SNRIs
Cymbalta for lower back pain
Cymbalta (duloxetine) will be used more for chronic musculoskeletal pain in the lower back or due to osteoarthritis . Cymbalta is already approved for neuropathic pain . Plus, it's approved for chronic musculoskeletal pain, so physicians are hearing more about this use, too. Some antidepressants do have analgesic effects, especially tricyclics (amitriptyline, …
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Rheumatology
Drug interactions with colchicine
As a clinical pharmacist, you should focus on common and serious drug interactions. Dosing and drug interactions with colchicine for acute gout are still causing confusion. We're all used to the old way of dosing colchicine for acute gout, two tabs initially then one tab every 2 hours until the pain stops, diarrhea starts, or a max of 5 tabs per day. But this c…
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Rheumatology
Caffeine may worsen rheumatoid arthritis
As a clinical pharmacist, you should always be aware of drug interactions. There's concern that caffeine might reduce the efficacy of methotrexate for rheumatoid arthritis ... Methotrexate decreases inflammation by increasing adenosine levels. Caffeine might cause a problem, because it's an adenosine receptor ANTAGONIST. It's goi…
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Steroids
Help patients stick with METHOTREXATE for rheumatoid arthritis
New guidelines will lead to questions about treating rheumatoid arthritis , especially with the plethora of medication options. For more information, see topic on Overview of rheumatoid arthritis . Which medication is first-line ? Recommend sticking with oral methotrexate 7.5 mg once weekly for most patients. Generally ad…
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Rheumatology
The latest recommendations for treating osteoarthritis
As a clinical pharmacist, it's essential to emphasize that exercise (such as walking and strengthening exercises) and weight loss, if needed, remain the main approaches for management. It's important to note that while oral NSAIDs like naproxen are often effective, they may not be suitable for everyone due to potential risks to the heart, stomach, and kidney…
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Rheumatology
Comparison of GOUT therapies
G out is one of the most common forms of arthritis. It occurs more often in men. During a gout attack, high uric acid levels lead to the formation of uric acid crystals in joints (usually knees, ankles, and feet; can affect elbows, wrists, and fingers). Symptoms can include pain, redness, joint swelling and limited range of motion, and fever. Gout risk factors inc…
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Rheumatology
Screening and management of osteoporosis
Introduction ㅡ Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Osteoporosis itself is asymptomatic, and often remains undiagnosed until a fragility fracture occurs. An osteoporotic fracture is a fragility fracture occurring as a consequen…
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