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First-line Choice (first-line + choice)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Clinical issues in using buprenorphine in the treatment of opiate dependence

DRUG AND ALCOHOL REVIEW, Issue 3 2000
Dr A. Chadderton MB
Abstract This paper looks at the current role of buprenorphine in the treatment of opiate dependence. It suggests that buprenorphine is a useful alternative to methadone and that in at least some cases it may be the preferred option. Buprenorphineis a partial agonist and a partial antagonist with a ceiling of opiate activity probably approximately equal to 30mg methadone. It achieves this at a dose of 10-12mg, although there is considerable individual variation. Because of its ceiling effect it has a good safety profile compared to full agonists such as methadone although some overdose deaths, particularly in conjunction with benzodiazepine abuse, have been reported in France. Induction of buprenorphine may take slightly longer than for methadone and there is a higher dropout rate compared to methadone in the first 2 weeks. This is probably due to the antagonist action of buprenorphine causing more withdrawal symptoms in comparison to methadone. Also, the ceiling effect for buprenorphine means that some clients do not experience sufficient opiate activity to satisfy them. Buprenorphine has a long half-life and dissociates slowly from opiate receptors. Most clients can be dosed second-daily but some find this unacceptable due to mood swings and/or withdrawal symptomson the second day. For these clients daily dosing is required. Transferring from buprenorphine to methadone is straightforward and well tolerated by clients. Transferring from methadone to buprenorphine, however, is more difficult because of the partial antagonist action of buprenorphine. Clients experience withdrawal symptoms that can take up to 2 weeks to settle. Most clients find these symptoms unacceptable when transferring from doses of over 30mg of methadone. The optimum method for transferring from methadone to buprenorphine is still to be determined. Withdrawal from buprenorphine appears to be relatively easier than from methadone. This is presumably due to buprenorphine's partial agonist effect at mureceptors. It is expected that during 2000 buprenorphine will be approved for use in Australia for the treatment of opiate dependence. It may well becomea first-line choice for opiate replacement in heroin dependence. It is also likely to be useful in assisting detoxification fromboth methadone and heroin. [source]

A critical review of aspirin in the secondary prevention of noncardioembolic ischaemic stroke

INTERNATIONAL JOURNAL OF STROKE, Issue 4 2010
Domenico Inzitari
Both secondary prevention (such as lifestyle modifications, pharmacotherapy or surgery) and an understanding of the influence of risk factors (including the different aetiologic mechanisms of cerebral ischaemia) play a pivotal role in reducing the burden of recurrent stroke. Regarding the types of preventative treatments available, variations exist across all clinical studies, including differences in target populations (including the type of cerebral ischaemia), risk factors, length of follow-up, drop-out rates and outcomes, which makes translating the results of clinical trials to individual patients difficult. However, with such limitations in mind, this critical albeit nonsystematic review, which compared aspirin with other antiplatelets and in combination with other drugs, showed that the benefit from aspirin treatment is consistently shown in ischaemic stroke, while harms are limited. Furthermore, no definite superiority is apparent across different antiplatelet therapies. Dual antiplatelet regimens may expose to a slight but measurable higher risk of haemorrhagic complications, perhaps in selective groups of patients (i.e. those with severe small-vessel disease or in selective racial groups). Based on our analysis, the indication of aspirin as the first-line choice, also recommended by several acknowledged international or national guidelines, may be confirmed. However, the complex nature of patients at risk of recurrent ischaemic stroke necessitates a comprehensive approach, which should be driven by the primary care physician, whose role is central to successful actions for secondary stroke prevention. [source]

Attitudes to prescription of antiplatelet drugs by diabetes health workers

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 8 2007
A Woodward RN, MPhill Diabetes Specialist Nurse
Abstract The aim of this survey was to explore the attitudes to antiplatelet drug use amongst a group of UK diabetes specialist medical and nursing personnel. A postal questionnaire survey was circulated to all consultant diabetologists, specialist registrars in diabetes and diabetes specialist nurses working in the Mersey Deanery area. Seventy-eight questionnaires were sent out, 63 (81%) returned. The perceived use of antiplatelet therapy was significantly higher for type 2 diabetes compared with type 1 diabetes, especially in the absence of complications or cardiovascular risk factors (52% vs 21%, p = 0.0004). Responses were more variable for type 1 diabetes: more nurses than doctors advised antiplatelet drugs in the absence of risk factors (46% vs 5%, p = 0.0002) and in the presence of smoking (79% vs 51%, p = 0.034). Aspirin was first-line choice of antiplatelet drug; clopidogrel was generally used for gastric intolerance and aspirin allergy. We conclude that the combination of limited evidence base and imprecise guidelines is not favouring proper usage of antiplatelet drugs and that more evidence-based didactic guidelines are required. Copyright © 2007 John Wiley & Sons. [source]

ACE inhibitors: their propertiesand current role in hypertension

PRESCRIBER, Issue 14 2009
Sze-Yuan Ooi MB BS
ACE inhibitors remain the first-line choice of treatment of hypertension in patients under 55 years, and second line in other patient groups. Our Drug Review considers their properties and the latest evidence for their use in hypertension, followed by further sources of information and an analysis of prescription data. Copyright © 2009 Wiley Interface Ltd. [source]