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Garach Bhavikkumar, D.
- The Rationale of Use of Combination Therapy in Hypertensive Patients
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Authors
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1 Department of Pharmacy, JJT University, Vidyanagari, Churu Jhunjhunu Road, Chudela, District-Jhunjhunu–333001, Rajasthan, IN
1 Department of Pharmacy, JJT University, Vidyanagari, Churu Jhunjhunu Road, Chudela, District-Jhunjhunu–333001, Rajasthan, IN
Source
Research Journal of Pharmacology and Pharmacodynamics, Vol 5, No 1 (2013), Pagination: 19-25Abstract
The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Control of hypertension and treatment of concomitant pathophysiologic conditions require use of multiple drugs. Unfortunately, most studies regarding hypertensive disease have focused on monotherapy. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. Thus, our knowledge of combination therapy in the treatment of hypertension is to a great extent extrapolation from monotherapy. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. This combination therapy presents the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. Angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists combinations should be particularly efficacious in reducing hypertensive target organ disease. Both of these drug classes have been shown to reduce hypertensive heart disease, diminish microproteinuria, and the decline in renal function. With regard to hypertensive vascular disease, both ACE inhibitors and calcium antagonists have documented benefits.Keywords
ACE Inhibitors, Calcium Antagonists (calcium Channel Blocker), Left Ventricular Hypertrophy, Hypertension, Congestive Heart Failure, Combination Therapy, Drug Therapy, Angiotensin Receptor Blocker, Beta Blockers and Diuretic
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- Postoperative Pain after Spine Surgery: Comparative Efficacy of Diclofenac and Etoricoxib in Combination with Tramadol and Paracetamol at Lower Doses
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Study Design: Prospective, single blind, randomized single centre study The analgesic efficacy and safety of etoricoxib and diclofenac was compared in combination with tramadol and paracetamol at lower doses. Primary outcome measures were Visual Analogue Scale (VAS) and need for rescue analgesics and secondarily, average daily pain relief and patients' subjective rating of study medication were measured.
Background: Posterior spinal surgery is a common major orthopedic operation for certain spine disorders, however POP from the wound is unavoidable, which may increase morbidity and incidence of complications and prolong postoperative rehabilitation. It is difficult to achieve effective pain control using a single treatment. Most analgesics cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety and tolerability concerns. Rational combinations of analgesic with different mechanisms of action can improve efficacy and/or tolerability and safety compared with full analgesic dose individually.
Material and methods: 203 patients of spine surgery were divided in to 2 groups: group E (n=103, received etoricoxib 30 mg twice daily orally) and group D (n=100, received diclofenac 12.5 mg i.m. twice daily on the day of surgery and 25 mg thrice daily orally from the next day of surgery). Both groups received tramadol/paracetamol combination. Rescue medication as required were given. POP (post operative pain) was evaluated by VAS every 24 hr for 10 days.
Results: The POP of both study groups, as measured by VAS showed a significant reduction of pain at rest as well as on movement (p=0.0001) progressively in 10 days. There was no significant difference between the groups, except on day 2 when group D showed higher efficacy in reducing pain at movement. Significant differences were not found in need for rescue analgesic, daily pain relief, patient's preference and adverse outcomes in the groups.
Conclusion: Etoricoxib and diclofenac in combination with tramadol and paracetamol at lower doses are effective in reducing spinal POP especially after the first 48 hours.
Authors
Affiliations
1 Department of Pharmacy, JJT University, Vidyanagari, Churu Jhunjhunu Road, Chudela, District-Jhunjhunu–333001, Rajasthan, IN
1 Department of Pharmacy, JJT University, Vidyanagari, Churu Jhunjhunu Road, Chudela, District-Jhunjhunu–333001, Rajasthan, IN
Source
Research Journal of Pharmacology and Pharmacodynamics, Vol 5, No 1 (2013), Pagination: 62-68Abstract
Objective:Study Design: Prospective, single blind, randomized single centre study The analgesic efficacy and safety of etoricoxib and diclofenac was compared in combination with tramadol and paracetamol at lower doses. Primary outcome measures were Visual Analogue Scale (VAS) and need for rescue analgesics and secondarily, average daily pain relief and patients' subjective rating of study medication were measured.
Background: Posterior spinal surgery is a common major orthopedic operation for certain spine disorders, however POP from the wound is unavoidable, which may increase morbidity and incidence of complications and prolong postoperative rehabilitation. It is difficult to achieve effective pain control using a single treatment. Most analgesics cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety and tolerability concerns. Rational combinations of analgesic with different mechanisms of action can improve efficacy and/or tolerability and safety compared with full analgesic dose individually.
Material and methods: 203 patients of spine surgery were divided in to 2 groups: group E (n=103, received etoricoxib 30 mg twice daily orally) and group D (n=100, received diclofenac 12.5 mg i.m. twice daily on the day of surgery and 25 mg thrice daily orally from the next day of surgery). Both groups received tramadol/paracetamol combination. Rescue medication as required were given. POP (post operative pain) was evaluated by VAS every 24 hr for 10 days.
Results: The POP of both study groups, as measured by VAS showed a significant reduction of pain at rest as well as on movement (p=0.0001) progressively in 10 days. There was no significant difference between the groups, except on day 2 when group D showed higher efficacy in reducing pain at movement. Significant differences were not found in need for rescue analgesic, daily pain relief, patient's preference and adverse outcomes in the groups.
Conclusion: Etoricoxib and diclofenac in combination with tramadol and paracetamol at lower doses are effective in reducing spinal POP especially after the first 48 hours.
Keywords
Pain, Combination, Low Dose, Analgesia, NSAIDs, COXIBsReferences
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