胃复安联合针灸加艾灸治疗糖尿病合并尿潴留的效果分析

目的了解胃复安联合针灸加艾灸治疗糖尿病合并尿潴留的临床效果。方法80例糖尿病合并尿潴留患者,随机分为治疗组和对照组,各40例。两组患者均给予基础治疗,治疗组患者加用胃复安联合针灸加艾灸治疗。比较两组患者临床疗效。结果治疗后,治疗组中31例患者治愈,8例患者好转,1例患者无效,总有效率为97.50%;对照组中18例患者治愈,12例患者好转,10例患者无效,总有效率为75.00%;治疗组患者的治疗总有效率显著高于对照组,差异具有统计学意义(P<0.05)。结论应用胃复安联合针灸加艾灸治疗糖尿病合并尿潴留得到满意临床治疗效果,值得推广应用。     

胃复安引起双侧下颌关节脱位一例

胃复安引起双侧下颌关节脱位一例山东省莱西市人民医院口腔科张贤奎患者刘某，男，３５岁。因下颌前伸，开闭口困难２．５ｈ来诊。患者因患胃炎，服用胃复安、庆大霉素片治疗。胃复安于饭前３０ｍｉｎ口服，每次１０ｍｇ，每日３次。第６次服药后约２ｈ左右，感下颌不自主...     

Efficacy and tolerability of nasally administered compared to parenterally administered metoclopramide in the symptomatic treatment of chemotherapy-induced emesis in cancer outpatients A controlled clinical study

The clinical efficacy and tolerability of a new nasal spray formulation of metoclopramide (MTC) was evaluated in terms of its ability to prevent the nausea and vomiting induced by a moderately emetic chemotherapy (cisplatin 20 mg/m² weekly as radioenhancer+radiotherapy for a fractionated total of 60 Gy) in 12 patients with non-small-cell lung cancer, stage IIIB. The first chemotherapy cycle was administered without any prophylaxis in order to identify those patients who experienced grade 2 nausea and/or vomiting. As prophylaxis during the second cycle, these patients were given MTC 20 mg i.v. at time zero, and MTC 20 mg i.m. after 4 h and 8 h; during the third cycle, they received MTC 40 mg by nasal spray 2 h before chemotherapy, followed by the same dose at 4 h and 8 h. The two prophylactic treatments (parenteral injections and nasal spray) proved to be therapeutically equivalent: complete protection, 6 and 6 patients respectively; major protection, 2 and 3 patients; minor protection, 1 and 1 patients; no protection, 3 and 2 patients. The control of nausea was satisfactory, with 7 and 9 patients respectively experiencing grade 0–1 nausea. Comparative analysis of individual responses confirmed the similar anti-emetic efficacy of the two regimens. No adverse reactions were observed at any time during the course of the study, and all 12 patients judged the acceptability of the new formulation as optimal. It can thus be concluded that the use of metoclopramide nasal spray represents an effective, safe, easily managed and low-cost therapeutic alternative for the prophylaxis and treatment of emesis induced by low-dose chemotherapy. The results of the present study could also promote a regular use of the MTC nasal spray in other fields of oncological supportive therapy.     

甲氧氯普胺口崩片的制备及体外溶出度考察

摘 要 目的： 制备甲氧氯普胺口崩片并优化处方,并对其体外溶出度进行考察。方法: 采用全因子试验设计,以填充剂配比（X₁）、崩解剂（X₂,%）用量为影响因素,以脆碎度（Y₁,%）、崩解时限（Y₂,s）、甲氧氯普胺在15 min的溶出度（Y₃,%）为片剂考察指标优化处方;并考察其在4种溶出介质中的溶出行为。结果: 甲氧氯普胺口崩片的最优处方组成为：填充剂甘露醇与微晶纤维素比例为2.5∶1、崩解剂占片重为6.5%。甲氧氯普胺口崩片在4种溶出介质中累积溶出度均大于80%。结论:甲氧氯普胺口崩片处方设计合理,制备工艺可行,质量可控。     

Metoclopramide for the treatment of diabetic gastroparesis

ABSTRACT

Introduction: Gastroparesis is a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction. Diabetes is the most commonly known cause of gastroparesis. Management of diabetic gastroparesis involves lifestyle modifications, glycemic control, pharmacological drugs, and for refractory cases surgical treatments. Metoclopramide remains the only drug approved by the Food and Drug Administration for diabetic gastroparesis. The aim of this article is to provide a concise review of the pharmacology, clinical efficacy and tolerability of metoclopramide.

Areas covered: We searched PubMed using the key words ‘metoclopramide’, ‘diabetic gastroparesis’, and ‘gastric emptying’. The relevant articles and their bibliography were reviewed. Metoclopramide acts on several different receptors; primarily as a dopamine receptor antagonist, both peripherally improving gastric emptying, and centrally resulting in an anti-emetic effect. Metoclopramide side effects, mostly related to its ability to cross the blood-brain barrier, include drowsiness, restlessness, hyperprolactinemia, and tardive dyskinesia (TD), a movement disorder that may be irreversible.

Expert opinion: Metoclopramide carries a black box warning for use >12 weeks due to the risk of TD. However, gastroparesis patients experience chronic symptoms often requiring prolonged treatments. Physicians and patients look forward to FDA approval of new agents for gastroparesis with better efficacy and safety profile.     

Effect of different polymers and their combinations on the release of metoclopramide HCl from sustained-release hydrophilic matrix tablets

Metoclopramide HCl (MTC) is commonly used for the management of gastrointestinal disorders. It has a short biological half-life and is usually administered four times daily to maintain effective concentrations throughout the day. The aim of this study is to develop sustained-release hydrophilic matrix tablet formulations of drug to achieve reproducible and predictable release rates, extended duration of activity, decreased toxicity, reduction of required dose, optimized therapy, and improved patient compliance. Hydroxypropylmethyl cellulose (HPMC), carboxymethylcellulose sodium (NaCMC), chitosan and Carbopol 981 were incorporated in the matrix system separately or in combinations as release controlling factor by direct compression technique. Compatibility among the formulation components was assessed by DSC and FTIR analysis. MTC release from matrix was evaluated by using the US Pharmacopeia dissolution apparatus II. All formulations met the criteria of pharmacopeial requirements. Dissolution studies show that polymer type and concentration are important parameters on drug release. Chitosan, carbopol and NaCMC formulations exhibited pH-dependent drug release profile whereas HPMC did not. All the formulations containing 1:1 ratio of HPMC and chitosan exhibited desired drug release showing that all active substance releases progressively in a period of whole dissolution time and therefore it can be regarded as worthy of consideration for the manufacture of sustained-release MTC product.     

Relaxant effects of metoclopramide and magnesium sulfate on isolated pregnant myometrium: an in vitro study

BackgroundMetoclopramide and magnesium sulfate are extensively used agents in obstetrics. In this study, the relaxant properties of metoclopramide and magnesium sulfate on pregnant myometrium, together with the possible reversing influences of oxytocin and cabergoline (a dopamine D₂ receptor agonist), were investigated.MethodsMyometrial strips from 24 parturients were randomly allocated to four groups: control (Group CON), magnesium sulfate and oxytocin (Group MSO), metoclopramide and oxytocin (Group MEO), and metoclopramide and cabergoline (Group MEC). Myometrial strips were mounted on a myograph bathed in Krebs buffer. Saline (Group CON) and five incremental doses of magnesium sulfate (Group MSO) or metoclopramide (Groups MEO and MEC) were sequentially microinjected into the bath. Subsequently, oxytocin (Groups CON, MSO and MEO) or cabergoline (Group MEC) was microinjected into the bath. The myometrial contractile characteristics after each drug injection, including contractile force, interval and duration, were analyzed.ResultsMagnesium sulfate was more potent for prolonging myometrial contractile interval than reducing contractile force. Metoclopramide relaxed myometrial contractions by inhibiting contractile force and prolonging contractile interval in a concentration-dependent manner. Oxytocin reversed both the inhibited contractile force and the prolonged contractile interval caused by a high concentration of magnesium sulfate but accelerated the contractile interval and had no significant effect on the contractile force suppressed by metoclopramide. The relaxant effects of metoclopramide were completely reversed by cabergoline.ConclusionsBoth magnesium sulfate and metoclopramide relaxed myometrial contractions, and exhibited different responses to subsequent oxytocin treatment. The relaxant mechanism of metoclopramide may be via blockade of dopamine D₂ receptor, which requires further investigation.     

胃复安、非那根联合用药与格拉斯琼在防治化疗引起呕吐的疗效观察

目的观察以胃复安、非那根联合用药防治顺铂化疗引起呕吐的疗效。方法随机分为两组，一组为观察组，接受胃复安、非那根联合止吐，一组为对照组，接受格拉斯琼止吐。结果联合用药取得与格拉斯琼相似的止吐效果。结论胃复安＋非那根药价低，疗效好，在非禁忌病人及经济困难病人可选用。     

Postoperative nausea and vomiting prophylaxis: The efficacy of a novel antiemetic drug (palonosetron) combined with dexamethasone

BackgroundPalonosetron is a new, potent, and long-acting 5HT3-receptors antagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. This study is designed to evaluate its efficacy combined with dexamethasone in PONV prophylaxis in highrisk patients scheduled for laparoscopic surgeries.MethodsIn this double-blind, active-controlled study, 150 patients aged 20–55 years, ASA I–II, and with Apfel’s PONV score 2–4 were equally randomized to receive dexamethasone 8 mg before anesthesia induction and saline 30 min before the end of surgery (group D + S), dexamethasone 8 mg before anesthesia induction and metoclopramide 25 mg 30 min before the end of surgery (group D + M), or dexamethasone 8 mg combined with palonosetron 0.075 mg before anesthesia induction and saline 30 min before the end of surgery (group D + P). Incidences of early and late PONV, complete response, adverse events from antiemetics used, and overall patients’ satisfaction were recorded.ResultsThe incidence of PONV was comparable in the three groups 0–6 h postoperatively. Palonosetron–dexamethasone and dexamethasone–metoclopramide combination therapies significantly reduced the incidence of PONV at 6–12 h postoperatively compared to dexamethasone monotherapy (12% and 16%, vs. 36%, respectively, with P < 0.05). Moreover, palonosetron–dexamethasone combination therapy significantly reduced the incidence of PONV at 12–24 h postoperatively compared to both dexamethasone monotherapy (16% vs. 48%, P < 0.01), and dexamethasone–metoclopramide combination therapy (16% vs. 40%, P < 0.05). The incidence of adverse drug effects was comparable in the three groups. The overall patients’ satisfaction was significantly higher in palonosetron–dexamethasone combination therapy compared to other groups.ConclusionPalonosetron–dexamethasone combination is effective and safe in PONV (early and late) prophylaxis in high-risk patients undergoing laparoscopic surgeries with known high-risk of PONV.     

甲氧氯普胺与恩丹西酮对化疗或术后恶心呕吐的疗效和安全性荟萃分析

目的　对甲氧氯普胺与恩丹西酮预防化疗 /术后恶心、呕吐的有效性和安全性进行系统性评价。方法　系统检索Medline 196 6～ 2 0 0 2年数据库和中国生物医学文献光盘数据库 (CBMdisc) 1978～ 2 0 0 2年文献。根据纳入标准和排除标准筛选文献 ,由 2名评价者各自独立地对入选文献中有关试验设计、研究对象的特征、研究结果等内容进行摘录和质量评价 ,并对各研究结果进行异质性检验和数据合并。结果　共收集 33篇合格随机临床对照试验报告 ,评分在 6 5～ 95分之间 ,其中优质文献 (≥ 85分 )19篇。甲氧氯普胺治疗恶心、呕吐的近期 (用药时程为 1d和 3d)有效率明显不如恩丹西酮 ,差异有显著性 (P <0 .0 1) ,远期 (用药时程为 3d以上 )有效率差别不大。甲氧氯普胺引起锥体外系症状和腹痛、腹泻不良反应明显多于恩丹西酮 ,差异均有显著性 (P <0 .0 1)。而引起便秘不良反应明显少于恩丹西酮 ,差异有显著性 (P <0 .0 1)。引起头痛不良反应与恩丹西酮相仿 ,差异无显著性 (P =0 .4 1)。当甲氧氯普胺的日均剂量小于 2 0mg时 ,未见锥体外系症状发生 ;当日均剂量超过 10 0mg时 ,其锥体外系症状发生率为 17.4 %。结论　甲氧氯普胺治疗恶心、呕吐的疗效较恩丹西酮差 ,但远期疗效比较接近。甲氧氯普胺引起锥体外系症状和腹