Gene/Protein Disease Symptom Drug Enzyme Compound
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 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Somatic symptoms are one of the leading reasons for medical outpatient clinic visits, with the most common symptoms having a prevalence of 10% or more. However, the usual diagnostic workups are often unproductive, with less than 1 in 5 symptoms having an organic explanation after the initial physical examination and laboratory testing. Therapy appears more effective for some symptoms than for others. Of patients with unspecified pain or gastrointestinal complaints, greater than 70% state that some type of treatment has been helpful, whereas less than 50% of individuals with fatigue, dizziness, numbness, insomnia, sexual dysfunction, anxiety, or depression report any relief. Future educational efforts and research need to focus on that majority of symptoms that are either psychiatric or unexplained, in order to improve our current evaluation and management strategies.
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PMID:Symptoms in medical patients: an untended field. 173 31

Clomipramine is a newly marketed tricyclic antidepressant drug prescribed for obsessive-compulsive disorder (OCD). It selectively blocks neuronal uptake of serotonin. Clomipramine has been prescribed in Europe and Canada for 20 years in management of depression. Studies have now shown clomipramine to be effective in treating OCD. Dry mouth, visual disturbances, constipation, sexual dysfunction, somnolence, tremors, and dizziness are among the commonly reported side effects. Like other tricyclics, clomipramine exhibits a potential for cardiotoxicity, especially by impairing conduction and/or orthostasis. It also has the effect of lowering seizure threshold. Overdose risk is considerable. Careful medical supervision and adherence to prescribing guidelines are presumed to reduce medication risk factors. The outstanding benefit of this drug is its proved efficacy in the management of obsessive-compulsive disorder, as the first pharmacotherapy approved for this previously rather treatment-resistant condition.
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PMID:Clomipramine for obsessive-compulsive disorder: prescribing guidelines. 192 26

A double-blind, placebo- and amitriptyline-controlled comparison study was performed to evaluate the antidepressant efficacy of sertraline, a specific serotonin uptake inhibitor. Patients with DSM-III-defined major depression randomly received either sertraline (N = 149), amitriptyline (N = 149), or placebo (N = 150) once daily for the 8-week study period. The mean final daily medication dose for the all-patients group was 145 mg and 104 mg for the sertraline- and amitriptyline-treatment groups, respectively. As measured by the Hamilton Rating Scale for Depression and the Clinical Global Impressions Scale, both the sertraline and amitriptyline treatment groups showed a significantly greater improvement from baseline (p less than or equal to .001) than the placebo group. The sertraline group had a higher proportion of gastrointestinal complaints and male sexual dysfunction than either the amitriptyline or the placebo group. The amitriptyline group showed a higher proportion of anticholinergic and sedative side effects and dizziness compared with patients who received either sertraline or placebo.
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PMID:Antidepressant efficacy of sertraline: a double-blind, placebo- and amitriptyline-controlled, multicenter comparison study in outpatients with major depression. 189 91

Common symptoms account for substantial patient disability and health services utilization. To determine the prevalence of 15 symptoms and the adequacy of therapy, 500 medical outpatients were surveyed. The 410 respondents indicated which symptoms were "major problems" and what therapy, if any, had been helpful. Each symptom was present in at least 10% of patients, with the most prevalent symptoms being fatigue (33%) and back pain (32%). Patients were clustered into three groups: (1) 140 were asymptomatic or monosymptomatic, (2) 135 reported 2 or 3 symptoms, and (3) 135 had 4 or more symptoms. The majority (77%) of these symptoms had been previously reported to a physician. Whereas 80% of patients with pain syndromes and gastrointestinal complaints had obtained some therapeutic benefit, only 39% of the individuals with fatigue, dyspnea, dizziness, insomnia, sexual dysfunction, depression, and anxiety reported any relief. Better therapy is needed for these common outpatient complaints.
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PMID:The prevalence of symptoms in medical outpatients and the adequacy of therapy. 1132 37

Choice of an antidepressant medication is, in part, based on the side effects produced by a drug and the desire to avoid certain reactions in a particular patient. The clinician needs a reliable method of predicting which medications are most likely to produce specific untoward effects. Understanding the synaptic pharmacology of the most commonly used agents could serve as a tool for predicting possible side effects and drug-drug interactions. Antidepressant drugs alter neurotransmitter effects at nerve synapses, probably by blocking norepinephrine and serotonin reuptake, and blockade of neurotransmitter receptor sites - primarily the histamine H1 receptor, the muscarinic receptor, and the alpha-1-adrenoceptor. Possible clinical side effects related to some of these interactions include tachycardia, tremor, and (possibly) male sexual dysfunction (associated with norepinephrine reuptake blockade); sedation (associated with histamine H1 blockade); orthostatic hypotension, dizziness, and reflex tachycardia (associated with alpha-1-adrenoceptor blockade), and blurred vision, dry mouth, and memory dysfunction (associated with muscarinic receptor blockade). Pharmacologic data that demonstrate the potencies and selectivities of the antidepressant drugs for reuptake blockade and receptor site antagonism might allow the clinician to make an informed, rational choice of antidepressant therapy. This paper presents data on drug potencies and selectivities, and attempts to relate these data to anticipated side effects and drug-drug interactions.
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PMID:Pharmacology of antidepressants. 289 25

The long-term treatment of essential hypertension with terazosin, a new once-a-day alpha 1-adrenergic blocking agent, was evaluated in 364 hypertensive patients who received total daily doses of 1 to 40 mg for 3 weeks to 56 months. Consistent mean decreases in supine and standing systolic and diastolic blood pressures were observed throughout the study for patients treated with terazosin as monotherapy (supine, 9 to 12/10 to 13 mm Hg; and standing, 12 to 18/11 to 14 mm Hg) or in combination with other antihypertensive agents (supine, 12 to 16/12 to 15 mm Hg; and standing, 16 to 22/13 to 19 mm Hg). The most commonly reported adverse experiences were dizziness, headache, asthenia, cold symptoms, and nasal congestion. Adverse effects and metabolic disorders often associated with diuretics and beta blockers such as sexual dysfunction, hyperglycemia, hyperuricemia, hypokalemia, or adverse lipid effects were seen infrequently during long-term treatment with terazosin as monotherapy. Overall, terazosin was shown to be effective, safe, and well tolerated by most patients.
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PMID:Terazosin, a new selective alpha 1-adrenergic blocking agent. Results of long-term treatment in patients with essential hypertension. 290 Dec 67

A multicentre study was undertaken to determine whether side effects induced by hypotensive drugs could be reduced by replacement with low dose captopril. There were 100 patients on combinations of drugs, including diuretics, beta-blocking agents, methyldopa, clonidine and vasodilators. A questionnarie to obtain information on quality of life was completed by the patients. Each patient had major drugs, possibly responsible for side effects, withdrawn. Captopril was added at an initial dose of 12.5 up to 25 mg b.i.d. and titrated to a maximum of 50 mg t.i.d., until the blood pressure was equal to or lower than the level on entry into the study. Blood pressure was measured every two weeks and questionnaries were completed a number of times during the treatment period and scored at random, not in chronological order. A marked drop in blood pressure was obtained: mean systolic blood pressure went down from 173.4 +/- 2 to 154.5 +/- 2 mm Hg and diastolic blood pressure dropped from 104.5 +/- 11 to 9l.5 +/- 12 mm Hg. Neither tachycardia nor orthostasis was observed. Side effects, including inability to concentrate, nightmares, dizziness and sexual dysfunction, were reduced in 36% of the patients. Captopril itself produced no significant additional adverse reactions. It is concluded that captopril is a safe and effective drug, which can replace antihypertensive drugs that have deleterious side effects.
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PMID:Captopril as a replacement therapy in hypertension improving quality of life--a multicentre study. 331 35

The long-term efficacy and safety of labetalol, an antihypertensive agent with combined beta- and alpha-blocking activity, were evaluated alone (number = 193) and in combination with a diuretic (number = 144) in an open-label multicenter trial of 337 hypertensive patients aged 21 to 75 years, including initially 205 (61 percent) men and 219 (65 percent) Caucasians. There were 219 (65 percent) mild, 85 (25 percent) moderate, and 33 (10 percent) severe hypertensive patients. Labetalol (100 to 1,200 mg twice a day) alone or in combination with a diuretic reduced the mean standing blood pressure by 13/11 and 25/16 mm Hg to 135/88 and 130/91 mm Hg, respectively (p less than 0.01), and supine blood pressure by 6/7 and 18/13 mm Hg to 141/86 and 138/90 mm Hg (p less than 0.01), respectively. Blood pressure reductions observed at one month were maintained after one year; 206 (62 percent) patients had 10 mm Hg or greater reductions and 184 (56 percent) patients were maintained at diastolic blood pressures less than 90 mm Hg. Most frequently reported drug-related side effects included fatigue (14 percent), dizziness (12 percent), nausea (11 percent), nasal stuffiness (8 percent), headache (4 percent), and male sexual dysfunction (14 percent). Side effects were generally of mild to moderate intensity and often transient. In addition, in 27 (8 percent) patients reversible asymptomatic transaminase elevations to greater than twice normal developed at some time during the study. In 13 (4 percent) patients these alterations resolved during continued labetalol therapy, but in five (2 percent) patients these marked elevations led to discontinuation of the drug. A total of 32 (9.5 percent) patients were terminated prematurely due to side effects (most commonly genitourinary or gastrointestinal) possibly attributable to the drug. These findings indicate that labetalol with or without a diuretic is a potentially effective, safe, and relatively well-tolerated long-term antihypertensive therapy.
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PMID:Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension. 635 1

The antihypertensive efficacy and the incidence of side effects of prazosin and hydralazine were compared in a randomized, double-blind trial in 232 adult male hypertensives who could not be controlled with hydrochlorothiazide alone. There were no significant differences between regimens in the percentage of patients who attained goal blood pressure (reduction of diastolic blood pressure to below 90 mm Hg and at least 5 mm less than the baseline randomization pressure), effect on pulse rate or the incidence or reasons for terminations. Absolute reduction of blood pressure was similar for both drugs except for sitting systolic pressure at 3 and 6 months, when prazosin effected a 3.7- and 3.6-mm Hg greater response (p less than 0.05). Orthostatic dizziness (p less than 0.005), sexual dysfunction (p less than 0.02), and nightmares (p less than 0.02) were more frequent with prazosin than with hydralazine; nevertheless, patient compliance was similar for both drugs. An unexpected finding was the lack of pulse rate increase associated with hydralazine, particularly in older patients.
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PMID:Comparison of prazosin with hydralazine in patients receiving hydrochlorothiazide. A randomized, double-blind clinical trial. 702 44

Drug development in psychiatry has evolved from a process dependent on chance discovery to one based on rationally targeting specific mechanisms of action believed to be important in the pathophysiology underlying psychiatric syndromes. Antidepressant pharmacotherapy is the first area to have substantially benefited from this evolution. Serotonin selective reuptake inhibitors (SSRIs) were the first class of psychiatric medications developed based on such molecular targeting. Nefazodone is a new antidepressant that combines blockade of the serotonin-2 receptor with serotonin uptake inhibition. Perhaps as a result of this dual action, nefazodone caused fewer complaints of nervousness (e.g., agitation, anxiety), insomnia, and tremors and a higher incidence of confusion, dizziness, and vision disturbance than do other advanced generation antidepressants based on several different ways of assessing the relative incidence of these adverse effects. Reports of sexual dysfunction on nefazodone and bupropion treatment were lower than on treatment with other recently released antidepressants.
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PMID:Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. 764 68


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