Symptomatic treatments

In 1959, H.K. Beecher, author of The Measurement of Subjective Responses wrote Notwithstanding the fact that the limelight in therapeutics has for some time been focused on the great advances made in chemotherapy, it is nonetheless true that much of medicine is still concerned with the treatment of symptoms . This statement is true and holds on until this date. 

Prior to the 1940s almost all pharmacotherapy conducted by physicians is merely the alleviation of symptoms of disease and causal treatment consisted mostly of surgical interventions. It is only that after the development of antiparasitic agents and an-tiinfectives, like salvarsan and later penicillin, that causal treatment was known and that the understanding was induced that if possible, a disease should be treated at its root (causal treatment) in favor of symptomatically. This created the insight that causal treatment bears more weight compared to symptomatic treatment. 

Although in general, causal treatment is more beneficial to the patient, this form of treatment is not always available for all diseases. Today, it is even rare for a variety of diseases like carcinoma. 

Apart from disease entities, one recognizes a variety of symptoms that makes up a disease, like pain, fever, convulsions, cough, rhinitis, nausea, meteorism, diarrhea, headache, dyspnea, anorexia, insomnia, constipation, etc. All these symptoms could make up a symptom complex or syndrome, or may stand alone by themselves without being part of a disease entity. The term of symptomatic drug treatment usually refers to its use for the alleviation of symptoms, whether as a part of a syndrome or standing alone. 

Symptomatic treatment still is an important treatment modality, and should be regarded as equally important as causal treatment. When one neglects symptoms or treat them inappropriately it may result in aggravation of the situation. On the other hand, treatment of all symptoms a patient may have, especially excessive treatment, will increase the risk of adverse reactions, which eventually could be dangerous. The guidance given in this chapter will discuss the drugs of choice for the use in symptoms seen 

---

Hj Antihistamine Treatment in Allergic Diseases. H -receptor antagonists are used for the symptomatic treatment of several allergic... 

At this writing anticholinergic agents are not widely used for the symptomatic treatment of asthma, although compounds such as atropine [51 -55-8] C17H23NO3, (18) have been used for centuries (111). Inhalation of the smoke produced by burning herbal mixtures, such as Datura Stramonium provided bronchodilation and rehef from some of the symptoms of asthma. The major active component in these preparations was atropine or other closely related alkaloids (qv). 

Trigclic Antidepressants. Imipramine (38) was introduced in the late 1950s as one of the first pharmacotherapies for depression. At that time, chlorproma2ine [50-53-3] was the first effective antipsychotic treatment to be discovered. Researchers looked for similar chemical stmctures and imipramine was found to be effective in the symptomatic treatment of depression. Over the years, other congeners, such as desipramine (39), amitriptyline (40), and dothiepin (41), were synthesized and shown to be clinically efficacious antidepressant dmgs (121). These substances, known under the general mbric of tricycHc antidepressants, share a basic chemical stmcture comprising... 

Bismuth subsahcylate [14882-18-9] Pepto-Bismol, is a basic salt of varying composition, corresponding approximately to i9-H0CgH4C02(Bi0). Like a number of other insoluble bismuth preparations, it is not currentiy approved in the United States for the treatment of peptic ulcer disease but is under active investigation for this purpose (180). It does appear to be effective for the rehef of mild diarrhea and for the prevention of travelers diarrhea (181). The ready availabiUty of this dmg, however, may lead to its ovemse and result in toxic effects caused by both the saUcylate and bismuth components. It has been suggested that bismuth subsahcylate is somewhat effective in the symptomatic treatment of isosporiasis, a disease caused by the intracellular parasite Isospora belli (182). 

The treatment approach to RA has undergone a major evolutionary change in recent years with a move away from predominantly symptomatic treatment approaches towards much earlier intervention with diseasemodifying anti-rheumatic drug (DMARD) therapy and... 

Relative contraindications to the use of anticholinesterase treatment include a history of cardiovascular disease, asthma, glaucoma, and gastrointestinal or genitourinary obstruction. Symptomatic treatment of tachyarrhythmias with propranolol may be considered P blockers, however, are less effective than physostigmine. 

Youle M, Oslo M (2007) A double-blind, parallel-group, placebo-controUed, multicentre study of acetyl L-carnitine in the symptomatic treatment of antiretroviral toxic neuropathy in patients with HIV-1 infection. HIV Med 8(4) 241-250... 

In 58 percent of cases, symptomatic treatment with Valium, pheno-barbital, or paregoric, for a period ranging from 2 to 14 days, was required to control drug effects. However, in 42 percent of the cases, symptoms were successfully managed with more conserva-... 

Determine appropriate symptomatic treatment choices and a detailed therapeutic plan for a specific patient. 

Symptomatic treatment minimizes the impact of multiple sclerosis on quality of life. 

Symptomatic treatment focuses on minimizing the withdrawal symptoms to help patients be as comfortable as possible (Tables 33-6 through 33-8). This is combined with the use of methadone or buprenorphine (Suboxone or Subutex ) to suppress the withdrawal symptoms by providing a p opioid full or partial agonist in a tapering dose schedule within a controlled environment. 

The drugs used for T. cruzi include nifurtimox (Lampit) and benznidazole (Rochagan). Oral nifurtimox is available from the CDC, while benznidazole is only available in Brazil. The adult dose of nifurtimox is 8 to 10 mg/kg per day in divided doses for 120 days. Since children seem to tolerate the dose better than adults, the pediatric dose of nifurtimox in children 1 to 10 years old is 15 to 20 mg/kg per day, and the dose for children 11 to 16 years old is 12.5 to 15 mg/kg per day in divided doses. Symptomatic treatment for heart failure associated with Chagas disease should be initiated. The gastrointestinal complications may require surgical revisions and reconstruction. 

Mild to moderate rash symptomatic treatment with antihistamine and continuation of offending agent ... 

These symptoms are consistent with the pharmacological action and usually appear in the order of nausea, chest pains, blurred vision. Removal from exposure and symptomatic treatment have thus far been followed by rapid abatement of symptoms. 

Symptomatic treatment. The chorea of Huntington s disease responds (partially) to treatment with neuroleptics, which, through blockade of D2 receptors, may help to increase basal ganglia output to more normal levels. Dopamine-depleting agents, such as reserpine or tetra-benazine have also been used. At best, these agents are only moderately effective and they should only be used if the chorea truly interferes with activities of daily living or produces social embarrassment. Neuroleptics and... 

Antimicrobial therapy is used to treat otitis media however, a high percentage of children will be cured with symptomatic treatment alone. Antibiotic use reduces the duration of symptoms by about 1 day. 

Smith PF. (2007) Symptomatic treatment of multiple sclerosis using cannabinoids Recent advances. Expert Rev Neurother 7 1157-1163. 

Symptomatic treatment in parkinsonism for the purpose of restoring a dopaminergic-cholinergic balance in the corpus striatum. Antiparkinsonian agents, such as benzatropine (p. 188), readily penetrate the blood-brain barrier. At centrally equi-effective dosage, their peripheral effects are less marked than are those of atropine. 

---