Brian Hemstreet

Evidence for the Use of Gabapentin in the Treatment of Diabetic Peripheral Neuropathy

BACKGROUND One of the most common peripheral nerve complications of diabetes is painful diabetic peripheral neuropathy (DPN). Although tricyclic antidepressants (TCAs) have traditionally been used to relieve the pain of this condition, gabapentins reported efficacy in various neuropathic pain states and its favorable side-effect profile compared with other available agents have led to interest in the use of this agent for the treatment of DPN. OBJECTIVES This paper reviews the current clinical literature on the effectiveness and tolerability of gabapentin in the treatment of DPN. It also considers whether the evidence favors gabapentins use as an alternative or first-line agent. METHODS A search of the English- and French-language literature for the years 1990 through 2000 was performed using MEDLINE, Current Contents/Clinical Medicine, and International Pharmaceutical Abstracts, plus the reference lists of the articles identified through this search. The search terms used were gabapentin, anticonvulsant, diabetic peripheral neuropathy, and neuropathy. Included studies were limited to trials in human subjects. RESULTS The literature search identified several case reports and case series, as well as 3 small placebo-controlled studies (2 complete, 1 brief report) and 1 comparative trial against the TCA amitriptyline. The designs and dosing regimens differed between studies. CONCLUSIONS Many clinicians consider gabapentin an alternative treatment option in patients with DPN who are unable to tolerate traditional agents or in whom traditional agents are contraindicated. To date, gabapentin has been well tolerated, superior to placebo, and equivalent to amitriptyline in small clinical trials of short duration. Although overall efficacy and safety profiles appear to be favorable, larger long-term studies are needed to determine the place of gabapentin in relation to other treatment options. There is currently insufficient evidence from controlled trials to support the use of gabapentin as first-line therapy for DPN.

Use of Sucralfate in Renal Failure

OBJECTIVE: To assess the potential for the development of aluminum toxicity in patients with renal insufficiency or chronic renal failure who are taking sucralfate. DATA SOURCES: Clinical literature accessed through MEDLINE (1966–December 1999) and International Pharmaceutical Abstracts (1970–December 1999). Key search terms included sucralfate, renal failure, renal insufficiency, and end-stage renal disease. DATA SYNTHESIS: Urinary excretion is an important route of elimination for systemically absorbed aluminum. Accumulation of aluminum in patients with impaired renal function may lead to significant toxicity. A potential source of aluminum is the antiulcer medication sucralfate. Studies and case reports evaluating the use and toxicity of sucralfate in patients with normal renal function, as well as those with renal failure or renal insufficiency, were reviewed. CONCLUSIONS: Aluminum accumulation and toxicity have been reported with the use of sucralfate in patients with compromised renal function. The risk of toxicity most likely represents a long-term complication of sucralfate use in this patient population. Toxicity may be enhanced by concurrent use of other aluminum-containing medications, such as phosphate binders or antidiarrheal preparations. These medications, in addition to sucralfate, should be avoided if possible in patients with end-stage renal disease. Patients with renal failure or renal insufficiency who are undergoing prolonged sucralfate therapy should be monitored for potential signs of aluminum toxicity.

Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 18th Edition

Self-Care Components of Selected Chronic Disorders (Chapter 45). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (17th Edition). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care up-to-date product availability information, whereas the 17th edition includes some. Pharmacists, firth edition, Robert McCarthy, Jones and Handbook of Nonprescription Drugs: an Interactive. Approach to SelfCare. 17th ed. Washington, DC:.

Vitamin D’s role in the pathogenesis and treatment of IBD

Vitamin D (VD) is a fat-soluble vitamin that exists in two major forms, ergocalciferol (VD2) and cholecalciferol (VD3). 1,2 The classiceffects of VD involve calcium and phosphorus homeostasis and regulation of bone mineralization. More recently, it has been recognized thatVD has a host of other intra-organ autocrine, paracrine, and intracrine actions that may result in significant immunomodulatory effects. 1 As aresult, there is greater interest in the possible role of VD defficiency in the development of chronic in ammatory conditions such as in ammatorybowel disease (IBD). 1–3 This chronic, incurable, immune-mediated in ammatory disorder of the gastrointestinal tract consists of twosubtypes, Crohn disease (CD) and ulcerative colitis. 4