RESUMEN
Short acting oral formulas make part of optimal opioid analgesia. The use of short acting oral morphine has not widely spread in Hungary, and these drugs completely lacked from the market for three years. Since December 2015 short acting morphine-sulphate has again been commercialised. The causes of the market failure are analysed in this article. The aim of the retrospective analysis is to help the accessibility of the medicine to every patient in need. Prescription morphine use depends on the harmonised cooperation of a number of actors. Besides regulating and financing authorities and professional organisations, patients and the opinion forming media are also responsible for building up the right routine.
Asunto(s)
Analgésicos Opioides , Analgésicos de Acción Corta , Accesibilidad a los Servicios de Salud , Dependencia de Morfina/prevención & control , Derivados de la Morfina , Dolor/tratamiento farmacológico , Administración Oral , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Analgésicos de Acción Corta/administración & dosificación , Analgésicos de Acción Corta/efectos adversos , Industria Farmacéutica , Educación Médica Continua , Fentanilo/administración & dosificación , Agencias Gubernamentales , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Hungría , Seguro de Salud , Medios de Comunicación de Masas , Derivados de la Morfina/administración & dosificación , Derivados de la Morfina/efectos adversos , Derivados de la Morfina/farmacología , Dolor/etiología , Pautas de la Práctica en Medicina , UniversidadesRESUMEN
In clinical trials a single dose of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has shown a rapid antidepressant effect in patients with treatment-resistant depression and bipolar depression. The implications of glutaminergic mechanisms in depression and the rapid effect of a single dose of ketamine could open new pathways to understand the pathophysiology of depression and the development of novel rapid-acting antidepressant drugs.
Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Antagonistas de Aminoácidos Excitadores/uso terapéutico , Ketamina/uso terapéutico , Enfermedad Aguda , Analgésicos de Acción Corta/administración & dosificación , Analgésicos de Acción Corta/efectos adversos , Analgésicos de Acción Corta/química , Analgésicos de Acción Corta/uso terapéutico , Anestésicos Disociativos/administración & dosificación , Anestésicos Disociativos/efectos adversos , Anestésicos Disociativos/química , Anestésicos Disociativos/uso terapéutico , Antidepresivos/administración & dosificación , Antidepresivos/efectos adversos , Antidepresivos/química , Trastorno Bipolar/tratamiento farmacológico , Antagonistas de Aminoácidos Excitadores/administración & dosificación , Antagonistas de Aminoácidos Excitadores/efectos adversos , Antagonistas de Aminoácidos Excitadores/química , Humanos , Ketamina/administración & dosificación , Ketamina/efectos adversos , Ketamina/química , Placebos , Escalas de Valoración Psiquiátrica , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptores de N-Metil-D-Aspartato/antagonistas & inhibidores , Resultado del TratamientoRESUMEN
AIM: There is a need to elucidate the variables associated with testosterone suppression among men on daily opioid therapy for chronic pain. OBJECTIVE: The objective of this study was to examine several variables related to opioid use including daily dose, duration of action (long acting vs. short acting), and specific opioid to ascertain specific influences on total serum testosterone levels in men with chronic pain who use opioids daily. SETTING: This is a retrospective cohort study of men within the Kaiser Permanente, Northern California (KPNC) health care system on some form of daily opioid use for chronic pain. PARTICIPANTS: Eighty-one men between the age of 26 and 79 years were seen in a chronic pain clinic between January 2009 and June 2010. All men were on stable dose of an opioid for at least 3 months, none with a previous diagnosis of hypogonadism. MAIN OUTCOME MEASURES: Total serum AM testosterone levels were measured at KPNC Regional Laboratory. RESULTS: Average total serum AM testosterone levels for this population showed 53% of all men receiving daily opioids were hypogonadal (AM total serum testosterone <250 ng/dL). In men receiving long-acting opioids, 74% (34/46) were hypogonadal compared with 34% (12/35) in men using short-acting opioids (hydrocodone or oxycodone) exclusively [AM total testosterone: median, 126 ng/dL; mean, 169 ng/dL (SD, 128 ng/dL) vs. median, 283 ng/dL; mean, 315 ng/dL (SD, 142 ng/dL); P<0.001]. After controlling for daily dosage and body mass index, men on long-acting opioids had 4.78 times greater odds of becoming hypogonadal than did men on short-acting opioids [95% confidence interval (CI), 1.51-15.07; P=0.008]. Body mass index was also significantly associated with hypogonadism (odds ratio, 1.13; 95% CI, 1.03-1.24; P=0.006), whereas daily dose was not (odds ratio, 1.02; 95% CI, 0.99-1.05; P=0.29). CONCLUSIONS: Among a contemporary sample of men receiving chronic daily opioids, we found a high prevalence of hypogonadism associated with duration of action, but not with total daily dose of the opioid.