Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

(1) Intermittent claudication is usually a sign of generalised vascular atheroma, with prognosis mainly depending on the degree of coronary and cerebral involvement. Treatment is based on smoking cessation and regular exercise. Vasodilators have a purely symptomatic effect, modest at best, in increasing walking distance; (2) Cilostazol, a phosphodiesterase III inhibitor, is licensed in France (after 20 years on the market in Japan) as a treatment intended to increase walking distance in patients with intermittent claudication; (3) A double-blind placebo-controlled trial in 1439 patients showed no reduction in mortality after 3 years of treatment; (4) Cilostazol has been compared with pentoxifylline, another vasodilator with uncertain efficacy, in 3 clinical trials. No tangible difference in efficacy was observed; (5) A meta-analysis of 7 double-blind placebo-controlled trials in a total of 1579 patients showed that cilostazol increased the pain-free walking distance by about 30 metres and the maximum walking distance by about 50 metres; (6) There is some evidence that cilostazol causes a dose-dependent increase in mortality, although the data are not statistically significant. However, excess mortality has been documented with other phosphodiesterase III inhibitors, especially in patients with heart failure; (7) Cilostazol can provoke dose-dependent cardiac arrhythmias, and sometimes haemorrhage (due to its antiplatelet effect); (8) Cilostazol is extensively metabolised by cytochrome P450 isoenzymes CYP 3A4 and CYP 2C6, creating a high risk of pharmacokinetic interactions with other drugs and with food; (9) In practice, patients with intermittent claudication should not be given cilostazol; they should instead be prescribed an antiplatelet drug and encouraged to stop smoking and to exercise regularly.
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PMID:Cilostazol: new drug. Intermittent claudication: too little efficacy, too many risks. 1958 17

Brain derived nerve factor (BDNF) is a trophic factor belonging to the neurotrophin family. It is upregulated in various inflammatory conditions, where it may contribute to altered pain states. In cystitis, little is known about the relevance of BDNF in bladder-generated noxious input and bladder overactivity, a matter we investigated in the present study. Female rats were intraperitoneally (i.p.) injected with cyclophosphamide (CYP; 200 mg/kg). They received saline or TrkB-Ig(2) via intravenously (i.v.) or intravesical administration. Three days after CYP-injection, animals were anaesthetized and cystometries performed. All animals were perfusion-fixed and the spinal cord segments L6 collected, post-fixed and processed for c-Fos and phosphoERK immunoreactivity. BDNF expression in the bladder, as well as bladder histology, was also assessed. Intravesical TrkB-Ig(2) did not change bladder reflex activity of CYP-injected rats. In CYP-animals treated with i.v. TrkB-Ig(2) a decrease in the frequency of bladder reflex contractions, in comparison with saline-treated animals, was observed. In spinal sections from the latter group of animals, the number of phosphoERK and c-Fos immunoreactive neurons was lower than in sections from saline-treated CYP-animals. BDNF immunoreactivity was higher during cystitis but was not changed by TrkB-Ig(2) i.v. treatment. Evaluation of the bladder histology showed similar inflammatory signs in the bladders of inflamed animals, irrespective of the treatment. Data show that i.v. but not intravesical administration of TrkB-Ig(2) reduced bladder hyperactivity in animals with cystitis to levels comparable to those observed in unirritated rats. Since i.v. TrkB-Ig(2) also reduced spinal extracellular signal-regulated kinase (ERK) activation, it is possible that BDNF contribution to inflammation-induced bladder hyperactivity is via spinal activation of the ERK pathway. Finally, the reduction in c-Fos expression indicates that TrkB-Ig(2) also reduced bladder-generated noxious input. Our results show that sequestration of BDNF may be considered a new therapeutic strategy to treat chronic cystitis.
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PMID:Sequestration of brain derived nerve factor by intravenous delivery of TrkB-Ig2 reduces bladder overactivity and noxious input in animals with chronic cystitis. 2007 9

Tapentadol hydrochloride (17(-)-(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol) is a newly released analgesic that works at two levels: by acting as a p-opioid agonist and as a modulator of descending inhibitory pathways through its effects on neurotransmitters involved in these pathways. The theoretical advantage is the provision of synergistic analgesic activities, which may lessen the need for opioid escalation. The advantage is its potential as a possible new agent in neuropathic pain. Preclinical models confirm analgesic properties in acute pain and neuropathic pain models, but with less potency than morphine. Tapentadol has minimal CYP 450 interactions limiting potential for drug interactions. Human clinical trial data in nonmalignant pain suggest less potency than a step-3 opioid, and the drug remains to be tested in patients with cancer pain and neuropathic pain.
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PMID:Tapentadol: an initial analysis. 2156 Oct 31

Opioids are increasingly used to manage not only acute but also chronic pain and heroine addiction. These patients usually receive many other medications that can interfere with the effects of opioids and vice versa. Patients often need combinations of drugs for their pain management, for treating opioid-related adverse effects or for other indications including depression and anxiety. Several antibiotics can also have interactions with opioids. It is important to understand what potential interactions exist between opioids and other drugs. Drug interactions can occur due to pharmacokinetic interactions including effects of absorption, metabolic pathways, drug transport through membranes and protein binding. Our knowledge of the metabolism of opioids has significantly increased over the last years and it is now possible to appreciate the role CYP enzymes, mainly CYP 2D6 and 3A4/5, in the metabolism of many commonly used opioids like codeine and oxycodone. Our knowledge regarding the role of the transporter proteins in drug interactions related to opioids is unfortunately meagre. Opioids inhibit the gastrointestinal system and can thus change the absorption of other drugs. Opioids can have synergistic or additive interactions with other drugs that have analgesic or sedative effects. Endogenous opioids control many physiological functions and exogenous opioids can have effects on all important transmitter systems (cholinergic, GABAergic, dopaminergic and serotonergic). The literature in this field is mainly based on case reports. Interindividual differences play an important role. Other potential interactions include prolongation of the QT-interval and lowering of the threshold for convulsions.
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PMID:Non-analgesic effects of opioids: interactions between opioids and other drugs. 2274 48

Treatment of medullary thyroid cancer is mainly based on surgery. Life expectancy exceeds 10 years in almost half of patients with inoperable advanced or metastatic disease. Cytotoxic chemotherapy is generally ineffective when this malignancy progresses. Vandetanib (Caprelsa, AstraZeneca), a multiple kinase inhibitor, is authorised in the European Union for use in this setting. Its clinical evaluation is mainly based on a double-blind, randomised, placebo-controlled trial in 331 patients, 70% of whom had progressed within the previous 6 months. Median follow-up (2 years) is too short to detect an impact on overall survival (about 85% in both groups). Analyses based on other outcomes (progression-free survival and pain) are unreliable, due to the large amount of missing data. The adverse effect profile of vandetanib is unfavourable: it includes diarrhoea and other gastrointestinal disorders, cardiovascular disorders, and cutaneous, neuropsychological, haemorrhagic and metabolic disorders. Visual disturbances have also been observed. Vandetanib also prolongs the QT interval: 3 cases of torsades de pointes and 9 sudden deaths have already been reported. Renal failure increases this risk. Numerous pharmacokinetic interactions are likely to occur, notably via cytochrome P450 isoenzyme CYP 3A4. Vandetanib reduces the effectiveness of levothyroxine. Vandetanib should not be combined with other drugs that prolong the QT interval. The long half-life of vandetanib (about 3 weeks) must be taken into account when managing interactions and adverse effects. There is no firm evidence that vandetanib has a favourable harm-benefit balance in patients with inoperable advanced or metastatic medullary thyroid cancer.
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PMID:Vandetanib: too dangerous in medullary thyroid cancer. 2318 43

Treprostinil, a stable prostacyclin analogue used in the treatment of pulmonary arterial hypertension, is in development as a sustained release oral tablet, treprostinil diolamine (United Therapeutics Corp, Research Triangle Park, NC). As combination therapy yields additional benefit in pulmonary arterial hypertension, treprostinil diolamine may be used with sildenafil, a phosphodiesterase-5 inhibitor. This study was designed to evaluate the presence of a pharmacokinetic drug interaction between treprostinil diolamine and sildenafil. Treprostinil is primarily metabolized by cytochrome (CYP) P450 2C8 with minor contribution from CYP2C9. Sildenafil is metabolized by CYP3A4 with minor contribution from CYP2C9. Eighteen healthy volunteers were randomized to receive 4.5 days each of (1) treprostinil diolamine alone, (2) sildenafil alone, and (3) combination treprostinil diolamine and sildenafil in an open-label, 3-period, 3-sequence crossover study. The geometric mean ratio (90% confidence intervals) for combination/agent alone of steady state area under the concentration-time curve and peak concentration (Cmax) were 0.972 (0.824-1.145) and 1.030 (0.900, 1.1-9), respectively, for treprostinil diolamine and were 0.881 (0.804-0.966) and 0.910 (0.876-0.946), respectively, for sildenafil. The results suggest lack of a metabolic interaction between treprostinil diolamine and sildenafil, as geometric mean ratio 90% confidence intervals were within 0.8-1.25. Combination therapy was well tolerated but had slightly higher rates of nausea, headache, and extremity pain than monotherapy.
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PMID:Lack of a pharmacokinetic interaction between treprostinil diolamine and sildenafil in healthy adult volunteers. 2342 88

Oxygen deprivation followed by reoxygenation causes pathological responses in many disorders, including ischemic stroke, heart attacks, and reperfusion injury. Key aspects of ischemia-reperfusion can be modeled by a Caenorhabditis elegans behavior, the O2-ON response, which is suppressed by hypoxic preconditioning or inactivation of the O2-sensing HIF (hypoxia-inducible factor) hydroxylase EGL-9. From a genetic screen, we found that the cytochrome P450 oxygenase CYP-13A12 acts in response to the EGL-9-HIF-1 pathway to facilitate the O2-ON response. CYP-13A12 promotes oxidation of polyunsaturated fatty acids into eicosanoids, signaling molecules that can strongly affect inflammatory pain and ischemia-reperfusion injury responses in mammals. We propose that roles of the EGL-9-HIF-1 pathway and cytochrome P450 in controlling responses to reoxygenation after anoxia are evolutionarily conserved.
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PMID:Cytochrome P450 drives a HIF-regulated behavioral response to reoxygenation by C. elegans. 2381 Dec 25

A novel series of 3-arylsulfonylamino-5,6-dihydro-6-substituted-1H-pyrazolo[3,4-c]pyridine-7-ones was designed and synthesized as 5-HT6 ligands. Among the derivatives synthesized, the lead compound, 12b, having piperidine functionality at the 6-position and (1-naphthyl)sulfonamino at the 3-position of the core structure showed the most potent 5-HT6 inhibitory activity in vitro, good stability without CYP liability, and good neuropathic pain alleviation activity in a rat animal model.
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PMID:Synthesis and the 5-HT6 receptor antagonistic effect of 3-arylsulfonylamino-5,6-dihydro-6-substituted pyrazolo[3,4]pyridinones for neuropathic pain treatment. 2382 Mar 87

The purpose of this article is to provide an overview of some of the important information related to safety and tolerability of duloxetine. Duloxetine, a potent reuptake inhibitor of serotonin and noradrenaline, is effective for the treatment of major depressive disorder, anxiety disorder, and painful diabetic neuropathy (PDN). Duloxetine is safe and well-tolerated across indications, with few reported serious side effects. Common adverse events are consistent with the pharmacology of the molecule and are mainly referable to the gastrointestinal and the nervous systems. Duloxetine should not be used in combination with CYP 1A2 inhibitors or nonselective, irreversible monoamine oxidase inhibitors. Duloxetine has a generally favorable side effect profile and dosing is simple. Nausea is the most common side effect, but it occurs less frequently if treatment is initiated at 30 mg . day-1 and titrated after one week to 60 mg . day-1, an efficacious dosage at which pain relief can occur within one week. Clinical trials have demonstrated the analgesic efficacy of duloxetine for PDN and fibromyalgia in addition to improvements in quality-of-life measurements. Furthermore trials for osteoarthritis, headache, and the pain associated with Parkinson disease may provide insight into alternative uses for duloxetine.
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PMID:[Duloxetine for chronic pain management: pharmacology and clinical use]. 2390 4

TRP-channels are the most prominent family of ligand-gated ion channels for pain perception. In sensory neurons, TRPV1-V4, TRPA1 and TRPM8 are expressed and are responsible for the conversion of external stimuli to painful sensations. Under pathophysiological conditions, excessive activity of TRP-channels leads to mechanical allodynia and thermal hyperalgesia. Among the endogenous TRP-channel sensitizers, activators and inhibitors, more than 50 arachidonic acid- and linoleic acid-metabolites from the COX-, LOX- and CYP-pathways, as well as lysophospholipids and isoprenoids can be found. As a consequence, these lipids represent the vast majority of endogenous TRP-channel modulators in sensory neurons. Although the precise mechanisms of TRP-channel modulation by most lipids are still unknown, it became clear that lipids can either bind directly to the target TRP-channel or modulate TRP-channels indirectly by activating G-protein coupled receptors. Thus, TRP-channels seem to be key sensors for lipids, integrating and interpreting incoming signals from the different metabolic lipid pathways. Here, we discuss the specific properties of the currently known endogenous lipid-derived TRP-channel modulators concerning their ability to activate or inhibit TRP-channels, the molecular mechanisms of lipid/TRP-channel interactions and specific TRP-regulatory characteristics of the individual lipid families.
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PMID:TRP-channels as key integrators of lipid pathways in nociceptive neurons. 2428 69


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