Worst Article Ever

[lobelsteve]

Medications for Pain: The Overlooked Drugs to Reconsider When Prescribing for Pain

A review of pain medications of the past and how they may help to optimize the treatments of today.

www.doximity.com

Written by a pharmacist and horrible advice for 95% of it. Insanity. Would offer choline mg trilisate for young healthy folks if failed celebrex, mobic, diclofenac, and otc nsaids.
I do use SMRs as opiate alternatives.
The rest of the article is pure trash.

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[deleted131481]

Dantrolene?! Save it for malignant hyperthermia.

We actually used mexilitine every now and then in fellowship. Maybe I'll pick it up again!

 

[myrandom2003]

Orphenadrine I use. They tout vioxx which you can’t even get, and levorphanol is not carried by any pharmacy in my region.
Otherwise, this is the stuff is silly.

 

[clubdeac]

Ha! I just read that article last night. Was wondering what some of you thought of it

 

[Gnarvin]

I have often thought about trying mexilitine but I never used it during fellowship and it appears that it has such serious potential side effects that I have never pulled the trigger. If anyone has used it before, what do you start with dosing wise and what would be contraindications/cautions for it?

 

[deleted131481]

I have often thought about trying mexilitine but I never used it during fellowship and it appears that it has such serious potential side effects that I have never pulled the trigger. If anyone has used it before, what do you start with dosing wise and what would be contraindications/cautions for it?

It's oral lidocaine analogue - very minimal as far as serious SEs. Article below: start 150mg daily and go up to 150mg tid. Seen doses as high as 900mg daily in literature.

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects - PubMed

Chronic pain, mexiletine, IV lidocaine, pain, neuropathic pain, neuropathy, fibromyalgia, QTc, tolerability.

pubmed.ncbi.nlm.nih.gov

They advocate a baseline EKG but literature doesn't support serious cardiac events. Lidocaine thought to be therapeutic for some arrythmias. Still I'd probably still avoid with serious cardiac disease or arrythmias.

 

[Gnarvin]

Thank you!

 

[Espn123]

Nuts

 

[Ducttape]

there is a reason that these medications were forgotten.


they never worked.

also:

Opioid analgesics may be considered as adjunctive therapy upon initiation and during optimization of non-opioid analgesics especially for severe pain,

which has happened like once in the past 200 years.

as far as i am aware, darvocet - propoxyphene - has been voluntarily withdrawn by the FDA in 2019. it is not available.


finally, the final dagger to this article:

Dr. Pham dedicates this article mentor and friend Jeffrey Fudin, PharmD.

 

[Ferrismonk]

Mexiletine? That's playing with fire for something that doesn't work. Monitor QTc interval, caution in CHF, HTN, seizures, and liver problems.

A local fellowship program near me used to do lidocaine infusions and if those "worked" the patient was titrated on to Mexiletine. Most patients I saw from this place did not report much relief with the medication. When I weaned them off they noticed no difference in their pain.

No thanks.

 

[Multimodal]

I get tons of these stupid links in my email everyday but this one stood out. Im glad to see Im not alone. I saw orphenadrine and was excited b/c I use that too but then I hit dantrolene and tuned out......just because in theory you can, does not mean, in practice, you should.

mexilitine sucks. has an NNT of a sideways 8

 

[deleted131481]

Mexiletine? That's playing with fire for something that doesn't work. Monitor QTc interval, caution in CHF, HTN, seizures, and liver problems.

A local fellowship program near me used to do lidocaine infusions and if those "worked" the patient was titrated on to Mexiletine. Most patients I saw from this place did not report much relief with the medication. When I weaned them off they noticed no difference in their pain.

No thanks.

Those side effects are generally non-existent or overblown if not an overt overdose. Mexilitine is safer than TCAs.

When have you seen lidocaine issues in the OR? Do you avoid it in CHF?

Agree NNT sucks. Most of our neuropathics suck though and I'm convinced half my responders are placebo. Gabapentin 100mg prn? Sure why not.

 

[soccrwz]

Those side effects are generally non-existent or overblown if not an overt overdose. Mexilitine is safer than TCAs.

When have you seen lidocaine issues in the OR? Do you avoid it in CHF?

Agree NNT sucks. Most of our neuropathics suck though and I'm convinced half my responders are placebo. Gabapentin 100mg prn? Sure why not.

you wouldn't see it, even if it did occur, because you give them a host of meds after including fentanyl prop and paralytics; many would get perioral numbness if you were intravascular with a test dose with an epidural so not exactly apples to apples

 

[deleted131481]

you wouldn't see it, even if it did occur, because you give them a host of meds after including fentanyl prop and paralytics; many would get perioral numbness if you were intravascular with a test dose with an epidural so not exactly apples to apples

True it's quite different. However I would think you would still see cardiac effects. Arrythmias and QTc prolongation generally do not happen with lidocaine/mexilitine and if anything these are therapeutic for those. Seizure would be hidden with lido+ other drugs. I don't think it has been reported with mexilitine except in attempted suicide.

I had never heard of mexilitine when I started fellowship a few years back and for some reason took an interest. I spent way too much time reading the drug information handout and random studies on it. What I recall was that it was much safer than people thought, but worked about as crappy as expected.

Anyways I don't even use the drug currently, haven't in years since fellowship although have thought about it. Once they fail two neuropathics the odds of any others working out are quite low in my experience.