Combining tramadol and celecoxib into a co-crystal of celecoxib-tramadol provides peripherally and centrally mediated analgesia.
The Nationwide Institutes of Wellness report that soreness is the most popular reason for in search of healthcare care.1 Information from 2012 believed that 126.1 million grown ups in the United States endure from discomfort,2 which can be nociceptive (from tissue personal injury), neuropathic (from nerve injury), or nociplastic (from a sensitized anxious technique). There is also overlap in the different forms of suffering.3
Multimodal remedy to handle soreness isdefined by the Worldwide Affiliation for the Study of Pain as the concurrent use of separate therapeutic brokers with diverse mechanisms of action. This blend of agents is aimed to handle distinctive pain mechanisms.4,5 Co-crystal formulations can be regarded as a multimodal treatment.
The Fda defines co-crystals as crystalline components composed of 2 or additional various molecules in the exact same lattice.6 Combining tramadol and celecoxib into a co-crystal of celecoxib-tramadol (CTC) presents peripherally and centrally mediated analgesia.4
System OF Action
CTC (Seglentis Kowa Prescribed drugs The us, Inc) is an Food and drug administration-authorized Routine IV controlled material. It is indicated for the management of acute agony in grown ups that is extreme ample to demand an opioid analgesic and for which alternative treatment plans are inadequate.
The manner of motion of tramadol is not fully comprehended. It is thought to be thanks to binding to mu-opioid receptors and weak inhibition of reuptake of norepinephrine and serotonin. The system of motion of celecoxib is considered to be thanks to inhibition of prostaglandin synthesis, primarily by means of cyclooxygenase-2 (COX-2).7
DOSING AND ADMINISTRATION
CTC consists of celecoxib 56 mg and tramadol hydrochloride 44 mg. Initiate remedy with 2 tablets each 12 hrs as required for pain relief. When beginning treatment method with this celecoxib-tramadol pill formulation, take into account the suffering severity, client response, prior analgesic remedy, and risk factors for habit, abuse, and misuse.
The complete prescribing facts recommends to explore availability of naloxone with the patient. CTC must be applied for the shortest duration aligned with individual procedure objectives.7
The efficacy and protection of CTC was evaluated in a randomized, double-blind, parallel group review comparing CTC to tramadol, celecoxib, and placebo for acute soreness right after bunionectomy with osteotomy (bone cutting treatment). The research enrolled sufferers ≥18 a long time of age with acute postoperative soreness (rated >5 and <9 on a 0-10 Numeric Pain Rating Scale [NPRS]). Patients had a mean baseline pain intensity of 6.7 on the NPRS.7
The primary efficacy endpoint was time-weighted summed pain intensity difference over 48 hours (SPID48). Researchers reported patients in the CTC group had statistically significantly better mean SPID48 scores than any of the other groups after bunionectomy.7
Negative differences in the score corresponded to an amelioration of pain. The total scale ranged from -480 (best) to +480 (worst). A higher negative value of SPID indicated greater pain relief (Table 1).8
Table 1. Outcome Measures8
ADVERSE EVENTS (AEs)
The most common AEs with incidence greater than 5% in adults taking CTC are nausea, vomiting, dizziness, headache, and somnolence. There is a boxed warning in the FDA-approved label that describes the risks of addiction, abuse, and misuse. The celecoxib-tramadol tablet is available under the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program.7
The boxed warning also includes cardiovascular thrombotic events and risk factors for life-threatening respiratory depression in children. It also describes gastrointestinal bleeding, ulceration, and perforation.
Cytochrome P450 interactions and risk with concomitant CNS depressants are also explained. Due to the large volume of information in the boxed warning, pharmacists should refer to the full prescribing information for comprehensive details.7
CTC is contraindicated in ages <12 years of age and during postoperative management in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. It should not be used in CABG surgery or in individuals with acute or severe bronchial asthma.
CTC is contraindicated with gastrointestinal obstruction and with monoamine oxidase inhibitors (MAOIs) within the past 14 days. It should not be used in individuals with urticaria or other allergic reactions after taking aspirin or other nonsteroidal anti-inflammatory agents. Additional warnings include serotonin syndrome, risk of seizure, risk of suicide, adrenal insufficiency, renal and hepatotoxicity.7
There is a risk of fetal harm with CTC in pregnant women. Breastfeeding is not recommended. The safety and efficacy of CTC in pediatrics has not been established. Elderly individuals taking nonsteroidal anti-inflammatory agents are determined to be at greater risk for serious AEs so individuals taking CTC should be monitored.7
In summary, despite the availability of multiple pharmacotherapies, many individuals
continue to suffer in pain. Because pain can involve multiple mechanisms, combining products with different mechanisms of action, or in the form of a co-crystal formulation, may be a therapeutic option.
- Pain. National Institutes for Health. National Center for Complementary and Integrative Health. Updated June 3, 2022. Accessed June 3, 2022. https://www.nccih.nih.gov/health/pain
- Nahin R. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 201516(8):769-780. doi:10.1016/j.jpain.2015.05.002
- Cohen S., Vase L., Hooten W. Chronic pain: an update on burden, best practices and new advances. Lancet.2021397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7
- Almansa C, Frampton C, Vela J, Whitelock S, Plata-Salamán C. Co-crystals as a new approach to multimodal analgesia and the treatment of pain. J Pain Res.201912:2679–2689
- Raffa R, Pergolizzi J Jr., Tallarida R. Analgesic combinations. J Pain.201011(8):701–709. doi:10.1016/j.jpain.2009.12.010
- Regulatory classification of pharmaceutical co-crystals guidance for the industry. US Food and Drug Administration. February 2018. Accessed 6/3/2022. https://www.fda.gov/media/81824/download
- Seglentis. Prescribing information. Kowa Pharmaceuticals America, Inc. 2021. Accessed June 1, 2022. https://www.kowapharma.com/documents/SEGLENTIS_Prescribing_Information.pdf
- Seglentis. Efficacy demonstrated in the phase 3 clinical trial. Kowa Pharmaceuticals America, Inc. May 2022. Accessed June 1, 2022. https://www.seglentis.com/clinical-data/efficacy