Drug Treatment of Depression in the 1990sMöller, H.; Volz, Hans-Peter
doi: 10.2165/00003495-199652050-00001pmid: 9118813
This article looks at the most important developments of antidepressants in the 1990s. The major properties of selective serotonin reuptake inhibitors, reversible and selective inhibitors of monoamine oxidase type A, selective serotonin and noradrenaline reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants are discussed. On the basis of the specific advantages and disadvantages of these compounds, unmet medical needs in the psychopharmacological treatment of depression are considered and the profile of an ideal antidepressant is outlined, followed by some closing remarks on potential new mechanisms of action.
Drug Treatment of Chemotherapy-Induced Delayed EmesisTavorath, Ranjana; Hesketh, Paul
doi: 10.2165/00003495-199652050-00002pmid: 9118814
Chemotherapy-induced emesis has a major adverse impact on patients undergoing therapy for various malignancies, and this has led to considerable research in this field. Most investigative efforts have concentrated on the acute phase of emesis that occurs within the first 24 hours after chemotherapy, and significant strides forward have been made with this problem. Better control of acute emesis with newer agents such as the serotonin 5-HT3 receptor antagonists has focused increasing attention on a second phase of nausea and vomiting, known as delayed emesis, which occurs more than 24 hours after chemotherapy. This delayed phase is often not as well controlled with the antiemetics that have proven effective in acute emesis, and contributes to the distress associated with emetogenic chemotherapy.
Choosing the Right Lipid-Regulating AgentFarmer, John; Gotto, Antonio
doi: 10.2165/00003495-199652050-00003pmid: 9118815
If dietary therapy and other lifestyle changes do not adequately normalise blood lipid levels, lipid-regulating drugs, as single-drug or combination-drug therapy, may be prescribed to supplement lifestyle changes. Evaluation of the individual patient’s health and risk status, determination of the dyslipidaemia, definition of treatment goals and a clear understanding of the mechanisms and effects of lipid-regulating agents are necessary for optimisation of treatment. Although all the available lipid-regulating agents lower low density lipoprotein (LDL) cholesterol, the agents with the greatest LDL cholesterol-lowering effect are the bile acid sequestrants, which up-regulate the LDL receptor by the decrease in intrahepatic cholesterol caused by the interruption of enterohepatic circulation of cholesterol-rich bile acids, and the HMG-CoA reductase inhibitors, which partially inhibit HMG-CoA reductase. The agents with the greatest triglyceride-lowering effect are nicotinic acid, which decreases the production of very low density lipoprotein (VLDL) cholesterol and reduces the availability of free fatty acids in the circulation, and the fibric acid derivatives, which increase lipoprotein lipase activity and may also decrease the release of free fatty acids. Although the safety profile of the available lipid-regulating drugs has been established, patients should be monitored for potential adverse effects and interactions with concomitantly administered agents. When used correctly, lipid-regulating drug therapy is highly effective in the treatment of a variety of dyslipidaemias.
Pharmacotherapy of Raynaud’s PhenomenonBelch, Jill; Ho, Meilien
doi: 10.2165/00003495-199652050-00006pmid: 9118818
Primary Raynaud’s phenomenon is common, particularly in younger women, and may be familial. Vasospasm is not confined to the digits and may involve, for example, the tongue and nose, and also visceral organs like the heart, oesophagus or lung and cerebral circulation. Symptoms tend to be milder in primary compared with secondary Raynaud’s phenomenon, which is associated with other disorders such as the connective tissue diseases. Indeed, the severity of symptoms often acts as the predictor for the much later onset of the associated systemic disease. Occupational Raynaud’s phenomenon is related to the use of vibrating instruments, and a significant proportion of patients may be cured by an early change in job. In those over 60 years of age, Raynaud’s phenomenon is commonly a result of atherosclerotic obstructive arterial disease, and screening for and treatment of the risk factors is appropriate.