The Effect of Combined Therapy of Intranasal Desmopressin Spray and Sublingual Piroxicam in Patients with Acute Renal Colic

Yıl 2009, Cilt: 16 Sayı: 1, 29 - 32, 01.02.2009

Cüneyt Özden Cevdet Serkan Gökkaya İsa Günay Özgür Demirdal Özdem Levent Özdal Ali Memiş

Öz

Introduction: Desmopressin is a synthetic antidiuretic hormone (ADH) analogue. When it is compared to ADH, the anti-diuretic effect is more and longer. In recent years it is used to relieve pain in patients with acute renal colic. In the present study we evaluated the effect of combined therapy of intranasal desmopressin spray and sublingual piroxicam in patients with acute renal colic. Materials and Methods: Forty-five patients with renal colic included into the study. Patients were randomized into 3 groups. The first group (n=15) received 40 µg intranasal desmopressin spray, the second group (n=15) 40 mg sublingual piroxicam and the third group (n=15) received 40 µg intranasal desmopressin spray in addition to 40 mg sublingual piroxicam. To evaluate the intensity of pain, visual analogue scale (VAS) was used and the patients were asked to grade the pain ranging from 0-10. Results: Mean pain scores 10 and 20 minutes after the treatment was lower in group 3 when compared to the other groups and there was not any significant difference between group 1 and 2. Mean pain scores 30 minutes after the treatment in group 1 was significantly higher when compared to other groups and there was not any significant difference in groups 2 and 3. Need for additional treatment (intramuscular 50 mg pethidin) was significantly lower in group 3 (59.1%, 27.3% and 13.6% respectively). Conclusion: Our data demonstrated that combined therapy of sublingual piroxicam and intranasal desmopressin was effective to relieve pain in patients with acute renal colic. Key words: Desmopressin, Piroxicam, Acute Renal Colic

Anahtar Kelimeler

Desmopressin, Piroxicam, Acute Renal Colic

Akut Renal Kolikli Hastalarda Dilaltı Piroksikam ve İntranazal Dezmopressin Kombine Tedavisinin Etkisi

Öz

Giriş: Dezmopressin sentetik antidiüretik hormon (ADH) analoğudur. ADH ile karşılaştırıldığında antidiüretik etkisi daha fazla ve uzundur. Son yıllarda akut renal kolik ağrısının tedavisinde kullanılmaktadır. Bu çalışmada akut renal kolik ağrılı hastalarda dilaltı piroksikam ve intranasal dezmopressin kombine tedavisinin etkisi değerlendirildi. Materyal-Metot: Çalışmaya 45 renal kolikli hasta dahil edildi. Hastalar randomize olarak 3 gruba ayrıldı. İlk gruba (n=15) 40 µg intranazal dezmopressin sprey, 2. gruba 40 mg dilaltı piroksikam ve 3. gruba ise 40 mg dilaltı piroksikama ek 40 µg intranazal dezmopressin verildi. Hastaların ağrı şiddeti görsel anolog skala (VAS) kullanılarak 0 ile 10 arasında derecelendirildi. Bulgular: Tedaviden 10 ve 20 dakika sonra ortalama ağrı skoru grup 3'de diğer gruplara göre daha düşüktü ve grup 1 ile 2 arasında anlamlı fark yoktu. Tedaviden 30 dakika sonra ortalama ağrı skoru grup 1'de diğer gruplara göre daha yüksekti ve grup 2 ile 3 arasında anlamlı fark yoktu. Tedavi sonrası ek tedavi ihtiyacı (intramusküler 50 mg pethidin) grup 3'de anlamlı derecede daha düşüktü (sırasıyla; %59.1, %27.3 ve %13.6). Sonuç: Bizim sonuçlarımız akut renal kolikli hastaların ağrısının dindirilmesinde piroksikam ve intranazal dezmopressin kombine tedavisinin etkili olduğunu gösterdi. Anahtar kelimeler: Dezmopressin, Piroksikam, Akut Renal Kolik

Anahtar Kelimeler

Dezmopressin, Piroksikam, Akut Renal Kolik

Kaynakça

• Rembratt A, Graugaard-Jensen C, Senderovitz T, Norgaard JP, Djurhuus JC. Pharmacokinetics and pharmacodynamics of desmopressin administered orally versus intravenously at daytime versus night-time in healthy men aged 55-70 years. Eur J Clin Pharmacol 2004; 60:397-402.
• Kimoto Y, Constantinou CE. Effects of [1-desamino-8-D- arginine] vasopressin and papaverine on rabbit renal pelvis. Eur J Pharmacol 1990; 17:359-62.
• Lopes T, Dias JS, Marcelino J, Varela J, Ribeiro S, Dias J. An assessment of the clinical efficacy of intranasal desmopressin spray in the treatment of renal colic. BJU Int 2001; 87: 322-5.
• Constantinides C, Kapralos V, Manousakas T, Mitropoulos D, Alamanis C, Dimopoulos C. Management of renal colic with intranasal desmopressin spray. Acta Urol Belg 1998; 66:1-3.
• Miralles R, Camí J, Gutiérrez J, Torné J, Garcés JM, Badenas JM. Diclofenac versus dipyrone in acute renal colic: a double- blind controlled trial. Eur J Clin Pharmacol 1987; 33:527-8.
• Al-Waili NS. Intramuscular tenoxicam to treat acute renal colic. Br J Urol 1996; 77:15-6.
• Perlmutter A, Miller L, Trimble LA, Marion DN, Vaughan ED Jr, Felsen D. Toradol, an NSAID used for renal colic, decreases renal perfusion and ureteral pressure in a canine model of unilateral ureteral obstruction. J Urol 1993; 149:926- 30.
• Lennon GM, Bourke J, Ryan PC, Fitzpatrick JM. Pharmacological options for the treatment of acute ureteric colic. An in vitro experimental study. Br J Urol 1993; 71:401- 7.
• Gramke HF, Petry JJ, Durieux ME, Mustaki JP, Vercauteren M, Verheecke G, et al. Sublingual piroxicam for postoperative analgesia: preoperative versus postoperative administration: a randomized, double-blind study. Anesth Analg 2006; 102:755- 8.
• Olkkola KT, Brunetto AV, Mattila MJ. Pharmacokinetics of oxicam nonsteroidal anti-inflammatory agents. Clin Pharmacokinet 1994; 26: 107-20.
• Altay B, Horasanli K, Sarica K, Tanriverdi O, Kendirci M, Miroglu C. Double-blind, placebo-controlled, randomized clinical trial of sublingual or intramuscular piroxicam in the treatment of renal colic. A comparative study. Urol Int 2007; 79:73-5.
• Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition. Am J Med 1999; 13:65-70.
• El-Sherif AE, Salem M, Yahia H, al-Sharkawy WA, al-Sayrafi M. Treatment of renal colic by desmopressin intranasal spray and diclofenac sodium. J Urol 1995; 153:1395-8.
• Patchev VK, Racké K, Almeida OF. Adrenalectomy and experimental hypercorticalism modulate the basal, corticotropin-releasing-hormone- and arginine-vasopressin- stimulated release of hypothalamic beta-endorphin. Neuroendocrinology 1991; 54:111-7.
• Kjaer A. Vasopressin as a neuroendocrine regulator of anterior pituitary hormone secretion. Acta Endocrinol (Copenh) 1993; 129:489-96.