducing opioid use and adverse effects.
Med Lett Drugs Ther. 2022 Mar 7;64(1645):33-40 | Show Full IntroductionHide Full Introduction

Atogepant (Qulipta) for Migraine Prevention

   
The Medical Letter on Drugs and Therapeutics • November 1, 2021;  (Issue 1636)
Atogepant (Qulipta – Abbvie), an oral small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ("gepant"), has been approved by the FDA for prevention of episodic migraine in adults....
Atogepant (Qulipta – Abbvie), an oral small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ("gepant"), has been approved by the FDA for prevention of episodic migraine in adults. It is the second oral CGRP receptor antagonist to be approved in the US for this indication; the first was rimegepant (Nurtec ODT), which is also approved for acute treatment of migraine. Parenteral CGRP monoclonal antibodies are approved for prevention of migraine (see Table 3).
Med Lett Drugs Ther. 2021 Nov 1;63(1636):169-71 | Show Full IntroductionHide Full Introduction

Tramadol Oral Solution (Qdolo) for Pain

   
The Medical Letter on Drugs and Therapeutics • May 31, 2021;  (Issue 1625)
The opioid agonist tramadol is now available in an oral solution (Qdolo – Athena Bioscience) for management of pain severe enough to require an opioid and for which alternative treatment options are...
The opioid agonist tramadol is now available in an oral solution (Qdolo – Athena Bioscience) for management of pain severe enough to require an opioid and for which alternative treatment options are inadequate. Tramadol has been available for years in immediate-release tablets and capsules, extended-release capsules (Ultram, and others), and in a fixed-dose combination tablet with acetaminophen (Ultracet, and generics).
Med Lett Drugs Ther. 2021 May 31;63(1625):83-4 | Show Full IntroductionHide Full Introduction

Oliceridine (Olinvyk) - A New Opioid for Severe Pain

   
The Medical Letter on Drugs and Therapeutics • March 8, 2021;  (Issue 1619)
Oliceridine (Olinvyk - Trevena), an IV opioid agonist, has been approved by the FDA for management of acute pain severe enough to require an opioid and for which alternative treatment options are...
Oliceridine (Olinvyk - Trevena), an IV opioid agonist, has been approved by the FDA for management of acute pain severe enough to require an opioid and for which alternative treatment options are inadequate.
Med Lett Drugs Ther. 2021 Mar 8;63(1619):37-9 | Show Full IntroductionHide Full Introduction

Orphengesic Forte - An Old Analgesic Combination Returns

   
The Medical Letter on Drugs and Therapeutics • November 16, 2020;  (Issue 1611)
A fixed-dose combination of orphenadrine citrate, aspirin, and caffeine (Orphengesic Forte – Galt; previously available as Norgesic Forte) has been approved as a prescription drug by the FDA for treatment...
A fixed-dose combination of orphenadrine citrate, aspirin, and caffeine (Orphengesic Forte – Galt; previously available as Norgesic Forte) has been approved as a prescription drug by the FDA for treatment of mild to moderate pain caused by acute musculoskeletal disorders. Single-ingredient generic orphenadrine citrate is available by prescription in oral and injectable formulations and has been used for years as an adjunct for treatment of acute musculoskeletal pain. Orphengesic Forte is being marketed as a non-opioid alternative for pain relief.
Med Lett Drugs Ther. 2020 Nov 16;62(1611):180-1 | Show Full IntroductionHide Full Introduction

IV Meloxicam (Anjeso) for Pain

   
The Medical Letter on Drugs and Therapeutics • June 29, 2020;  (Issue 1601)
The FDA has approved Anjeso (Baudax Bio), an IV formulation of the nonsteroidal anti-inflammatory drug (NSAID) meloxicam, for once-daily treatment of moderate to severe pain in adults. Oral...
The FDA has approved Anjeso (Baudax Bio), an IV formulation of the nonsteroidal anti-inflammatory drug (NSAID) meloxicam, for once-daily treatment of moderate to severe pain in adults. Oral meloxicam (Mobic, and others), which is only indicated for treatment of chronic pain associated with osteoarthritis or rheumatoid arthritis, has been available for 20 years. IV formulations of ketorolac, ibuprofen (Caldolor), and acetaminophen (Ofirmev) are also available for treatment of pain.
Med Lett Drugs Ther. 2020 Jun 29;62(1601):100-2 | Show Full IntroductionHide Full Introduction

Cannabis and Cannabinoids

   
The Medical Letter on Drugs and Therapeutics • November 18, 2019;  (Issue 1585)
Cannabis (marijuana) contains more than 60 pharmacologically active cannabinoids; delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best known. THC is the main psychoactive constituent of...
Cannabis (marijuana) contains more than 60 pharmacologically active cannabinoids; delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best known. THC is the main psychoactive constituent of cannabis. CBD, unlike THC, does not produce intoxication or euphoria.
Med Lett Drugs Ther. 2019 Nov 18;61(1585):179-82 | Show Full IntroductionHide Full Introduction

Benzhydrocodone/Acetaminophen (Apadaz) for Pain

   
The Medical Letter on Drugs and Therapeutics • July 15, 2019;  (Issue 1576)
The FDA has approved Apadaz (KemPharm), a short-acting, fixed-dose combination of benzhydrocodone and acetaminophen, for short-term management (≤14 days) of acute pain severe enough to require an opioid...
The FDA has approved Apadaz (KemPharm), a short-acting, fixed-dose combination of benzhydrocodone and acetaminophen, for short-term management (≤14 days) of acute pain severe enough to require an opioid and for which alternative treatment options are inadequate. Benzhydrocodone is a prodrug of hydrocodone. Fixed-dose combinations of short-acting hydrocodone and acetaminophen or ibuprofen have been available for years and are the most abused opioid products in the US. Apadaz was developed under the presumption that inclusion of the inactive prodrug would reduce the potential for abuse of the combination by non-oral routes such as smoking, snorting, or injection, but the FDA did not approve Apadaz as an abuse-deterrent formulation.
Med Lett Drugs Ther. 2019 Jul 15;61(1576):110-2 | Show Full IntroductionHide Full Introduction

Roxybond - An Abuse-Deterrent Formulation of Short-Acting Oxycodone

   
The Medical Letter on Drugs and Therapeutics • September 10, 2018;  (Issue 1555)
The FDA has approved Roxybond (Daiichi Sankyo), an short-acting (SA) oxycodone formulation with abuse-deterrent properties, for treatment of pain requiring management with an opioid. Roxybond is the first...
The FDA has approved Roxybond (Daiichi Sankyo), an short-acting (SA) oxycodone formulation with abuse-deterrent properties, for treatment of pain requiring management with an opioid. Roxybond is the first SA opioid to be approved as an abuse-deterrent product. Oxaydo, another IR oxycodone formulation, has properties that discourage its intranasal and intravenous use, but is not considered an abuse-deterrent product by the FDA. Use of opioids for treatment of pain was reviewed in a recent issue.
Med Lett Drugs Ther. 2018 Sep 10;60(1555):145-6 | Show Full IntroductionHide Full Introduction

Opioids for Pain

   
The Medical Letter on Drugs and Therapeutics • April 9, 2018;  (Issue 1544)
Use of nonopioid drugs for pain was reviewed in a previous issue. For many types of moderate to severe acute pain, acetaminophen and/or an NSAID may be as effective as an opioid. Immediate-release formulations...
Use of nonopioid drugs for pain was reviewed in a previous issue. For many types of moderate to severe acute pain, acetaminophen and/or an NSAID may be as effective as an opioid. Immediate-release formulations of full opioid agonists should generally be used for acute pain that is severe enough to require treatment with an opioid. Use of extended-release or long-acting opioid formulations initially and treatment durations >1 week have been associated with an increased risk of unintended long-term use.
Med Lett Drugs Ther. 2018 Apr 9;60(1544):57-64 | Show Full IntroductionHide Full Introduction

Comparison Table: Some Oral/Topical Opioid Analgesics (online only)

   
The Medical Letter on Drugs and Therapeutics • April 9, 2018;  (Issue 1544)
...
View the Comparison Table: Some Oral/Topical Opioid Analgesics
Med Lett Drugs Ther. 2018 Apr 9;60(1544):e64-7 | Show Full IntroductionHide Full Introduction

Nonopioid Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • February 12, 2018;  (Issue 1540)
Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. Use of opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many nociceptive and neuropathic pain conditions. Use of opioids for pain will be reviewed in a future issue.
Med Lett Drugs Ther. 2018 Feb 12;60(1540):24-32 | Show Full IntroductionHide Full Introduction

Comparison Table: Some Nonopioid Analgesics for Pain (online only)

   
The Medical Letter on Drugs and Therapeutics • February 12, 2018;  (Issue 1540)
...
View the Comparison Table: Some Nonopioid Analgesics for Pain
Med Lett Drugs Ther. 2018 Feb 12;60(1540):e32-5 | Show Full IntroductionHide Full Introduction

Drugs for Epilepsy

   
The Medical Letter on Drugs and Therapeutics • July 31, 2017;  (Issue 1526)
Treatment of epilepsy should begin with a single antiepileptic drug (AED), increasing its dosage gradually until seizures are controlled or adverse effects become intolerable. If seizures...
Treatment of epilepsy should begin with a single antiepileptic drug (AED), increasing its dosage gradually until seizures are controlled or adverse effects become intolerable. If seizures persist, specialists generally recommend trying at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs concurrently. When used for the appropriate seizure type, AEDs are roughly equivalent in efficacy. Drug choice is usually based on factors such as ease of use, adverse effects, drug interactions, presence of comorbidities, and cost.
Med Lett Drugs Ther. 2017 Jul 31;59(1526):121-30 | Show Full IntroductionHide Full Introduction

FDA Warns Against Use of Codeine and Tramadol in Children and Breastfeeding Women

   
The Medical Letter on Drugs and Therapeutics • May 22, 2017;  (Issue 1521)
The FDA has issued new warnings about the use of the opioid analgesics codeine and tramadol in children, particularly those...
The FDA has issued new warnings about the use of the opioid analgesics codeine and tramadol in children, particularly those <12 years old, and in breastfeeding women due to concerns about the risk of respiratory depression and death. The FDA previously issued warnings about these drugs in 2013 and 2015.
Med Lett Drugs Ther. 2017 May 22;59(1521):86-8 | Show Full IntroductionHide Full Introduction

Celecoxib Safety Revisited

   
The Medical Letter on Drugs and Therapeutics • December 19, 2016;  (Issue 1510)
The results of a clinical trial (PRECISION) comparing the cardiovascular safety of the COX-2 selective NSAID celecoxib (Celebrex, and generics) with that of ibuprofen and naproxen, which are...
The results of a clinical trial (PRECISION) comparing the cardiovascular safety of the COX-2 selective NSAID celecoxib (Celebrex, and generics) with that of ibuprofen and naproxen, which are nonselective, have been described in the lay press in terms that may overestimate the safety of celecoxib.
Med Lett Drugs Ther. 2016 Dec 19;58(1510):159 | Show Full IntroductionHide Full Introduction

A New Abuse-Deterrent Opioid - Xtampza ER

   
The Medical Letter on Drugs and Therapeutics • June 20, 2016;  (Issue 1497)
The FDA has approved Xtampza ER (Collegium), a new extended-release, abuse-deterrent capsule formulation of oxycodone, for management of pain severe enough to require daily, around-the-clock, long-term...
The FDA has approved Xtampza ER (Collegium), a new extended-release, abuse-deterrent capsule formulation of oxycodone, for management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Med Lett Drugs Ther. 2016 Jun 20;58(1497):77-8 | Show Full IntroductionHide Full Introduction

Buprenorphine Buccal Film (Belbuca) for Chronic Pain

   
The Medical Letter on Drugs and Therapeutics • April 11, 2016;  (Issue 1492)
Belbuca (Endo), a buccal formulation of the partial opioid agonist buprenorphine, has been approved by the FDA for management of pain severe enough to require daily, around-the-clock, long-term opioid...
Belbuca (Endo), a buccal formulation of the partial opioid agonist buprenorphine, has been approved by the FDA for management of pain severe enough to require daily, around-the-clock, long-term opioid treatment. Buprenorphine is also available as a transdermal patch (Butrans) and in a parenteral formulation (Buprenex, and generics) for treatment of pain. A sublingual formulation of buprenorphine and buccal and sublingual formulations containing buprenorphine and the opioid antagonist naloxone are approved for use as alternatives to methadone for treatment of opioid dependence.
Med Lett Drugs Ther. 2016 Apr 11;58(1492):47-8 | Show Full IntroductionHide Full Introduction

Low-Dose Meloxicam (Vivlodex) for Osteoarthritis Pain

   
The Medical Letter on Drugs and Therapeutics • March 14, 2016;  (Issue 1490)
The FDA has approved Vivlodex (Iroko), a low-dose formulation of the nonsteroidal anti-inflammatory drug meloxicam (Mobic, and generics), for management of osteoarthritis pain. According to the manufacturer,...
The FDA has approved Vivlodex (Iroko), a low-dose formulation of the nonsteroidal anti-inflammatory drug meloxicam (Mobic, and generics), for management of osteoarthritis pain. According to the manufacturer, the new formulation aligns with stronger FDA warnings about the cardiovascular risks of NSAIDs and the recommendation to use the lowest possible doses of these drugs.
Med Lett Drugs Ther. 2016 Mar 14;58(1490):35-6 | Show Full IntroductionHide Full Introduction

Transdermal Fentanyl (Ionsys) for Postoperative Pain

   
The Medical Letter on Drugs and Therapeutics • November 9, 2015;  (Issue 1481)
A patient-controlled fentanyl iontophoretic transdermal system (Ionsys – The Medicines Company) is now available for short-term management of acute postoperative pain in adults requiring opioid...
A patient-controlled fentanyl iontophoretic transdermal system (Ionsys – The Medicines Company) is now available for short-term management of acute postoperative pain in adults requiring opioid analgesia in the hospital. Before using Ionsys, patients must be titrated to a comfortable level of analgesia with another opioid formulation.
Med Lett Drugs Ther. 2015 Nov 9;57(1481):155-6 | Show Full IntroductionHide Full Introduction

Extended-Release Hydrocodone (Hysingla ER) for Pain

   
The Medical Letter on Drugs and Therapeutics • May 11, 2015;  (Issue 1468)
The FDA has approved a second extended-release (ER) formulation of the oral opioid agonist hydrocodone (Hysingla ER – Purdue) for management of pain severe enough to require continuous long-term therapy...
The FDA has approved a second extended-release (ER) formulation of the oral opioid agonist hydrocodone (Hysingla ER – Purdue) for management of pain severe enough to require continuous long-term therapy and for which alternative treatment options are inadequate. Hysingla ER tablets have abuse-deterrent properties to discourage their misuse.
Med Lett Drugs Ther. 2015 May 11;57(1468):71-2 | Show Full IntroductionHide Full Introduction

Rescheduling of Hydrocodone Combination Products

   
The Medical Letter on Drugs and Therapeutics • October 13, 2014;  (Issue 1453)
The Drug Enforcement Administration (DEA) has reclassified all hydrocodone combination products as schedule II controlled substances; they were previously classified as schedule III. Hydrocodone alone...
The Drug Enforcement Administration (DEA) has reclassified all hydrocodone combination products as schedule II controlled substances; they were previously classified as schedule III. Hydrocodone alone (Zohydro ER) is already a schedule II controlled substance.
Med Lett Drugs Ther. 2014 Oct 13;56(1453):101-2 | Show Full IntroductionHide Full Introduction

Extended-Release Oxycodone and Acetaminophen (Xartemis XR)

   
The Medical Letter on Drugs and Therapeutics • July 21, 2014;  (Issue 1447)
The FDA has approved a fixed-dose extended-release formulation of oxycodone and acetaminophen (Xartemis XR – Mallinckrodt) for oral treatment of acute pain severe enough to require an opioid. Oxycodone is...
The FDA has approved a fixed-dose extended-release formulation of oxycodone and acetaminophen (Xartemis XR – Mallinckrodt) for oral treatment of acute pain severe enough to require an opioid. Oxycodone is available in the US as a single entity in oral immediate-release (Oxecta, and others) and extendedrelease (OxyContin) formulations. Immediate-release oxycodone is also available in combination with aspirin (Percodan, and others), acetaminophen (Percocet, and others), or ibuprofen (see Table 1).
Med Lett Drugs Ther. 2014 Jul 21;56(1447):59-61 | Show Full IntroductionHide Full Introduction

In Brief: Low-Dose Indomethacin (Tivorbex) for Pain

   
The Medical Letter on Drugs and Therapeutics • July 21, 2014;  (Issue 1447)
The same pharmaceutical company (Iroko) that recently marketed low-dose diclofenac (Zorvolex) for treatment of mild to moderate acute pain1 has now received approval from the FDA to market a low-dose oral...
The same pharmaceutical company (Iroko) that recently marketed low-dose diclofenac (Zorvolex) for treatment of mild to moderate acute pain1 has now received approval from the FDA to market a low-dose oral formulation of indomethacin (Tivorbex) for the same indication. Tivorbex is available in 20- and 40-mg capsules; conventional immediate-release indomethacin capsules contain 25 mg and 50 mg of the drug.

The rationale for this new product is the same as the one offered for Zorvolex: the drug is formulated as submicron particles that increase surface area, leading to faster dissolution and absorption. According to the package insert, the time to reach peak serum concentrations (Tmax) was 1.67 hours with a 40-mg capsule of Tivorbex, compared to 2.02 hours with a standard 50-mg capsule of indomethacin.

The problem with Tivorbex is the same as the problem with Zorvolex: there are no studies comparing its efficacy to that of standard doses of indomethacin or to any other NSAID. In addition, indomethacin is generally considered one of the most potent NSAIDs and one of those most likely to cause GI bleeding, increase cardiovascular risk, and damage the kidneys. There is no good reason to use indomethacin in any dosage for treatment of mild to moderate pain.

  1. Low-dose diclofenac (Zorvolex) for pain. Med Lett Drugs Ther 2014; 56:19.


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Med Lett Drugs Ther. 2014 Jul 21;56(1447):64 | Show Full IntroductionHide Full Introduction

Low-Dose Diclofenac (Zorvolex) for Pain

   
The Medical Letter on Drugs and Therapeutics • March 3, 2014;  (Issue 1437)
The FDA has approved Zorvolex (Iroko), a low-dose oral formulation of the relatively COX-2 selective NSAID diclofenac, for treatment of mild-to-moderate acute pain in...
The FDA has approved Zorvolex (Iroko), a low-dose oral formulation of the relatively COX-2 selective NSAID diclofenac, for treatment of mild-to-moderate acute pain in adults.
Med Lett Drugs Ther. 2014 Mar 3;56(1437):19-20 | Show Full IntroductionHide Full Introduction

Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • April 1, 2013;  (Issue 128)
Pain can be acute or chronic. The two major types of chronic pain are nociceptive pain and neuropathic pain. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. The two major types of chronic pain are nociceptive pain and neuropathic pain. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids and is often treated with adjuvant drugs such as antidepressants and antiepileptics. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
Treat Guidel Med Lett. 2013 Apr;11(128):31-42 | Show Full IntroductionHide Full Introduction

Fentanyl Sublingual Spray (Subsys) for Breakthrough Cancer Pain

   
The Medical Letter on Drugs and Therapeutics • May 14, 2012;  (Issue 1390)
The FDA has approved a sublingual spray formulation of fentanyl (Subsys – Insys) for management of breakthrough pain in adult cancer patients who are receiving and are tolerant to opioid therapy (taking...
The FDA has approved a sublingual spray formulation of fentanyl (Subsys – Insys) for management of breakthrough pain in adult cancer patients who are receiving and are tolerant to opioid therapy (taking ≥60 mg/day of oral morphine or the equivalent). Fentanyl is already available in the US for intravenous, intrathecal, epidural, transdermal and transmucosal use.
Med Lett Drugs Ther. 2012 May 14;54(1390):39-40 | Show Full IntroductionHide Full Introduction

Off-Label Use of Ketorolac for Athletic Injuries

   
The Medical Letter on Drugs and Therapeutics • May 14, 2012;  (Issue 1390)
Recent reports indicate that intramuscular (IM) injection of the nonsteroidal anti-inflammatory drug (NSAID) ketorolac (Toradol, and others), sometimes directly into injured muscles, has become a...
Recent reports indicate that intramuscular (IM) injection of the nonsteroidal anti-inflammatory drug (NSAID) ketorolac (Toradol, and others), sometimes directly into injured muscles, has become a common practice in US locker rooms.
Med Lett Drugs Ther. 2012 May 14;54(1390):37 | Show Full IntroductionHide Full Introduction

Bupivacaine Liposome Injection (Exparel) for Postsurgical Pain

   
The Medical Letter on Drugs and Therapeutics • April 2, 2012;  (Issue 1387)
The FDA has approved a new formulation (Exparel – Pacira) of the local anesthetic bupivacaine (Marcaine, and others) for use in the management of postsurgical pain in...
The FDA has approved a new formulation (Exparel – Pacira) of the local anesthetic bupivacaine (Marcaine, and others) for use in the management of postsurgical pain in adults.
Med Lett Drugs Ther. 2012 Apr 2;54(1387):26-7 | Show Full IntroductionHide Full Introduction

In Brief: Immediate-Release Oxycodone (Oxecta) for Pain

   
The Medical Letter on Drugs and Therapeutics • March 5, 2012;  (Issue 1385)
The FDA has approved a new tablet formulation of immediate-release (IR) oxycodone (Oxecta – King) for management of acute and chronic moderate to severe pain.Oxecta uses a tamper-resistant technology designed...
The FDA has approved a new tablet formulation of immediate-release (IR) oxycodone (Oxecta – King) for management of acute and chronic moderate to severe pain.

Oxecta uses a tamper-resistant technology designed to deter oxycodone abuse by injection or nasal snorting. Dissolving the crushed tablet in water or alcohol converts it into a viscous gel mixture, making it difficult to inject. Crushing the tablet and inhaling it through the nose causes burning and irritation. Whether the new formulation will actually prevent abuse of the drug has not been established. Oxecta is classified as a Schedule II controlled substance.1

In patients who have not been receiving opioid analgesics, the recommended starting dosage of Oxecta is 5 to 15 mg every 4 to 6 hours as needed for pain. Oxycodone has no analgesic ceiling, but dosage is usually limited by its adverse effects. Use of similar abuse-resistant tablets has been associated with reports of difficulty swallowing the tablets.2 Oxecta tablets should be swallowed whole and taken with enough water to ensure complete swallowing.

1. Drugs for pain.Treat Guidel Med Lett 2010; 8:25.

2. US Food and Drug Administration. Center for Drug Evaluation and Research. Oxecta (oxycodone HCl) tablets. Summary Review. Available at www.accessdata.fda.gov/scripts/cder/drugsatfda. Acccessed February 24, 2012.

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Med Lett Drugs Ther. 2012 Mar 5;54(1385):20 | Show Full IntroductionHide Full Introduction

Epidural Corticosteroid Injections for Lumbar and Cervical Radiculopathy

   
The Medical Letter on Drugs and Therapeutics • January 23, 2012;  (Issue 1382)
For patients with radicular pain unresponsive to conservative treatment after 1-2 months and no progressive neurologic deficit, epidural corticosteroid injections are often tried before surgical...
For patients with radicular pain unresponsive to conservative treatment after 1-2 months and no progressive neurologic deficit, epidural corticosteroid injections are often tried before surgical intervention.
Med Lett Drugs Ther. 2012 Jan 23;54(1382):5-6 | Show Full IntroductionHide Full Introduction

Intranasal Ketorolac (Sprix)

   
The Medical Letter on Drugs and Therapeutics • January 23, 2012;  (Issue 1382)
An intranasal formulation of ketorolac tromethamine (Sprix – Lutipold) has been approved by the FDA for short-term (up to 5 days) treatment of moderate to moderately severe pain in adults. It is the first...
An intranasal formulation of ketorolac tromethamine (Sprix – Lutipold) has been approved by the FDA for short-term (up to 5 days) treatment of moderate to moderately severe pain in adults. It is the first nonsteroidal anti-inflammatory drug (NSAID) to become available in an intranasal formulation. Ketorolac tromethamine is also available in oral, ophthalmic and injectable formulations.
Med Lett Drugs Ther. 2012 Jan 23;54(1382):7-8 | Show Full IntroductionHide Full Introduction

Fentanyl Nasal Spray (Lazanda) for Pain

   
The Medical Letter on Drugs and Therapeutics • December 12, 2011;  (Issue 1379)
The FDA has approved a nasal spray formulation of fentanyl (Lazanda – Archimedes) for management of breakthrough pain in adult cancer patients who are already receiving and are tolerant to opioid...
The FDA has approved a nasal spray formulation of fentanyl (Lazanda – Archimedes) for management of breakthrough pain in adult cancer patients who are already receiving and are tolerant to opioid therapy. Fentanyl is already available in the US for intravenous, intrathecal, epidural, transdermal and oral transmucosal use.
Med Lett Drugs Ther. 2011 Dec 12;53(1379):99-100 | Show Full IntroductionHide Full Introduction

Once-Daily Gabapentin (Gralise) for Postherpetic Neuralgia

   
The Medical Letter on Drugs and Therapeutics • November 28, 2011;  (Issue 1378)
A new once-daily formulation of gabapentin (Gralise – Depomed) has been approved by the FDA for treatment of postherpetic neuralgia (PHN). Immediate-release (IR) gabapentin (Neurontin, and others),...
A new once-daily formulation of gabapentin (Gralise – Depomed) has been approved by the FDA for treatment of postherpetic neuralgia (PHN). Immediate-release (IR) gabapentin (Neurontin, and others), which has been available in the US since 1994, is also approved for this indication, but is taken three times a day. Extended-release gabapentin enacarbil (Horizant) was recently approved by the FDA for treatment of restless legs syndrome.
Med Lett Drugs Ther. 2011 Nov 28;53(1378):94 | Show Full IntroductionHide Full Introduction

Extended-Release Hydromorphone (Exalgo) for Pain

   
The Medical Letter on Drugs and Therapeutics • August 8, 2011;  (Issue 1370)
The FDA has approved the opioid agonist hydromorphone in a once-daily extended-release (ER) oral tablet formulation (Exalgo – Covidien) for the management of moderate to severe pain in opioid-tolerant...
The FDA has approved the opioid agonist hydromorphone in a once-daily extended-release (ER) oral tablet formulation (Exalgo – Covidien) for the management of moderate to severe pain in opioid-tolerant patients requiring continuous, long-term therapy. Another hydromorphone ER formulation (Palladone – Purdue) was available previously, but was withdrawn from the market because taking it with alcohol could interfere with the extended-release mechanism and lead to rapid release of potentially lethal amounts of the drug ("dose-dumping").
Med Lett Drugs Ther. 2011 Aug 8;53(1370):62-3 | Show Full IntroductionHide Full Introduction

Capsaicin Patch (Qutenza) for Postherpetic Neuralgia

   
The Medical Letter on Drugs and Therapeutics • May 30, 2011;  (Issue 1365)
The FDA has approved a topical 8% patch formulation of capsaicin (Qutenza – NeurogesX), available only by prescription, for local treatment of postherpetic neuralgia. Postherpetic neuralgia occurs after...
The FDA has approved a topical 8% patch formulation of capsaicin (Qutenza – NeurogesX), available only by prescription, for local treatment of postherpetic neuralgia. Postherpetic neuralgia occurs after herpes zoster in about one third of patients ≥60 years old and can persist for months or even years.
Med Lett Drugs Ther. 2011 May 30;53(1365):42-3 | Show Full IntroductionHide Full Introduction

In Brief: Fentanyl Sublingual Tablets (Abstral) for Breakthrough Cancer Pain

   
The Medical Letter on Drugs and Therapeutics • May 16, 2011;  (Issue 1364)
The FDA has approved the marketing of fentanyl sublingual tablets (Abstral – ProStrakan) for treatment of breakthrough pain in adult cancer patients who are already receiving and are tolerant to opioid...
The FDA has approved the marketing of fentanyl sublingual tablets (Abstral – ProStrakan) for treatment of breakthrough pain in adult cancer patients who are already receiving and are tolerant to opioid therapy. It is the fourth transmucosal formulation of fentanyl to become available in the US for this indication.1-3

The manufacturer recommends an initial dose of 100 mcg, a maximum of 2 doses per breakthrough pain episode, and use for no more than 4 breakthrough pain episodes per day. As with all formulations of fentanyl, strong inhibitors of CYP3A4 such as clarithromycin (Biaxin, and others) or itraconazole (Sporanox, and others) can increase serum concentrations of the drug to levels that can cause respiratory depression even in opioid- tolerant patients. A single dose of any formulation of transmucosal fentanyl could be fatal for a child.

1. Fentanyl buccal tablet (Fentora) for breakthrough pain. Med Lett Drugs Ther 2007; 49:78.

2. Drugs for pain. Treat Guidel Med Lett 2010; 8:25.

3. Fentanyl buccal soluble film (Onsolis) for breakthrough cancer pain. Med Lett Drugs Ther 2010; 52:30.

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Med Lett Drugs Ther. 2011 May 16;53(1364):40 | Show Full IntroductionHide Full Introduction

Duloxetine (Cymbalta) for Chronic Musculoskeletal Pain

   
The Medical Letter on Drugs and Therapeutics • May 2, 2011;  (Issue 1363)
Previously approved by the FDA for treatment of depression, general anxiety disorder, diabetic peripheral neuropathic pain and fibromyalgia, duloxetine (Cymbalta – Lilly) has now also been approved...
Previously approved by the FDA for treatment of depression, general anxiety disorder, diabetic peripheral neuropathic pain and fibromyalgia, duloxetine (Cymbalta – Lilly) has now also been approved for treatment of chronic musculoskeletal pain.
Med Lett Drugs Ther. 2011 May 2;53(1363):33-4 | Show Full IntroductionHide Full Introduction

Transdermal Buprenorphine (Butrans) for Chronic Pain

   
The Medical Letter on Drugs and Therapeutics • April 18, 2011;  (Issue 1362)
The FDA has approved the partial opioid agonist buprenorphine in a transdermal formulation (Butrans – Purdue) for treatment of moderate to severe chronic pain. Buprenorphine has been available in the US...
The FDA has approved the partial opioid agonist buprenorphine in a transdermal formulation (Butrans – Purdue) for treatment of moderate to severe chronic pain. Buprenorphine has been available in the US for years in parenteral formulations for pain and in sublingual tablets for opioid dependence.1 Transdermal buprenorphine has been available in Europe for several years.2
Med Lett Drugs Ther. 2011 Apr 18;53(1362):31-2 | Show Full IntroductionHide Full Introduction

In Brief: Does Acetaminophen Increase Blood Pressure?

   
The Medical Letter on Drugs and Therapeutics • April 18, 2011;  (Issue 1362)
A recent article in Circulation reported that acetaminophen (Tylenol, and others; paracetamol outside the US) increased blood pressure in patients with coronary artery disease. This conclusion was based on a...
A recent article in Circulation reported that acetaminophen (Tylenol, and others; paracetamol outside the US) increased blood pressure in patients with coronary artery disease. This conclusion was based on a randomized, placebo-controlled crossover trial in 33 patients; acetaminophen 1 g three times daily for 2 weeks was associated with statistically significant increases in blood pressure of 2.9 mmHg systolic and 2.2 mmHg diastolic.1

NSAIDs can increase blood pressure; the mechanism is thought to be inhibition of cyclooxygenase leading to decreased renal prostaglandin activity. Acetaminophen also inhibits cyclooxygenase (primarily COX-2) and decreases prostaglandin activity.2

The small increases in blood pressure reported with acetaminophen would probably be inconsequential in low-risk patients, but might be a concern for those with cardiovascular disease. Like most drugs, acetaminophen should be used in the lowest effective doses for the shortest possible time. Mild to moderate pain due to osteoarthritis or headache generally responds to a dose of 650 mg.3

1. I Sudano et al. Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation 2010; 122:1789.

2. B Hinz et al. Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man. FASEB J 2008; 22:383.

3. Drugs for pain. Treat Guidel Med Lett 2010; 8:25.

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Med Lett Drugs Ther. 2011 Apr 18;53(1362):29 | Show Full IntroductionHide Full Introduction

Fentanyl Buccal Soluble Film (Onsolis) for Breakthrough Cancer Pain

   
The Medical Letter on Drugs and Therapeutics • April 19, 2010;  (Issue 1336)
Fentanyl buccal soluble film (Onsolis – Meda) has been approved by the FDA for treatment of breakthrough pain in adult cancer patients who are already taking and are tolerant to around-the-clock opioid...
Fentanyl buccal soluble film (Onsolis – Meda) has been approved by the FDA for treatment of breakthrough pain in adult cancer patients who are already taking and are tolerant to around-the-clock opioid therapy. It is designated as a Schedule II controlled substance Two other oral transmucosal formulations of fentanyl are already available for this indication.
Med Lett Drugs Ther. 2010 Apr 19;52(1336):30-1 | Show Full IntroductionHide Full Introduction

Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • April 1, 2010;  (Issue 92)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
Treat Guidel Med Lett. 2010 Apr;8(92):25-34 | Show Full IntroductionHide Full Introduction

A Morphine/Naltrexone Combination (Embeda) for Pain

   
The Medical Letter on Drugs and Therapeutics • March 22, 2010;  (Issue 1334)
The FDA has approved an agonist/antagonist combination of morphine and naltrexone (Embeda – King) for treatment of chronic moderate to severe pain requiring around-the-clock analgesia for an extended period...
The FDA has approved an agonist/antagonist combination of morphine and naltrexone (Embeda – King) for treatment of chronic moderate to severe pain requiring around-the-clock analgesia for an extended period of time. The addition of naltrexone is intended to prevent abuse of morphine.
Med Lett Drugs Ther. 2010 Mar 22;52(1334):22-3 | Show Full IntroductionHide Full Introduction

Medical Marijuana

   
The Medical Letter on Drugs and Therapeutics • January 25, 2010;  (Issue 1330)
Fourteen states in the US - Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington - now permit, or soon will permit, some...
Fourteen states in the US - Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington - now permit, or soon will permit, some medical use of marijuana (Cannabis sativa). In some states, licensed facilities dispense botanical cannabis by prescription. In others, limited self-cultivation is permitted for medical use.
Med Lett Drugs Ther. 2010 Jan 25;52(1330):5-6 | Show Full IntroductionHide Full Introduction

Intravenous Ibuprofen (Caldolor)

   
The Medical Letter on Drugs and Therapeutics • January 11, 2010;  (Issue 1329)
An intraveneous (IV) formulation of ibuprofen (Caldolor - Cumberland) was recently approved by the FDA for use in adults. It can be administered alone for treatment of mild to moderate pain or as an adjunct to...
An intraveneous (IV) formulation of ibuprofen (Caldolor - Cumberland) was recently approved by the FDA for use in adults. It can be administered alone for treatment of mild to moderate pain or as an adjunct to opioid analgesics for moderate to severe pain. It is also approved for reduction of fever.
Med Lett Drugs Ther. 2010 Jan 11;52(1329):3-4 | Show Full IntroductionHide Full Introduction

Tapentadol (Nucynta) - A New Analgesic

   
The Medical Letter on Drugs and Therapeutics • August 10, 2009;  (Issue 1318)
The FDA has approved tapentadol hydrochloride (Nucynta - Ortho-McNeil Janssen) for oral treatment of moderate to severe acute pain in patients ≥18 years old. It has been classified as a Schedule II controlled...
The FDA has approved tapentadol hydrochloride (Nucynta - Ortho-McNeil Janssen) for oral treatment of moderate to severe acute pain in patients ≥18 years old. It has been classified as a Schedule II controlled substance
Med Lett Drugs Ther. 2009 Aug 10;51(1318):61-2 | Show Full IntroductionHide Full Introduction

In Brief: Heat and Transdermal Fentanyl

   
The Medical Letter on Drugs and Therapeutics • August 10, 2009;  (Issue 1318)
Transdermal fentanyl (Duragesic, and others) offers a convenient delivery system for patients with chronic pain1 but it has some drawbacks. One is that exposing the patch to heat, either from an external...
Transdermal fentanyl (Duragesic, and others) offers a convenient delivery system for patients with chronic pain1 but it has some drawbacks. One is that exposing the patch to heat, either from an external source, increased exertion or possibly high fever, could increase release of the drug, which might lead to an overdose and fatal respiratory depression.2 A recent article in the NY Times about this problem may have aroused the concerns of some patients using the patches.3

First approved for marketing by the FDA in 19914, transdermal fentanyl provides continuous delivery of the drug for about 3 days. After application of the patch, a depot of fentanyl forms in the upper layers of the skin. Serum concentrations of the drug increase gradually, reaching a peak (Cmax) in 24-72 hours. According to a pharmacokinetic model mentioned in the labeling, an increase in body temperature to 40°C (104°F) could increase fentanyl serum concentrations by 33%. Local application of heat near or on a fentanyl transdermal patch also increases systemic absorption; in one study, heating the patch during the first 4 hours after application increased maximum serum concentrations nearly three-fold.5 Unintentional increases in systemic fentanyl absorption caused by a heating pad, a warming blanket used during surgery and strenuous exertion have led to respiratory depression in 3 patients.6 No reports of clinical overdosage caused by fever have been published.

Serious adverse events may require removal of the patch and administration of an opioid antagonist such as naloxone (Narcan, and others). Monitoring for hypoventilation or cognitive impairment for at least 24 hours is recommended after removing the patch because fentanyl concentrations decrease slowly (50% decrease in about 17 hours) due to continued systemic absorption from the intracutaneous reservoir.

1. Drugs for pain. Treat Guidel Med Lett 2007; 5:23.
2. FDA Alert 7/15/2005; Update 12/21/2007. Information for healthcare professionals: Fentanyl transdermal system (marketed as Duragesic and generics). Available at www.fda.gov/cder/drug/InfoSheets/HCP/fentanyl_2007HCP.htm. Accessed July 27, 2009.
3. T Brown. Doctors and nurses, still learning. New York Times, April 29, 2009. Available at NYTimes.com. Accessed July 29, 2009.
4. Transdermal fentanyl. Med Lett Drugs Ther 1992; 34:97.
5. MA Ashburn et al. The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003; 4:291.
6. KA Carter. Heat-associated increase in transdermal fentanyl absorption. Am J Health Syst Pharm 2003; 60:191.

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Med Lett Drugs Ther. 2009 Aug 10;51(1318):64 | Show Full IntroductionHide Full Introduction

Acetaminophen Safety - Deja Vu

   
The Medical Letter on Drugs and Therapeutics • July 13, 2009;  (Issue 1316)
Concerns have surfaced again at the FDA and in the media about the safety of acetaminophen and the multiplicity of products on the market in the US that contain various amounts of...
Concerns have surfaced again at the FDA and in the media about the safety of acetaminophen and the multiplicity of products on the market in the US that contain various amounts of it.
Med Lett Drugs Ther. 2009 Jul 13;51(1316):53-4 | Show Full IntroductionHide Full Introduction

Milnacipran (Savella) for Fibromyalgia

   
The Medical Letter on Drugs and Therapeutics • June 15, 2009;  (Issue 1314)
Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a...
Milnacipran (Savella - Forest), an oral selective serotonin and norepinephrine reuptake inhibitor (SNRI), is the third drug approved by the FDA for management of fibromyalgia. The 2 others are pregabalin, a gammaaminobutyric acid (GABA) analog also approved for treatment of diabetic neuropathy, post-herpetic neuralgia and epilepsy, and duloxetine, an SNRI also approved for treatment of depression, diabetic neuropathy and generalized anxiety disorder.
Med Lett Drugs Ther. 2009 Jun 15;51(1314):45-8 | Show Full IntroductionHide Full Introduction

Spinal Decompression Machines

   
The Medical Letter on Drugs and Therapeutics • June 2, 2008;  (Issue 1287)
Spinal decompression machines offer a motorized form of mechanical traction. These devices, which are widely advertised to the public as a noninvasive alternative to surgery, are claimed to relieve low back...
Spinal decompression machines offer a motorized form of mechanical traction. These devices, which are widely advertised to the public as a noninvasive alternative to surgery, are claimed to relieve low back pain by decompressing discs, improving the flow of nutrients into the disc and rehydrating dried-out discs. Devices cleared by the FDA based on substantial similarity to previously approved power traction devices include the Accu- Spina System, DRS System, DRX9000, Lordex Traction Unit, Spinal Health Elite, SpineMED Decompression Table, SpineRx-LDM and VAX-D Therapeutic Table.
Med Lett Drugs Ther. 2008 Jun 2;50(1287):41-2 | Show Full IntroductionHide Full Introduction

Drugs for Migraine

   
The Medical Letter on Drugs and Therapeutics • March 1, 2008;  (Issue 67)
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve...
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Treat Guidel Med Lett. 2008 Mar;6(67):17-22 | Show Full IntroductionHide Full Introduction

A Diclofenac Patch (Flector) for Pain

   
The Medical Letter on Drugs and Therapeutics • January 14, 2008;  (Issue 1277)
Diclofenac epolamine patch 1.3% (Flector Patch - Alpharma), a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, has been approved by the FDA for topical treatment of acute pain...
Diclofenac epolamine patch 1.3% (Flector Patch - Alpharma), a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, has been approved by the FDA for topical treatment of acute pain due to minor strains, sprains and contusions. It is the first topical NSAID patch approved in the US. A diclofenac patch has been used in Europe since 1993. Diclofenac sodium (Voltaren, and others) is available in the US as an oral tablet, in a 1% gel for treatment of osteoarthritis (to be reviewed in a future issue), in a 3% gel (Solaraze) for treatment of actinic keratoses, and in an ophthalmic formulation.
Med Lett Drugs Ther. 2008 Jan 14;50(1277):1-2 | Show Full IntroductionHide Full Introduction

Extended-Release Cyclobenzaprine (Amrix)

   
The Medical Letter on Drugs and Therapeutics • December 17, 2007;  (Issue 1276)
An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine...
An extended-release formulation of the centrally-acting muscle relaxant cyclobenzaprine (Amrix - Cephalon) has been approved by the FDA for treatment of muscle spasms. Immediate-release (IR) cyclobenzaprine (Flexeril, and others) has been available since 1977.
Med Lett Drugs Ther. 2007 Dec 17;49(1276):102-3 | Show Full IntroductionHide Full Introduction

Fentanyl Buccal Tablet (Fentora) for Breakthrough Pain

   
The Medical Letter on Drugs and Therapeutics • September 24, 2007;  (Issue 1270)
The FDA has approved a transmucosal tablet formulation of fentanyl citrate (Fentora - Cephalon) for management of breakthrough pain in opioid-tolerant patients with cancer. An oral transmucosal fentanyl lozenge...
The FDA has approved a transmucosal tablet formulation of fentanyl citrate (Fentora - Cephalon) for management of breakthrough pain in opioid-tolerant patients with cancer. An oral transmucosal fentanyl lozenge on a stick (Actiq, and others) is also available for this indication, and is widely used off-label for chronic, non-cancer pain as well.
Med Lett Drugs Ther. 2007 Sep 24;49(1270):79-6 | Show Full IntroductionHide Full Introduction

Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • April 1, 2007;  (Issue 56)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants and anticonvulsants have been used to treat neuropathic pain. Combining two different types of analgesics may nprovide an additive analgesic effect without increasing adverse effects.
Treat Guidel Med Lett. 2007 Apr;5(56):23-32 | Show Full IntroductionHide Full Introduction

Oral Oxymorphone (Opana)

   
The Medical Letter on Drugs and Therapeutics • January 1, 2007;  (Issue 1251)
Oxymorphone hydrochloride, a semi-synthetic opioid agonist, has been available for many years in the US as Numorphan (Endo) for parenteral use and as a rectal suppository. Now it has been approved by the FDA...
Oxymorphone hydrochloride, a semi-synthetic opioid agonist, has been available for many years in the US as Numorphan (Endo) for parenteral use and as a rectal suppository. Now it has been approved by the FDA for oral administration as an immediate-release (IR) tablet (Opana) for treatment of moderate to severe acute pain, and as an extended-release tablet (Opana ER) for treatment of moderate to severe pain in patients requiring continuous opioid treatment for an extended period of time.
Med Lett Drugs Ther. 2007 Jan 1;49(1251):3-4 | Show Full IntroductionHide Full Introduction

A Combination of Oxycodone and Ibuprofen (Combunox) for Pain

   
The Medical Letter on Drugs and Therapeutics • January 2, 2006;  (Issue 1225)
A fixed-dose combination of oxycodone 5 mg and ibuprofen 400 mg (Combunox - Forest Laboratories) is now available and is being heavily advertised for short-term treatment of moderate to severe acute...
A fixed-dose combination of oxycodone 5 mg and ibuprofen 400 mg (Combunox - Forest Laboratories) is now available and is being heavily advertised for short-term treatment of moderate to severe acute pain.
Med Lett Drugs Ther. 2006 Jan 2;48(1225):3-4 | Show Full IntroductionHide Full Introduction

Ziconotide (Prialt) for Chronic Pain

   
The Medical Letter on Drugs and Therapeutics • December 5, 2005;  (Issue 1223)
The FDA has approved ziconotide (Prialt - Elan) intrathecal infusion for management of severe chronic pain in patients who are intolerant of or refractory to other treatments. Ziconotide is a synthetic neuronal...
The FDA has approved ziconotide (Prialt - Elan) intrathecal infusion for management of severe chronic pain in patients who are intolerant of or refractory to other treatments. Ziconotide is a synthetic neuronal N-type calcium channel blocker. It is intended for use with a programmable implanted microinfusion device, but an external microinfusion device can be used temporarily.
Med Lett Drugs Ther. 2005 Dec 5;47(1223):103-4 | Show Full IntroductionHide Full Introduction

Duloxetine (Cymbalta) for Diabetic Neuropathic Pain

   
The Medical Letter on Drugs and Therapeutics • August 15, 2005;  (Issue 1215)
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI) available for treatment of depression, has also been approved by the FDA for treatment of...
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI) available for treatment of depression, has also been approved by the FDA for treatment of neuropathic pain associated with diabetic peripheral neuropathy (DPN). Duloxetine is one of two drugs approved specifically for management of neuropathic pain due to diabetes; the other, pregabalin (Lyrica - Pfizer), will be marketed soon and will be reviewed in the next issue of The Medical Letter.
Med Lett Drugs Ther. 2005 Aug 15;47(1215):67-8 | Show Full IntroductionHide Full Introduction

Ropinirole for Restless Legs Syndrome

   
The Medical Letter on Drugs and Therapeutics • August 1, 2005;  (Issue 1214)
Ropinirole (Requip - GlaxoSmithKline), a dopamine agonist already available for treatment of Parkinson's disease, is now the first drug approved by the FDA for treatment of moderate to severe restless legs...
Ropinirole (Requip - GlaxoSmithKline), a dopamine agonist already available for treatment of Parkinson's disease, is now the first drug approved by the FDA for treatment of moderate to severe restless legs syndrome (RLS).
Med Lett Drugs Ther. 2005 Aug 1;47(1214):62-4 | Show Full IntroductionHide Full Introduction

In Brief: Palladone Withdrawn

   
The Medical Letter on Drugs and Therapeutics • August 1, 2005;  (Issue 1214)
The Medical Letter review of Palladone (hydromorphone HCl) extended-release capsules (March 14, 2005) warned that a lethal dose could be released if the new formulation was taken with alcohol. Because of that...
The Medical Letter review of Palladone (hydromorphone HCl) extended-release capsules (March 14, 2005) warned that a lethal dose could be released if the new formulation was taken with alcohol. Because of that risk, the FDA asked the manufacturer (Purdue) to withdraw the drug from the market (FDA News. July 13, 2005; FDC Reports – “The Pink Sheet” July 18, 2005; 67:3).
Med Lett Drugs Ther. 2005 Aug 1;47(1214):61 | Show Full IntroductionHide Full Introduction

Palladone for Chronic Pain

   
The Medical Letter on Drugs and Therapeutics • March 14, 2005;  (Issue 1204)
A once-daily extended-release (ER) oral formulation of the opioid analgesic hydromorphone hydrochloride (Palladone - Purdue Pharma) has been approved by the FDA for treatment of opioid-tolerant patients with...
A once-daily extended-release (ER) oral formulation of the opioid analgesic hydromorphone hydrochloride (Palladone - Purdue Pharma) has been approved by the FDA for treatment of opioid-tolerant patients with persistent moderate to severe pain. Hydromorphone HCl, a semisynthetic congener of morphine and active metabolite of hydrocodone that has been used since the 1920s, is also available in immediate-release oral, injectable and suppository forms (Dilaudid, and others).
Med Lett Drugs Ther. 2005 Mar 14;47(1204):21-3 | Show Full IntroductionHide Full Introduction

Addendum: Tramadol as an NSAID Alternative

   
The Medical Letter on Drugs and Therapeutics • February 14, 2005;  (Issue 1202)
In our January 17 issue, a short article on NSAID alternatives mentioned that tramadol (Ultram, and others), a weak opioid analgesic, could be helpful for some patients. A few readers have commented that we...
In our January 17 issue, a short article on NSAID alternatives mentioned that tramadol (Ultram, and others), a weak opioid analgesic, could be helpful for some patients. A few readers have commented that we should have said something about its drawbacks. The need for slow titration in dosage limits the drug's use for treatment of acute pain. Seizures have been reported with tramadol; patients taking an antidepressant or an antipsychotic drug may be at increased risk. Tramadol is not a controlled substance, but psychological and physical dependence have occurred.
Med Lett Drugs Ther. 2005 Feb 14;47(1202):16 | Show Full IntroductionHide Full Introduction

NSAID Alternatives

   
The Medical Letter on Drugs and Therapeutics • January 17, 2005;  (Issue 1200)
Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) may be asking their health care providers if they should continue, and some may be asking for alternatives. For most patients taking nonspecific...
Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) may be asking their health care providers if they should continue, and some may be asking for alternatives. For most patients taking nonspecific NSAIDs, it would be reasonable to continue. For those who are taking the COX-2 selective celecoxib (Celebrex) because they cannot tolerate the gastrointestinal (GI) effects of nonspecific NSAIDs, it seems reasonable to continue at doses no higher than 100 mg b.i.d. or 200 mg once daily; at these dosages cardiovascular risk has been no higher than with placebo. All NSAIDs, including COX-2 inhibitors, can decrease renal blood flow and cause fluid retention, hypertension and renal failure, especially in the elderly and in patients who take diuretics. The unpublished study that led to an FDA alert on an increased cardiovascular risk with naproxen (Naprosyn, and others) was conducted in patients older than 70. See NSAID addendum
Med Lett Drugs Ther. 2005 Jan 17;47(1200):8 | Show Full IntroductionHide Full Introduction

COX-2 Alternatives and GI Protection

   
The Medical Letter on Drugs and Therapeutics • November 8, 2004;  (Issue 1195)
With the removal of Vioxx from the market and concerns about cardiovascular toxicity with other selective COX-2 inhibitors, patients are looking for safe alternatives, and manufacturers of other drugs are...
With the removal of Vioxx from the market and concerns about cardiovascular toxicity with other selective COX-2 inhibitors, patients are looking for safe alternatives, and manufacturers of other drugs are looking for additional market share. The COX-2 inhibitors first became popular because they have less upper GI toxicity than older less selective NSAIDs, at least in the short term, in patients not taking aspirin.
Med Lett Drugs Ther. 2004 Nov 8;46(1195):91-2 | Show Full IntroductionHide Full Introduction

Duloxetine (Cymbalta): A New SNRI for Depression

   
The Medical Letter on Drugs and Therapeutics • October 11, 2004;  (Issue 1193)
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), has been approved by the FDA for treatment of major depressive disorder in adults, and more...
Duloxetine hydrochloride (Cymbalta - Lilly), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), has been approved by the FDA for treatment of major depressive disorder in adults, and more recently for diabetic peripheral neuropathy as well. The Medical Letter will review its role in diabetic neuropathy in a future issue.
Med Lett Drugs Ther. 2004 Oct 11;46(1193):81-3 | Show Full IntroductionHide Full Introduction

Drugs for Migraine

   
The Medical Letter on Drugs and Therapeutics • September 1, 2004;  (Issue 25)
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004;...
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004; 63:520). Drugs for prevention of migraine are listed in the table on page 65. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Treat Guidel Med Lett. 2004 Sep;2(25):63-6 | Show Full IntroductionHide Full Introduction

Gabapentin (Neurontin) for Chronic Pain

   
The Medical Letter on Drugs and Therapeutics • April 12, 2004;  (Issue 1180)
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a...
Gabapentin (Neurontin - Pfizer), which has been available in the US since 1994, is approved by the FDA only for treatment of partial epilepsy and postherpetic neuralgia, but is widely used off-label for a number of other indications, especially neuropathic pain syndromes. According to one report, among Medicaid recipients in Florida receiving gabapentin, 71% of prescriptions were for chronic pain and 8% for seizures and neuralgia ("The Pink Sheet" February 2, 2004; 66:30).
Med Lett Drugs Ther. 2004 Apr 12;46(1180):29-31 | Show Full IntroductionHide Full Introduction

Spinal Manipulation

   
The Medical Letter on Drugs and Therapeutics • May 27, 2002;  (Issue 1131)
Spinal manipulation has been used to treat not only back and neck pain, but also many other conditions. A recent commentary questioned its...
Spinal manipulation has been used to treat not only back and neck pain, but also many other conditions. A recent commentary questioned its safety.
Med Lett Drugs Ther. 2002 May 27;44(1131):50 | Show Full IntroductionHide Full Introduction

Valdecoxib (Bextra) - a New Cyclooxygenase-2 Inhibitor

   
The Medical Letter on Drugs and Therapeutics • April 29, 2002;  (Issue 1129)
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis,...
Valdecoxib (Bextra - Pharmacia/Pfizer), a selective cyclooxygenase (COX-2) inhibitor similar to celecoxib (Celebrex) and rofecoxib (Vioxx), was recently approved by the FDA for treatment of osteoarthritis, rheumatoid arthritis and primary dysmenorrhea.
Med Lett Drugs Ther. 2002 Apr 29;44(1129):39-41 | Show Full IntroductionHide Full Introduction

Rofecoxib for Osteoarthritis and Pain

   
The Medical Letter on Drugs and Therapeutics • July 2, 1999;  (Issue 1056)
Rofecoxib, a selective COX-2 inhibitor, has been approved by the FDA for treatment of osteoarthritis, acute pain and menstrual...
Rofecoxib, a selective COX-2 inhibitor, has been approved by the FDA for treatment of osteoarthritis, acute pain and menstrual pain.
Med Lett Drugs Ther. 1999 Jul 2;41(1056):59-62 | Show Full IntroductionHide Full Introduction

Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • August 14, 1998;  (Issue 1033)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain.
Med Lett Drugs Ther. 1998 Aug 14;40(1033):79-84 | Show Full IntroductionHide Full Introduction

Bromfenac for Analgesia

   
The Medical Letter on Drugs and Therapeutics • October 10, 1997;  (Issue 1011)
Bromfenac sodium (Duract - Wyeth-Ayerst), a nonsteroidal anti-inflammatory drug (NSAID), has been approved by the US Food and Drug Administration (FDA) and is being heavily advertised as an alternative to...
Bromfenac sodium (Duract - Wyeth-Ayerst), a nonsteroidal anti-inflammatory drug (NSAID), has been approved by the US Food and Drug Administration (FDA) and is being heavily advertised as an alternative to narcotics for short-term treatment of pain.
Med Lett Drugs Ther. 1997 Oct 10;39(1011):93-4 | Show Full IntroductionHide Full Introduction

Tramadol - A New Oral Analgesic

   
The Medical Letter on Drugs and Therapeutics • July 7, 1995;  (Issue 952)
Tramadol hydrochloride (Ultram - Ortho-McNeil), a centrally-acting analgesic marketed in Germany since 1977, was recently approved by the US Food and Drug Administration for oral treatment of moderate to...
Tramadol hydrochloride (Ultram - Ortho-McNeil), a centrally-acting analgesic marketed in Germany since 1977, was recently approved by the US Food and Drug Administration for oral treatment of moderate to moderately severe pain. Despite some opioid activity, tramadol has not been scheduled as a controlled substance.
Med Lett Drugs Ther. 1995 Jul 7;37(952):59-60 | Show Full IntroductionHide Full Introduction

Butorphanol Nasal Spray for Pain

   
The Medical Letter on Drugs and Therapeutics • November 12, 1993;  (Issue 909)
Butorphanol tartrate, a synthetic opioid agonist-antagonist analgesic previously available for injection, is now being marketed as a nasal spray (Stadol-NS - Mead Johnson). The spray was approved by the US...
Butorphanol tartrate, a synthetic opioid agonist-antagonist analgesic previously available for injection, is now being marketed as a nasal spray (Stadol-NS - Mead Johnson). The spray was approved by the US Food and Drug Administration (FDA) for any type of pain for which an opioid analgesic is appropriate, but the manufacturer is emphasizing use for treatment of migraine headache and postoperative pain. Drugs for pain were reviewed in the Medical Letter, volume 35, page 1, January 8, 1993.
Med Lett Drugs Ther. 1993 Nov 12;35(909):105-6 | Show Full IntroductionHide Full Introduction

Drugs for Pain

   
The Medical Letter on Drugs and Therapeutics • January 8, 1993;  (Issue 887)
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as...
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. (American Pain Society, Principles of analgesic Use, 3rd ed, Skokie, illinois: American pain society, 1992).
Med Lett Drugs Ther. 1993 Jan 8;35(887):1-6 | Show Full IntroductionHide Full Introduction

Transdermal Fentanyl

   
The Medical Letter on Drugs and Therapeutics • October 16, 1992;  (Issue 881)
Fentanyl, a synthetic opioid previously available for parenteral use in anesthesia (Sublimaze), has now been marketed in a controlled-release transdermal formulation (Duragesic - Janssen) for use in patients...
Fentanyl, a synthetic opioid previously available for parenteral use in anesthesia (Sublimaze), has now been marketed in a controlled-release transdermal formulation (Duragesic - Janssen) for use in patients with chronic pain severe enough to require opioid analgesia. It is not recommended for treatment of postoperative pain because of the drug's slow onset and prolonged duration of action.
Med Lett Drugs Ther. 1992 Oct 16;34(881):97-8 | Show Full IntroductionHide Full Introduction

Capsaicin - A Topical Analgesic

   
The Medical Letter on Drugs and Therapeutics • June 26, 1992;  (Issue 873)
Capsaicin, a vanillyl alkaloid found in hot peppers and related plants, is now available without a prescription as Zostrix-HP (GenDerm) for topical relief of pain due to diabetic neuropathy, herpes zoster, or...
Capsaicin, a vanillyl alkaloid found in hot peppers and related plants, is now available without a prescription as Zostrix-HP (GenDerm) for topical relief of pain due to diabetic neuropathy, herpes zoster, or arthritis. The new formulation contains 0.075% capsaicin; the drug was previously available in a 0.025% concentration as Zostrix.
Med Lett Drugs Ther. 1992 Jun 26;34(873):62-3 | Show Full IntroductionHide Full Introduction

Dezocine

   
The Medical Letter on Drugs and Therapeutics • October 19, 1990;  (Issue 829)
Dezocine (Dalgan - Astra), a new synthetic opioid agonist/antagonist structurally related to pentazocine (Talwin), was recently approved for parenteral use as an analgesic by the US Food and Drug...
Dezocine (Dalgan - Astra), a new synthetic opioid agonist/antagonist structurally related to pentazocine (Talwin), was recently approved for parenteral use as an analgesic by the US Food and Drug Administration.
Med Lett Drugs Ther. 1990 Oct 19;32(829):95-6 | Show Full IntroductionHide Full Introduction

Ketorolac Tromethamine

   
The Medical Letter on Drugs and Therapeutics • August 24, 1990;  (Issue 825)
Ketorolac (kee'; toe role ak) tromethamine (Toradol), manufactured by Syntex but also marketed by Roche, is the first parenteral nonsteroidal anti-inflammatory drug (NSAID) to become available for analgesic...
Ketorolac (kee'; toe role ak) tromethamine (Toradol), manufactured by Syntex but also marketed by Roche, is the first parenteral nonsteroidal anti-inflammatory drug (NSAID) to become available for analgesic use in the USA. Parenteral indomethacin (Indocin I.V.) has been marketed here since 1985, but only for treatment of patent ductus arteriosus in newborn infants. Other parenteral NSAIDs are available in other parts of the world, but low potency, poor aqueous solubility, and substantial tissue irritation on injection have limited their usefulness. Ketorolac has been approved by the US Food and Drug Administration for intramuscular (IM) treatment of moderate to severe pain.
Med Lett Drugs Ther. 1990 Aug 24;32(825):79-80 | Show Full IntroductionHide Full Introduction

Ibuprofen vs. Acetaminophen in Children

   
The Medical Letter on Drugs and Therapeutics • December 15, 1989;  (Issue 807)
Since the implication of aspirin in Reye's syndrome, acetaminophen (Tylenol; and others) has become the standard drug for symptomatic treatment of fever and pain in children. Ibuprofen, a nonsteroidal...
Since the implication of aspirin in Reye's syndrome, acetaminophen (Tylenol; and others) has become the standard drug for symptomatic treatment of fever and pain in children. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) available for many years in tables (Mortin; Advil; and others), has now become available in a suspension. The suspension will be sold by presecription for treatment of fever or arthritis in children.
Med Lett Drugs Ther. 1989 Dec 15;31(807):109-10 | Show Full IntroductionHide Full Introduction

Patient-Controlled Analgesia

   
The Medical Letter on Drugs and Therapeutics • November 17, 1989;  (Issue 805)
Automated intravenous delivery systems have recently become commercially available for intermittent self-administration of analgesics. Patient-controlled analgesia (PCA) has been used effectively to relieve...
Automated intravenous delivery systems have recently become commercially available for intermittent self-administration of analgesics. Patient-controlled analgesia (PCA) has been used effectively to relieve after a wide variety of surgical procedures. It has also been effective for pain associated with labor, sickle cell crisis, and chronic pain caused by cancer.
Med Lett Drugs Ther. 1989 Nov 17;31(805):104 | Show Full IntroductionHide Full Introduction