mobic and tizanidine

To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP).. Randomized controlled trial.. Outpatient clinic at a university hospital.. Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration.. The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program.. Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months.. The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942).. Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.

Topics: Adult; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Clonidine; Combined Modality Therapy; Disability Evaluation; Exercise Therapy; Extracorporeal Shockwave Therapy; Female; Humans; Low Back Pain; Male; Meloxicam; Middle Aged; Pain Measurement

Fast dissolving orodispersible film (ODF) was prepared for concurrent administration of biopharmaceutical classification system (BCS) class II drugs, i.e., meloxicam (MX) and tizanidine (TZ), using natural (xanthan gum), semisynthetic (hydroxypropyl methylcellulose and hydroxyethyl cellulose) and synthetic (polyvinyl alcohol) polymers. Compatibility of the ingredients of ODFs was ascertained through Fourier transform infra-red spectroscopy and differential scanning calorimetry. ODFs were characterized through disintegration time, pH of the surface of film, tensile strength, folding endurance, % elongation and content uniformity (MX and TZ) which were found in the range between 17±1.3-56±3.1 s, 5.11±0.07-6.28±0.05, 14.721±1.2-33.084±3.1 N/m2, > 100, 3.33±0.53-10.04±0.77 % and 98.01-99.34 % (MX) and 97.48-99.03 % (TZ), respectively. The values of moisture uptake, moisture loss and loss on drying of all formulations were in the range from 1.06±0.09-7.51±0.93 %, 0.06±0.01-2.3±0.08 % and 0.008±0.002-0.03±0.03 %, respectively. In vitro drug release study in simulated saliva fluid of pH 7.4 has shown that > 90 % MX and TZ was released within 5 min. Visual inspection, scanning electron microscope and X-ray diffraction analysis of all ODFs expressed their smooth surfaces. ODF prepared from xanthan gum (F5) exhibited better physicochemical and mechanical properties as compared to other formulations.

Topics: Administration, Oral; Biological Products; Clonidine; Drug Carriers; Drug Compounding; Drug Design; Drug Liberation; Meloxicam; Solubility; Spectroscopy, Fourier Transform Infrared

The purpose of the study was to develop Tizanidine HCl (TZN) and Meloxicam (MLX) loaded bilayer mucoadhesive films intended for buccal administration, aiming to enhance the bioavailability. Bilayer films were prepared by solvent evaporation technique selecting arabinoxylan (ARX) as a sustained release (SR) layer forming polymer and hydroxypropyl methylcellulose (HPMC) E-15 as an immediate release (IR) layer-forming polymer. Prepared films were subjected to in-vitro drug release, surface morphology, mechanical strength, compatibility of the ingredients, drug contents, ex-vivo mucoadhesion strength and drug permeation. Crossover study design was applied to study the in-vivo pharmacokinetics by using albino rabbits. Various pharmacokinetic parameters including AUC, Cmax, tmax and t1/2 of both drugs loaded in films were compared with standard solution/dispersion administered to the rabbits at the dose of 1mg/kg. The results unveiled instant release and permeation of MLX from IR layer, while good controlled release and permeation characteristics of TZN from SR films over 8 h. films were of uniform thickness with smooth surface and satisfactory mechanical strength. Mucoadhesion strength was sufficient to provide suitable contact time with mucosal membrane. The pharmacokinetic study exhibited prompt absorption of MLX with better AUC 0-t (6655.64 ng/ml*h vs 6538.99 ng/ml*h) and Cmax (436.98 ng/ml vs 411.33 ng/ml) from oral dispersion. Similarly buccal films has shown enhanced half-life (9.91hr vs 2.51 hr), AUC 0-t (1043.4 ng/ml*h vs 149.1 ng/ml*h) and Cmax (91.92 ng/ml vs 42.29 ng/ml) from oral solution. A statistical investigation disclosed a significantly improved pharmacokinetics of TZN and MLX after their absorption across buccal route following administration of buccal film (p<0.05). ARX proved expedient and bilayer buccal films as a drug delivery system ascertained the dual effect of providing instant release of one active agent and persistent release of another one with improved pharmacokinetics.

Topics: Adhesiveness; Administration, Buccal; Animals; Biological Availability; Chemistry, Pharmaceutical; Clonidine; Cross-Over Studies; Delayed-Action Preparations; Drug Compounding; Drug Delivery Systems; Drug Evaluation, Preclinical; Drug Liberation; Half-Life; Hypromellose Derivatives; Male; Meloxicam; Mouth Mucosa; Rabbits; Solubility; Thiazines; Thiazoles; Xylans

In temporomandibular disorders (TMDs), unless splints are effective, combined therapies are performed. The aim of this study is to show the effectiveness of the local anaesthethic injections (trigger point injections) to the masticatory muscles.. The study was composed of TMD patients and the predictor variables were therapy combinations including stabilization splint (SS) therapy, SS+trigger point injection therapy (TPI) and arthrocentesis. The primary outcome variables were pain and jaw movements. The follow-ups were done at 1st and 3rd months. 56 patients who were treated for TMD with only SS or combined therapies were included in the study. The effects of additional TPIs were compared to SS therapy alone. Also the effect of arthrocentesis was evaluated too.. All groups revealed significant decreases in pain scores. Decreases in mouth openings were observed in some of the patients in the injection groups.. The combined treatment method in which the injections were applied at shorter time intervals, was a more effective method for decreasing VAS scores in TMD patients in this study but further studies are required.

Topics: Arthrocentesis; Clonidine; Combined Modality Therapy; Humans; Injections; Masticatory Muscles; Meloxicam; Myofascial Pain Syndromes; Occlusal Splints; Pain Measurement; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Treatment Outcome; Trigger Points; Turkey; Visual Analog Scale

Tizanidine, an alpha2-adrenergic receptor agonist with myospasmolytic action, is indicated for the treatment of back pain either as monotherapy or in combination with nonsteridal anti-inflammatory drugs (NSAIDs). Tizanidine (0.25-1.0 mg/kg) significantly produced analgesic and anti-inflammatory effect in acetic acid induced writhing in mice and carrageenan-induced paw edema in rats, respectively. The effects were comparable with clonidine (0.25 and 0.50 mg/kg), another alpha2-agonist. Yohimbine (1 mg/kg), alpha2-adrenergic antagonist reversed the effect of tizanidine. Tizanidine (0.25 mg/kg) and clonidine (0.25 mg/kg) significantly potentiated the antinociceptive and anti-inflammatory effect of NSAIDs (nimesulide, meloxicam and naproxen). Tizanidine (1 mg/kg) did not alter basal pH, acidity (free and total) of gastric content and did not produce any mucosal injury in fasted rats. Tizanidine (1 mg/kg) significantly reduced meloxicam (UD50 3.21 mg/kg), nimesulide (UD50 24.52 mg/kg) and naproxen (UD50 14.10 mg/kg)-induced ulcerogenic effect (ulcer index, pH and free/total acidity). It is expected that tizanidine exerted gastrotprotection through stimulation of gastric and central alpha2-adrenergic receptors. Present investigation suggested that tizanidine not only enhance the analgesic and anti-inflammatory effect of NSAIDs but also improved gatstrointestinal tolerability of NSAIDs through modulation of central alpha-2-receptors. From this study, it can be speculated that tizanidine and NSAID combination therapy would prove to be a novel approach to treat nociceptive/inflammatory conditions with improved gastric tolerability of NSAIDs.

Topics: Adrenergic alpha-Agonists; Animals; Anti-Inflammatory Agents, Non-Steroidal; Clonidine; Drug Synergism; Drug Therapy, Combination; Meloxicam; Mice; Naproxen; Pain; Rats; Rats, Wistar; Receptors, Adrenergic, alpha-2; Stomach Ulcer; Sulfonamides; Thiazines; Thiazoles; Yohimbine