hydromorphone (PF329) / Ensysce Biosciences - LARVOL DELTA

Cross-Fostering with control dams rescues Gut Dysbiosis and Chromatin-associated Transcriptional Changes in Offspring of Opioid-Exposed Dams. (PubMed, bioRxiv) - "Here using a murine model of prenatal hydromorphone exposure, we examined gut microbiota, intestinal injury, transcriptomic signatures, and chromatin accessibility...Fecal microbiota transplantation from exposed dams recapitulated intestinal injury, indicating a microbiome-driven mechanism. These findings reveal a novel gut-microbiome-epigenome axis underlying opioid-induced injury and highlight early microbial intervention as a potential strategy to mitigate developmental harm."

Journal • Transplantation

Standardized Clinical Pathways Improve Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department (ASH 2023) - "A total of 0 (0%) hydromorphone PCAs were administered in the ED in the pre-pathway cohort compared to 4 (3.8%) hydromorphone PCA administered in the ED in the post-pathway cohort... Standardizing pain management using a clinical pathway has shown improvement in ED management of VOE in the first year post implementation with increased utilization of intranasal fentanyl and PCAs. Our goal of increased percentage of patients receiving pain medication within 30 minutes and decreased time to first analgesic was not achieved, however this is an ongoing project and with education in implementation of the clinical pathway we hope to continue to see long term progress. Additionally, in the future, we plan to expand use of this pathway to additional sites within our health care system."

Clinical • Anesthesia • Genetic Disorders • Hematological Disorders • Pediatrics • Sickle Cell Disease

Zn-CysHis Protein Factor Families: Role of Electrostatic Interaction of Zn-Domains in Factor Functions (PubMed, Mol Biol (Mosk)) - "We have shown that the positive electrostatic potential of Zn-domains plays an essential role in forming contact of factors' Zn-domains with DNA/RNA in three protein factor families PF00096, PF12874, and PF09329. While in other three families PF03119, PF08996, and PF01258 Zn-domains do not contact with nucleic acids, and electrostatic interactions do not play a distinctive role, consequently."

Journal

Rare case of laryngeal edema and anaphylaxis to Ofirmev (IV Acetaminophen): Case Report (ASRA-PM 2017) - "...The patient’s medication list prior to surgery included vancomycin (first dose a day prior with no complications), SQ Heparin, amitriptyline, abilify, clonazepam, flexeral, duloxetine, lamictal, losartan, levothyroxine, and hydromorphone...In our case, the medications received in the perioperative period were as follows: midazolam, propofol, fentanyl, vancomycin, zofran, bupivacaine, Ofirmev, ephedrine, and phenylephrine...Angioedema was noted in 8 out of 266 patients (3.01%). Despite IV Acetaminophen’s growth as a popular adjunct in the administration of balanced analgesia, this patient’s unfortunate case demonstrates the importance of vigilant monitoring in the acute pain setting."

Clinical • Biosimilar • Bipolar Disorder • Breast Cancer • Cardiovascular • CNS Disorders • Demo Pain • Depression • Immunology • Obesity • Oncology • Pain

Role of neuroimaging in progressive cognitive impairment (AGS-AM 2017) - "...Meds: aspirin, clopidogrel, prednisone, donepezil, duloxetine, gabapentin, mirtazapine, dextroamphetamine-amphetamine, fentanyl patch and hydromorphone...However neuroimaging findings were conclusive, and the diagnosis was established. This case illustrates the role of neuroimaging in cases of cognitive decline where there is an atypical clinical course or ambiguity."

Clinical • Alzheimer's Disease • Biosimilar • CNS Disorders • Depression • Epilepsy • Oncology • Ophthalmology

Regional Anesthesia in the Facilitation of Rapid Recovery following Complex, Multisystem Trauma (ASRA-PM 2017) - "...Decreasing the infusion rate abolished the epidural’s analgesic efficacy, thus the patient was started on a nalbuphine infusion which mitigated the respiratory depression while maintaining analgesia...We chose the T10-11 interspace to cover post-surgical pain while taking advantage of the hydrophilic properties of hydromorphone to cover his rib fractures. In this case, the utilization of ERAS recommendations including placement of a thoracic epidural proved successful via several benchmarks, including a reduced daily morphine equivalent from 180mg to 25mg, as well as a decreased length of stay as compared to the literature cited average."

Clinical • Acute Coronary Syndrome • Atherosclerosis • Biosimilar • CNS Disorders • Demo Pain • Depression • Dyslipidemia • Genito-urinary Cancer • Immunology • Oncology • Pain • Prostate Cancer

Randomized Prospective Trial Comparing the Use of Intravenous Versus Oral Acetaminophen in Total Joint Arthroplasty. (PubMed) - J Arthroplasty - "The use of IV acetaminophen may have a role when given intraoperatively to reduce the immediate pain after surgery. Following that, it does not provide a significant benefit in reducing pain or narcotic use when compared with the much less expensive PO form."

Journal • Biosimilar • Pain

"Dilaudid, Exalgo (hydromorphone) dosing, indications, interactions, adverse effects, and more https://t.co/wQAbxIaNIt via @medscape" (@Oxyconmdamu)

Adverse events • Biosimilar

"Dilaudid, Exalgo (hydromorphone) dosing, indications, interactions, adverse effects, and more https://t.co/ZGQQ0zylxn via @medscape"

Adverse events • Biosimilar

Postoperative pain following supraclavicular block as primary anesthetic for upper extremity surgery in the super obese patient case report and retrospective review of charts (ASRA-PM 2017) - "...Under ultrasound guidance, the brachial plexus was identified at a depth of 4 cm for a left supraclavicular block and 20 ml of 0.5% Ropivacaine with dexamethasone and 15 ml of 1.5% Mepivicaine was administered around the nerves...He received intravenous hydromorphone and was discharged home the same day...We suggest that morbidly obese patients must be carefully selected for ambulatory surgery, even when peripheral nerve blocks are the only anesthetics anticipated to be used. This is a medically challenging case and IRB approval is not required."

Retrospective data • Biosimilar • Cardiovascular • Diabetes • Obesity • Pain • Venous Thromboembolism

A Randomized Study of Prochlorperazine versus Hydromorphone for Acute Migraine (AHS 2017) - "Intravenous hydromorphone is substantially less effective than intravenous prochlorperazine for the treatment of acute migraine in the ED."

Clinical • HEOR • Migraine • Pain

Patients at Risk: Large Opioid Prescriptions After Total Knee Arthroplasty. (PubMed) - J Arthroplasty - "The quantity of opioids prescribed after TKA varied widely, ranging from a total MED of 273-3250 mg. The refill rate did not differ between large prescriptions (≥1400 mg) and smaller prescriptions. Excessive opioid prescriptions should be avoided as they did not decrease the number of refills and pose the risk of divergence and subsequent abuse."

Journal • Biosimilar • Pain

Are Prescribing Trends Driving the “Opioid Epidemic”? (AAPMgmt 2016) - "At BWH, the MEDs/Rx increased for hydrocodone, morphine, and oxycodone but not for methadone or hydromorphone. Even within institutions, there are marked differences in prescribing trends based on providers and patient population. By establishing benchmarks identified in this study, the authors hope that this institution and other institutions that replicate the methodology can better understand prescribing determinants and identify areas of concern to improved oral opioid prescribing and decreased morbidity and mortality."

Retrospective data • Biosimilar • Demo Pain • Pain

Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting. (PubMed) - Open Orthop J - "Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed."

Journal • Biosimilar • Pain

How much is just right? An evaluation of post-operative opioid prescribing for urologic procedures at a single institution (NEAUA 2017) - "...The most commonly prescribed opioid was hydromorphone (54%), followed by oxycodone (26%) and hydrocodone (20%)... Most patients received opioids post-operatively and used less than half of their prescription. These results suggest that over-prescription of opioids is common after urologic procedures. Unfortunately, few patients reported receiving instructions for safe disposal of unused opioid."

Clinical • Addiction (Opioid and Alcohol) • Biosimilar • Pain

Circulating miRNA Signature as a Potential Biomarker for the Prediction of Analgesic Efficacy of Hydromorphone. (PubMed, Int J Mol Sci) - "A significant correlation was observed between the analgesic efficacy and the putative MOR signal level, and patients with low MOR signal achieved better pain control (i.e., ΔVAS < 0) through hydromorphone. These results suggested that plasma miRNA signatures could serve as clinical biomarkers for the prediction of the analgesic efficacy of hydromorphone."

Biomarker • Clinical • Journal