hydrocodone + ibuprofen (Ibudone)

Comparative effectiveness of therapeutic ultrasound and pharmacotherapy in the management of muscular temporomandibular disorders: a randomized clinical trial.

Subhikshaa M M, Shetty Prathima P, Veena K M KM, Shenoy Prashanth P et al.

Temporomandibular disorders (TMDs) of muscular origin are a common cause of chronic orofacial pain and functional limitation. Conservative management includes pharmacotherapy and physiotherapeutic modalities such as therapeutic ultrasound. However, evidence directly comparing their effectiveness remains limited. This randomized clinical trial compared therapeutic ultrasound and pharmacotherapy in reducing pain intensity and improving mandibular function in patients with muscular TMDs. A prospective, parallel-group randomized clinical trial was conducted among 36 patients diagnosed with muscular TMDs according to Group I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Following ethical approval (YEC-1/2024/038) and CTRI registration (CTRI/2024/12/077788), participants were randomly allocated into two groups (n = 18). Group A received ibuprofen (400 mg), paracetamol (325 mg), and chlorzoxazone (250 mg) twice daily for seven days. Group B received therapeutic ultrasound (1 MHz, 1.0 W/cm², continuous mode) for 10 min daily for seven days. Pain intensity was assessed using the Numerical Rating Scale (NRS), and maximum mouth opening was measured using a Vernier calliper. Data were analysed using paired and independent Student's t-tests (p < 0.05). All participants completed the study. Both groups showed significant reductions in pain intensity and improvements in maximum mouth opening (p < 0.05). Mean NRS scores decreased from 6.31 ± 1.35 to 2.94 ± 1.06 in the pharmacotherapy group and from 5.56 ± 1.97 to 1.69 ± 1.08 in the therapeutic ultrasound group. Mean mouth opening increased from 40.31 ± 3.63 mm to 41.44 ± 2.94 mm and from 40.75 ± 3.55 mm to 43.63 ± 2.55 mm, respectively. Therapeutic ultrasound achieved significantly greater pain reduction (p = 0.002) and greater improvement in mouth opening (p = 0.032). No adverse events were reported. Both treatments were effective for muscular temporomandibular disorders; however, therapeutic ultrasound was associated with greater short-term improvements in pain intensity and maximum mouth opening than pharmacotherapy under the conditions of this study. https://ctri.nic.in/Clinicaltrials/login.php, identifier CTRI/2024/12/077788.

2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults.

Lau Chi Ieong CI, Chen Wei-Ta WT, Hou Tsung-Wei TW, Liaw Yi-Chia YC et al.

Since the publication of the Taiwan Headache Society's 2022 Guidelines for the Acute Treatment of Migraine Attacks, advances in headache medicine and the approval of new drugs in Taiwan have necessitated an update. To address clinical needs, the Guideline Committee of the Taiwan Headache Society reviewed evidence for pharmacological and non-pharmacological acute treatments using evidence-based principles. Drawing from the latest European, American, and international guidelines, and through expert consensus, this revision updates treatment roles, grades of recommendation, efficacy, and adverse-effect profiles. Currently, a broad range of medications is available in Taiwan for acute migraine management, categorised into "specific" and "non-specific" agents. Specific treatments include oral and intranasal triptans, and gepants, i.e., oral calcitonin gene-related peptide (CGRP) receptor antagonists. Non-specific agents include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, ibuprofen, naproxen). Injectable prochlorperazine is also strongly recommended. Ergotamine/caffeine combinations are less effective and are second-line agents, while high-dose aspirin is limited by gastrointestinal risk. Considering the potential risk of dependency, tramadol or tramadol/paracetamol combinations should be reserved until all other agents fail, and should be limited to oral forms. Other opioids, such as morphine, butorphanol, etc., lack evidence and are not recommended. Treatment should follow the principle of stratified care: oral NSAIDs for mild disability, with combination analgesics or parenteral NSAIDs as alternatives, and oral or intranasal triptans for moderate to severe disability, ideally administered early. Antiemetics may be added, and combining triptans with NSAIDs enhances efficacy. Rimegepant can be considered a first-line therapy, particularly for patients who are unresponsive or intolerant to triptans, have cardiovascular contraindications, or are at risk of developing medication overuse. In status migrainosus, parenteral corticosteroids with intravenous fluids are advised. Acetaminophen remains first-line for children and pregnant women. To prevent medication-overuse headache, acute treatments, including NSAIDs, acetaminophen, triptans, ergot derivatives, and combination analgesics, should not exceed two days per week, probably with the exception of rimegepant.

Pharmacological actions of novel beta-lactam and non-beta lactam compounds on major astrocytic glutamate transporters in the brain and liver of male C57BL/6 mice exposed chronically to hydrocodone.

Wong Woonyen W, Shareef Mohammed Adil A, Childers Wayne E WE, Abou-Gharbia Magid M et al.

Chronic exposure to opioid reduced the expression of astrocytic glutamate transporter 1 (GLT-1) and cystine/glutamate antiporter (xCT) in the mesocorticolimbic brain region and ceftriaxone, a beta-lactam antibiotic, attenuated this effect. Importantly, a novel synthetic non-antibiotic beta-lactam, MC-100093, was found effective in attenuating fentanyl and morphine overdose-induced reduction in GLT-1 expression in the nucleus accumbens (NAc) as well as attenuated fentanyl-induced liver inflammation and disruption of liver metabolites. In the present study, two novel synthetic non-antibiotic beta-lactams, MC-100093 and MC-290401, and one novel synthetic non-beta-lactam bicyclic, MC-290013, were tested in a mouse model of chronic exposure to hydrocodone with focus on GLT-1 expression as well as the transcriptional regulation of GLT-1. This study reports that MC-100093, MC-290401, and MC-290013 treatment attenuated hydrocodone-induced downregulation of GLT-1 in the NAc. MC-100093, MC-290401, and MC-290013 treatments normalized GLT-1 and xCT expression in the NAc, and this effect was associated with upregulation of NFκB in the nuclear fraction and downregulation of the expression of mTOR and IKB-α in the cytoplasmic fraction as well as upregulation of pAkt expression in the NAc. Furthermore, histological and statistical analyses revealed that MC-100093, MC-290401, and MC-290013 treatments attenuated chronic hydrocodone-induced liver inflammation (TNF-α, IL-1β, and IL-6). Finally, these GLT-1 modulators attenuated hydrocodone-induced upregulation of hepatic xCT and GLT-1. These findings suggest that these novel synthetic GLT-1 modulators may be considered as potential agents to attenuate hydrocodone-induced alterations in glutamate transporters and associated target proteins in the brain and liver.

Paediatric Posterior Reversible Encephalopathy Syndrome (PRES) Induced by Ibuprofen Intake: A Case Report.

Bargiacchi Giuditta G, De Marco Oriana O, Petruzzelli Luigi Annicchiarico LA, Tucci Celeste C et al.