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• UK prescription data from a longitudinal patient database were analysed retrospectively to assess persistence with darifenacin, flavoxate, oxybutynin (extended release [ER] and immediate release [IR]), propiverine, solifenacin, tolterodine (ER/IR) and trospium. • Data were extracted from the medical records of >1,200,000 registered patients via general practice software, and anonymized prescription data were collated for all eligible patients with documented OAB (n = 4833). • Data were collected on patients who started treatment between January 2007 and December 2007 and were collected up to December 2008, to allow each patient a full 12-month potential treatment period. Failure of persistence was declared after a gap of at least 1.5 times the length of the period of the most recent prescription. • The analysis included only patients who were new to a course of treatment (i.e. who had not been prescribed that particular treatment or dosage for at least 6 months before the study period).
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Emepronium bromide and flavoxate have both and separately been used with success in the treatment of detrusor instability. In this study we have combined the two drugs emepronium bromide and flavoxate and compared the results with emepronium bromide. 20 consecutive patients with an uninhibited bladder, 12 men and 8 women, were randomly allocated to treatment with either emepronium bromide/flavoxate or emepronium bromide. In this trial we found that treatment with the combination is significantly better than treatment with emepronium bromide only.
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Majority of Indian population is dependent on general practitioners (GPs) for medical services at primary care level in India. They are most preferred and considered to be first contact person for medical services at primary care level. But advances in medical science has put more emphasis on specialist culture and average Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates who are working as general physician are gradually feeling themselves less competent because they are less exposed to latest advances in treatment of diseases. Amidst such scenario, Christian Medical College (CMC) has come up with an idea: "The refer less and resolve more initiative". It has started a decentralized 2-year family medicine distance diploma course (Postgraduate Diploma in Family Medicine (PGDFM)) now accredited by Dr. MGR Medical University, Chennai, Tamil Nadu, that trains the GPs to become family medicine specialist.
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The c-AMP phosphodiesterase inhibiting properties of flavoxate and of its main metabolite i.e. 3-methylflavone-8-carboxylic acid (MFCA), were assayed in vitro and compared to those of theophylline. Flavoxate and MFCA are competitive phosphodiesterase inhibitors, and are 21 and respectively 5 times more potent than theophylline. The smooth muscle relaxing activity of flavoxate possibly relies on this enzymatic mechanism.
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No drug had a definite Naranjo score, but the following drug entities had probable Naranjo scores and 2° ACG scores ≥ 4: acetazolamide, "anorexiant mix," bupropion, cabergoline, "ecstasy," escitalopram, flavoxate, flucloxacillin, hydrochlorothiazide, hydrochlorothiazide/triamterene, mefenamic acid, methazolamide, oseltamivir, topiramate, topiramate/bactrim, and venlafaxine. Root chemical analysis revealed that sulfur-containing and non-sulfur-containing compounds contributed to bilateral 2° ACG.
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Amongst all the interventions studied, flavoxate was effective and well-tolerated, with almost negligible side effects, making it worthy of consideration for the treatment of OAB.
We conclude that the minimal side effects and high tolerability of flavoxate make it worthy of consideration for the treatment of several clinical urogynecological conditions. It deserves more clinical studies to assess its efficacy as no randomized controlled trials have been performed with flavoxate during the last decade. More studies and novel drug formulations may reveal or improve its efficacy in daily practice.
K(+) -Krebs'-induced contraction developed more slowly while 64 Hz electrical field stimulation-induced contraction developed faster in flavoxate-treated strips when compared to control. Amplitudes of maximal and steady-state contraction induced by 3 µmol/L carbachol were also larger after flavoxate treatment. Control strips showed an overall greater dependence on stimulus strength in eliciting the responses.
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Pharmacotherapy constitutes an important adjunct to behavioral therapy for the treatment of overactive bladder (OAB). Tolterodine and oxybutynin are commonly prescribed drugs for OAB treatment that exert their beneficial effect by suppressing bladder muscle contractions. However, high discontinuation rates have been observed for these drugs in clinical trials, as well as in real-world settings, in part due to adverse effects. Extended-release (ER) formulations were introduced with an improved tolerability profile over immediate-release (IR) versions of the 2 drugs. No study has compared persistence and adherence to therapy for both the ER and IR versions of tolterodine and oxybutynin.
Randomised trials and cross-over trials (blinded and unblinded) that are either placebo-controlled or comparing two or more treatments.
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The rostral pontine reticular formation has a strong inhibitory effect on micturition by facilitating lumbosacral glycinergic neurons. We assessed the influence of the rostral pontine reticular formation on the micturition reflex after noradrenaline injection in the medial frontal lobe. We also examined the relation between the medial frontal lobe and the rostral pontine reticular formation.
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The present study aimed to clarify, by means of micro-spectroscopy, the mechanism of aggregation of particles into granules during high-shear granulation. We used two types of pharmaceutical granules prepared by high-shear granulator, one containing mefenamic acid and the other containing flavoxate hydrochloride as poorly soluble active pharmaceutical ingredients (APIs). Lactose, cornstarch, and microcrystalline cellulose were used as excipients; and hydroxypropyl cellulose (HPC) was used as the binding agent. The distributions of components in granules were visualized by mapping cross-sections of individual granules with techniques utilizing mid-infrared spectroscopy at the SPring-8 synchrotron radiation facility and micro-Raman spectroscopy. In the distribution maps of mefenamic acid granules, distributions of mefenamic acid, cornstarch, and microcrystalline cellulose overlapped; in flavoxate hydrochloride granules, on the other hand, distributions of flavoxate hydrochloride and lactose overlapped. Assessment of the surface free energy of each component found that ingredients with overlapping distribution had similar surface properties. Therefore, it was revealed that in high-shear granulation, in addition to the granulator operating conditions and general properties of the formulation itself (such as the solubility and particle size of each ingredient), the surface properties of the ingredients and their interrelationships were also factors that determined the aggregation behavior of the particles.
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A high-performance liquid chromatographic method was proposed for the separation of relative impurities in industrial 3-methylflavone-8-carboxylic acid (MFCA) and its intermediate methyl 3-propionylsalicylate (MPS). Benzoic acid (BA), MPS, 6-chloro-3-methylflavone-8-carboxylic acid (MFCA-Cl) and methyl 5-chloro-3-propionylsalicylate (MPS-Cl) in MFCA, and MPS-Cl in MPS were respectively quantified by an external standard method. As results showed, the linearity of standard curves was excellent with the relative coefficients of over 0.999 for all the detected components, and the intra- and inter-day precisions of impurities determination were satisfactory with the relative standard deviation of not more than 8.0%. Under the selected experimental condition, the chromatographic fingerprints of MFCA and MPS were drawn synthetically, and the transfer of impurities in the stepwise reactions of MFCA manufacture was elucidated. The fingerprints have great potential in instructing the production of MFCA for industrial use and in conducting the conversion of relative impurities.
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In such a relatively rare condition there are obvious difficulties in identifying sufficient patients to participate in a randomised controlled trial. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence, the absence of randomised controlled trials makes it impossible to draw any firm conclusions.
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A detailed study and analysis of several hundred cases of motor urge incontinence in the female is presented and summarized. This includes the incidence, the history referring to a questionnaire with a new urge and stress score, the symptomatology, possible etiological factors, the cystometric manifestation and the responsiveness to several treatment modalities and medications. A comparison of flavoxate, emepronium, propantheline and a placebo for the treatment of urinary incontinence due to bladder instability is made, the results are discussed and recommendations are made.
Sixty-three reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of two trials which were unrandomised and unblinded studies with a control group for comparison of effect. Although these two trials, Micic 1988, (intravesical placental extract) and Milani 1988, (flavoxate) provided the strongest evidence they were not randomised and were essentially isolated controlled studies.
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The following assay methods for pharmacokinetic studies on flavoxate (F) and on its main metabolite, i.e. 3-methylflavone-8-carboxylic acid (A), are described. 1. Spectrophotometry for the assay of F and of A in plasma, 2. TLC-Spectrodensitometry and GLC for the assay of A in urine after acid hydrolysis, 3. TLC-Spectrodensitometry for determining the F : A ratio in plasma or in urine. It was found that F hydrolyzes into A. This process depends on the pH and on the medium. In water, at pH 5.0, F is stable, while in phosphate buffer at pH 7.4 the semi-hydrolysis time is 60 min. In a solution with bovine serum albumin, in rat, rabbit, dog or human plasma the semi-hydrolysis times are between 5 and 60 min. Finally the plasma-red cells repartitions of F and of A were studied in vitro in rat, rabbit, dog and human blood and found between 0.8 and 2.0 for F and between 2.1 and 4.6 for A.
Forty inpatient men and women, between 50 and 80 years of age, with nocturia due to bladder instability, resorption of postural edema, or senile involution were admitted to a clinical trial designed to test the possibility of reducing or eliminating nocturnal voidings by means of a single evening dose of rociverine or flavoxate. This six-day crossover trial was divided into three periods of two days each: pretrial, treatment with one drug, and treatment with the other drug. Either 20 mg of rociverine or 200 mg of flavoxate was given at 8 PM in randomized sequence. For each night of the study, the following data were recorded: interval between drug administration and first voiding, volume of first voiding, total volume of nocturnal urine, total volume of nocturnal urine plus volume of urine passed on waking, and total number of nocturnal voidings. The outcome was a significant reduction of the number of nocturnal voidings together with a marked lengthening of the interval between drug administration and first voiding, with no noteworthy differences between the two drugs. Considering the efficacy of rociverine and, even more important, the excellent tolerance of elderly patients to the drug, further study of rociverine in nocturia and in urinary incontinence seems indicated.
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A total of 82 female rats were anesthetized with urethane. Under isovolumetric conditions physiological saline, carbachol, flavoxate or propiverine was injected into the RPRF or intravenously. Changes in bladder activity and amino acid levels in the lumbosacral cord were examined.
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To assess the absolute and comparative efficacy, tolerability and safety of anticholinergic agents in MS patients.
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In rats, the effect of flavoxate on contractile responses in isolated detrusor strips, bladder contraction induced by pelvic nerve stimulation, isovolumetric rhythmic bladder contractions, and pelvic nerve activity were examined. In decerebrated cats, flavoxate was microinjected into the nuclei in the pons, and its effect on reflex micturition was observed.