Posted by merm on 3/26/2009, 5:46 am, in reply to "Current Drug Therapies for FM/CMP PAY ATTENTION TO WHAT YOU ARE TAKING"
Compounding Pharmacists
Compounding pharmacists are different than standard pharmacists. They are like the ancient apothecaries, only with all the present day knowledge and technology available. All pharmacists learn something about compounding prescriptions, but compounding pharmacists are specialists in the formulation of pharmaceutical compounds from basic ingredients, in the exact dosage form, strength and combination you require. You may need a dye-free, sugar-free, alcohol–free or preservative-free formulation, for example.
When you take a medication orally, you dose the whole body. Often this is not necessary for localized symptoms. It isn’t sufficient for any pharmacist to put a drug into topical form. This drug must be bioavailable in this form, and a true compounding pharmacist knows how to do this. Standard topical preparations compounded include NMDA- and Calcium Channel Blockers, medications such as Neurontin, NSAIDs and opioids. Your doctor may not be utilizing this option, and you may be able to provide him/her with an important contact.
Generic Medicines
Generic and brand name drugs are not always exact equivalents. Some FMS and CMP patients may be sensitive to the differences. The generic company must prove to the FDA that when someone takes the drug, the amount of the active substance released by the generic is the same as would be obtained with the brand- name drug (that it is bioequivalent). Doctors and patients are led to believe that this means the generics are the same as the brand names. This is not always true. The FDA considers two formulations as bioequivalent when the rate of adsorption varies no more than -20% or +25% (Banahan, Kolassa 1997). This means that there can be 20 percent less usable medication in a dose, or 25 percent more!
Prescription Medications List
This list of medications is only a partial listing of those used in FMS and CMP, and doesn’t even include all that we have in our book. For details on the use of common pharmaceutical and non-pharmaceutical medications for chronic pain, see The Chronic Pain Control Workbook (Catalano and Hardin, 1996) and Pain: Clinical Manual (McCaffery M. and C. Paseo, 1999).
Ambien (zolpidem): This is a hypnotic for insomnia. It can be a tremendously effective sleep aid, but you may have to get in bed right after you take it. One study showed that short-term treatment with Ambien (5 to 15 mg) doesn’t affect FMS pain, but is useful for sleep and subsequent daytime energy (Moldofsky, Lue, Mously et al. 1996). William Dement, the father of the field of sleep medicine, writes that Ambien is the safest and most useful sleep medication for long-term use as well (Dement and Vaughan, 1999). There have been some reports of serious depression from Ambien. Some patients have reported difficulty discontinuing it, and had to decrease it by a quarter pill a night. Others have had no problem. I have had an alarming number of people contact me saying that their doctors have refused to prescribe this medication because it is addictive, in spite of the fact that studies show that it has a lower abuse potential than other hypnotics (Soyka, Bottlender and Moller, 2000).
Atarax (hydroxyzine HCl): This antihistamine and anxiety-reliever may be useful if itch, rashes or hives is a problem.
BuSpar (buspirone HCl): This drug may improve memory, reduce anxiety, and help regulate body temperature. It is not as sedating as many other antianxiety drugs.
Catapres (clonidine): This drug may help Restless Leg Syndrome (RLS)(Wagner, Walters, Coleman et al. 1996).
COX-2 medications: Ariva, Vioxx, and Celebrex are sometimes called super aspirin. They are easier on the gastrointestinal tract than earlier NSAIDS. They may carry a greater risk of heart attack, stroke, or other cardiovascular problem (McAdam, Catella Lawson, Mardini et al. 1999).
Desyrel (trazodone): This antidepressant may help with sleep problems. It must be taken with food. It should not be used in women who may be or may become pregnant.
Diflucan (fluconazole): This antifungal penetrates all body tissues, including the central nervous system. Very short-term use can be considered if cognitive problems and/or depression are present and yeast is suspected. Yeast problems may indicate need for diet modification.
Effexor (venlafaxine HCl): This is an antidepressant and serotonin and norepinephrine reuptake inhibitor. Food has no effect on its absorption. When discontinuing this, taper off slowly.
Elavil (amitriptyline): This antidepressant is inexpensive, but it can cause photosensitivity, morning grogginess, weight gain, dry mouth, and slow intestinal movements. It may cause RLS.
Flexeril (cyclobenzaprine): This may sometimes stop spasms, twitches, and some tightness of the muscles. It generates stage-four sleep, but it may cause gastric upset and a feeling of detachment.
Ethyl Chloride: This vapocoolant spray is useful for spray and stretch treatment, to inhibit pain impulses, and to allow for passive stretching.
Guaifenesin: Guaifenesin is the active ingredient in many expectorants, and is used experimentally for FMS. Most OTC guaifenesin preparations contain sugar, alcohol, and/or pseudoephredine. These should be avoided.
Inderal (propranolol HCl): This may help reduce the pain load, although your blood pressure may drop with its use. Antacids will block its effect.
Klonopin (klonazepam): This is an antianxiety, anticonvulsive and antispasmodic medication. It may help with muscle twitching, RLS, and nighttime teeth grinding.
Lidocaine, intravenous: Studies show that in animals, intravenous lidocaine can provide prolonged relief of some types of allodynia (Chaplan, Bach, Shafer et al. 1995).
Neurontin (gabapentin): This anticonvulsant is effective for hyperalgesia and allodynia (Attal, Brasseur, Parker et al. 1998.) You may be able to lessen any side effects by drinking extra water. As dosage increases, bioavailability decreases. A 400 mg dose is about 25% less bioavailable than a 100 mg dose. This medication should not be discontinued abruptly.
Opioids: Due to the fact that some doctors consider the use of opioids to be controversial in the treatment of FMS and CMP, these medications are covered in depth at the end of this list.
NMDA (N-methyl-D-aspartate) inhibitors: NMDA antagonists can moderate or eliminate some symptoms of central sensitization, such as secondary hyperalgesia (Oestreicher, Desmeules, Piguet et al.1998.) NMDA inhibitors include ketamine, dextromethorphan, memantine, amantadine, methadone, dextropropoxyphene, and ketobemidone. NMDA-receptor inhibitors may be effective in the treatment of some types of chronic pain (Sang, 2000). Ketamine reduces pain in a sub-group of FMS patients (Graven-Nielsen, Aspegren, Henriksson et al. 2000). NMDA inhibitors also boost the effect of opioids.
Pamelor (nortriptyline HCl): This tricyclic antidepressant is used for insomnia. Some people find it stimulating, however, and must take it in the morning to allow restorative sleep that night.
Paxil (paroxetine HCl): This SSRI may also reduce pain, and has been found helpful in menopausal hot flashes (Gender Issues). Some people find it stimulating, and may need to take it in the morning to allow for sleep that night.
Piracetam: This is an extract of ginko biloba. It seems to step up the flow of messages between the two halves of the brain (Flicker and Grimley Evans, 2000). It may stimulate the cerebral cortex and increase the rate of metabolism and energy level of brain cells.
Procaine injection for TrPs: TrP Injection protocols can be found in Travell and Simons Trigger Point Manuals. TrP injections must be given in the proper manner, with the patient properly positioned for each specific muscle, and performed with spray and stretch, rewarming, and range of motion exercises. Perpetuating factors must be addressed for lasting effects. TrP injections are not to be done with steroids.
Relafen (nabumetone): This NSAID may be better tolerated because it is absorbed in the intestine, thus sparing the stomach.
Message Thread:
« Back to thread