Difference between revisions of "Zomepirac"

Latest revision as of 10:13, 20 September 2010

Zomepirac is an orally effective NSAID that has antipyretic actions. It was developed by McNeil Pharmaceutical and approved by the FDA in 1980 and sold as the sodium salt, zomepirac sodium, under the brand name Zomax. Due to its clinical effectiveness, it was preferred by doctors in many situations and obtained a large share of the analgesics market; however, it was subsequently withdrawn in March 1983 due to its tendency to cause serious anaphylaxis in an unpredictable subset of the patient population.^[1][2]

Indications

Zomepirac was indicated for the management of mild to severe pain.^[3] Multiple clinical trials demonstrated zomepirac to be more effective than aspirin or codeine alone and to be as effective as analgesic combinations containing codeine or other opioids.^{[4][5][6][7][8][9][10]} Zomepirac provided analgesia comparable with usual intramuscular doses of morphine in postoperative pain and that with long-term use, neither tolerance to its analgesic effect nor psychological or physical dependence had been demonstrated.^[3][11]

Chemical structure

Zomepirac is the sodium salt of 5-(4-chlorobenzoyl)-1,4 dimethyl-1H-pyrrole-2-acetate dihydrate. It is a pyrrole-acetic acid which is structurally related to tolmetin.

Mechanism of action

It is a prostaglandin synthetase inhibitor.^[12]

Toxicity

Zomepirac does not cause anaphylaxis directly, but it is metabolised by UGT to a reactive glucuronide, which binds irreversibly to plasma albumin.^[13]

References

1. ↑ Peter H. Rheinstein, Reporting of adverse drug events: a key to postmarketing drug safety, American Family Physician, Sept, 1992
2. ↑ Mark P. Grillo and Fengmei Hua, IDENTIFICATION OF ZOMEPIRAC-S-ACYL-GLUTATHIONE IN VITRO IN INCUBATIONS WITH RAT HEPATOCYTES AND IN VIVO IN RAT BILE, Drug Metabolism and Disposition, August 19, 2003
3. ↑ ^{3.0 3.1} Lewis JR (1981). "Zomepirac sodium. A new nonaddicting analgesic". JAMA. 246 (4): 377–9. doi:10.1001/jama.246.4.377. PMID 7241789. 
4. ↑ Steele CE, Jefferson WL (1983). "A multi-centre study of zomepirac in painful conditions: an analysis of clinical data for 15,484 patients". Current medical research and opinion. 8 (6): 382–91. doi:10.1185/03007998309111743. PMID 6221886. 
5. ↑ Mehlisch DR, Joy ED (1981). "Zomepirac sodium vs APC with codeine for oral surgery pain". Journal of oral surgery (American Dental Association : 1965). 39 (6): 426–9. PMID 7014804. 
6. ↑ Stambaugh JE, Sarajian C (1981). "Analgesic efficacy of zomepirac sodium in patients with pain due to cancer". Journal of clinical pharmacology. 21 (11-12 Pt 1): 501–7. PMID 7037868. 
7. ↑ Evans PJ, McQuay HJ, Rolfe M, O'Sullivan G, Bullingham RE, Moore RA (1982). "Zomepirac, placebo and paracetamol/dextropropoxyphene combination compared in orthopaedic postoperative pain". British journal of anaesthesia. 54 (9): 927–33. doi:10.1093/bja/54.9.927. PMID 7052110. CS1 maint: Multiple names: authors list (link)
8. ↑ Baird WM, Turek D (1980). "Comparison of zomepirac, APC with codeine, codeine and placebo in the treatment of moderate and severe postoperative pain". Journal of clinical pharmacology. 20 (4 Pt 2): 243–9. PMID 6991540. 
9. ↑ Mehlisch DR, Joy ED, Moore TE, Porter K, Stumpf AJ, Wolfe SH (1980). "Clinical comparison of zomepirac with APC/codeine combination in the treatment of pain following oral surgery". Journal of clinical pharmacology. 20 (4 Pt 2): 271–8. PMID 6991544. CS1 maint: Multiple names: authors list (link)
10. ↑ Diamond S, Medina JL (1981). "A double-blind study of zomepirac sodium and placebo in the treatment of muscle contraction headache". Headache. 21 (2): 45–8. doi:10.1111/j.1526-4610.1981.hed2102045.x. PMID 7016809. 
11. ↑ Wallenstein SL, Rogers A, Kaiko RF, Heidrich G, Houde RW (1980). "Relative analgesic potency of oral zomepirac and intramuscular morphine in cancer patients with postoperative pain". Journal of clinical pharmacology. 20 (4 Pt 2): 250–8. PMID 6991541. CS1 maint: Multiple names: authors list (link)
12. ↑ DC McLeod, Zomepirac (Zomax, McNeil Pharmaceutical), Drug Intelligence & Clinical Pharmacy: Vol. 15, No. 7, pp. 522-530.
13. ↑ Smith PC, McDonagh AF, Benet LZ (1986). "Irreversible binding of zomepirac to plasma protein in vitro and in vivo". Journal of clinical investigation. 77 (3): 934–939. doi:10.1172/JCI112392. PMC 423485 Freely accessible. PMID 3949982. CS1 maint: Multiple names: authors list (link)