New Drug Combination Might Be More Effective Pain Reliever The nutritional supplement, glucosamine,
boosts the pain relieving power of ibuprofen, according to a new study by Temple University
researchers in the Journal of Pharmacology and Experimental Therapeutics (JPET). This new drug
combination could one day allow patients to take a lower dose and get the same pain relief with
fewer unwanted side effects. Ronald Tallarida, Ph.D., and Alan Cowan, Ph.D., of Temple's School of
Medicine, and Robert Raffa, Ph.D., of Temple's School of Pharmacy, conducted the study
"Antinociceptive Synergy, Additivity, and Subadditivity with Combinations of Oral Glucosamine Plus
Nonopioid Analgesics in Mice," which was published in the November 2003 issue of JPET.
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Ibuprofen is a non-steroidal anti-inflammatory drug, or NSAID. NSAIDs, which also include aspirin,
are quite effective in relieving pain. They are so effective, in fact, that pain sufferers
sometimes take higher and higher doses in hope of more pain relief. High doses of NSAIDs,
especially when taken over long periods of time, can cause gastrointestinal upset, such as
heartburn, or even bleeding.
"Combining pain relievers into one pill can increase patient compliance, simplify prescribing, and
improve efficacy without increasing side effects, or conversely, decrease side effects without
losing efficacy," said Raffa.
In addition to these benefits, drug combinations can also sometimes yield a totally unexpected
effect, such as the magnification of a drug's powers. "When this happens, a phenomenon known as drug
synergism, it's like finding buried treasure," added Tallarida.
Glucosamine, a naturally occurring substance in the body, which is also available in synthetic form
over the counter, is used to treat osteoarthritis, a painful, degenerative joint disorder. While it
has been shown to prevent and repair bone and cartilage damage, researchers have yet to demonstrate
that glucosamine actually blocks pain.
"We embarked on this study with several questions: Can glucosamine actually block pain? And, can
glucosamine improve the pain-relieving powers of other drugs when the two are combined?" said
Tallarida.
First, the researchers confirmed that glucosamine, alone, does not block pain. It's believed that
any pain-relieving properties of glucosamine are a side effect of its ability to repair bone damage.
Next, they combined glucosamine with a variety of NSAIDs at a variety of dosages. With several
NSAIDs, including naproxen, the addition of glucosamine caused an additive effect, meaning the sum
of each drug's properties. When combined with aspirin or acetaminophen, the result was subadditive,
or less than the sum of each drug's properties. But when combined with ibuprofen, the researchers
found pain relief was enhanced and therefore synergistic.
"The next step will be to study this drug combination in clinical trials to see whether it can
enhance pain relief or offer pain relief using a lower dose of ibuprofen and therefore a lower risk
of side effects," said Cowan. The researchers are also investigating other possible drug
combinations for the potential relief of pain. Raffa and Tallarida played a role in the development
of Ultracet, a combination of tramadol and acetominophen used in the treatment of pain. And Cowan
contributed to the development of buprenorphine which, when combined with naloxone, is used in the
treatment of opiate addiction.
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This story has been adapted from a news release issued by Temple University.
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