Pachydermoperiostosis Medication

Updated: May 11, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Nonsteroidal anti-inflammatory drugs

Class Summary

These medications have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action in pachydermoperiostosis or primary hypertropic osteoarthropathy is not known. In general, NSAIDs inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist; these include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Ibuprin, Motrin, Advil, Excedrin IB)

Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Indomethacin (Indocin, Indochron E-R)

Indomethacin is rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation; it inhibits prostaglandin synthesis.

Meloxicam (Mobic)

Meloxicam decreases the activity of cyclo-oxygenase, which, in turn, inhibits prostaglandin synthesis. These effects decrease formation of inflammatory mediators.

Celecoxib (Celebrex)

Celecoxib primarily inhibits COX-2. COX-2 is an isoenzyme induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI tract toxicity. At therapeutic concentrations, the COX-1 isoenzyme is not inhibited, thus GI tract toxicity may be decreased. Seek the lowest dose for each patient.

Naproxen (Aleve, Naprosyn, Naprelan, Anaprox)

Naproxen is used for the relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase and prostaglandin synthesis.

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Antidote, Hypercalcemia

Class Summary

These agents inhibit bone resorption and increase renal calcium excretion.

Pamidronate (Aredia)

Pamidronate acts principally by inhibiting osteoclastic bone resorption.

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Bisphosphonate Derivative

Class Summary

These agents inhibit osteoclastic bone resorption.

Risedronate (Actonel)

Risedronate is a potent aminobisphosphonate. It inhibits bone resorption via actions on osteoclasts or osteoclast precursors. Supplementation with adequate calcium and vitamin D is required for effectiveness.

Risedronate has been shown to reduce bone resorption and increase bone mineral density of the spine by 5% and femoral neck by 1.6%. It has also has been shown to reduce the incidence of vertebral fractures by 41% and nonvertebral fractures by 39% over a period of 3 years in postmenopausal women.

In men with osteoporosis, significant mean increases in bone mineral density at the lumbar spine, femoral neck, trochanter, and total hip compared with placebo were shown after 2 years of treatment. It is indicated for prevention or treatment of osteoporosis.

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Antineoplastic Agent, Hormone Antagonist

Class Summary

These agents inhibit estrogen effects.

Tamoxifen (Nolvadex, Tamofen, Tamone)

Tamoxifen competitively binds to the estrogen receptor, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects.

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