Efficacy and tolerability studies evaluating a sleep aid and analgesic combination of naproxen sodium and diphenhydramine in the dental impaction pain model in subjects with induced transient insomnia

S Cooper, I Laurora, Y Wang, P Venkataraman, R An, T Roth, S Cooper, I Laurora, Y Wang, P Venkataraman, R An, T Roth

Abstract

Study objectives: The aim of this study was to evaluate the efficacy and tolerability of novel combination naproxen sodium (NS) and diphenhydramine (DPH) in subjects with postoperative dental pain along with transient insomnia induced by 5 h sleep phase advance. The present studies aimed to demonstrate the added benefit and optimal dosages of the combination product over individual ingredients alone in improving sleep and pain.

Methods: Each of the two studies was a two-centre, randomised, double-blind and double-dummy trial. In the first study, subjects were randomised into one of the following treatment arms: NS 440 mg/DPH 50 mg, NS 220 mg/DPH 50 mg, NS 440 mg or DPH 50 mg. In the second study, subjects received either NS 440 mg/DPH 25 mg, NS 440 mg or DPH 50 mg. The co-primary end-points in both studies were wake time after sleep onset (WASO) and sleep latency (SL) measured by actigraphy. Other secondary sleep and pain end-points were also assessed.

Results: The intent-to-treat population included 712 and 267 subjects from studies one and two, respectively. In the first study, only the NS 440 mg/DPH 50 mg combination showed significant improvements in both WASO vs. NS alone (-70.3 min p = 0.0002) and SL vs. DPH alone (25.50 and 41.50 min respectively, p < 0.0001). In the second study, the NS 440 mg/DPH 25 mg combination failed to show any significant improvements vs. either component alone.

Conclusions: Only the NS 440 mg/DPH 50 mg combination demonstrated improvement in both sleep latency vs. DPH 50 mg and sleep maintenance (WASO) vs. NS 440 mg. There were no serious or unexpected adverse events reported in either study.

Clinical trial registration: NCT01280591 (study 1); NCT01495858 (study 2).

© 2015 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Box plot for wake after sleep onset in study 1 (intent-to-treat population)
Figure 2
Figure 2
Time to sleep onset in study 1 (intent-to-treat population)
Figure 3
Figure 3
Box plot for wake after sleep onset in study 2 (intent-to-treat population)
Figure 4
Figure 4
Time to sleep onset in study 2 (intent-to-treat population)

References

    1. Ancoli-Israel S, Roth Th. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. Sleep. 1999;22:S347–53.
    1. Roehrs T, Vogel G, Sterling W, Roth T. Dose effects of temazepam in transientinsomnia. Drug Res. 1990;40(II):859–62.
    1. Roth T, Roehrs T, Zorick F. Pharmacological treatment of sleep disorders. In: Williams RL, Karacan I, Morre CA, editors. Sleep Disorders: Diagnosis and Treatment. 2nd edn. New York: John Wiley & Sons; 1988. pp. 373–95.
    1. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8:119–32.
    1. Raymond I, Nielsen TA, Lavigne G, Manzini C, Choiniere M. Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients. Pain. 2001;92:381–8.
    1. Doghramji K. The epidemiology and diagnosis of insomnia. Am J Manag Care. 2006;12:S214–20.
    1. 21 CFR Part 338. Nighttime Sleep-Aid Drug Products for Over-the-Counter Human Use; Final Monograph (accessed 20 August 2014)
    1. Teutsch G, Mahler DL, Brown CR, Forrest WH, James KE, Brown BW. Hypnotic efficacy of diphenhydramine, methapyrilene, and pentobarbital. Clin Pharmacol Ther. 1975;17:195–201.
    1. Rickels K, Morris RJ, Newman H, Rosenfeld H, Schiller H, Weinstock R. Diphenhydramine in insomniac family practice patients: a double-blind study. J Clin Pharmacol. 1983;23:234–42.
    1. Urquhart E. Analgesic agents and strategies in the dental pain model. J Dent. 1994;22:336–41.
    1. Cooper SA. Models for clinical assessment of oral analgesics. Am J Med. 1983;75:24–9.
    1. Cooper SA, Desjardins PJ. The value of the dental impaction pain model in drug development; analgesia: methods and protocols. In: Szallasi A, editor. Methods in Molecular Biology. Clifton, NJ: Springer Science + Business Media; 2010. pp. 175–90. Vol. 617.
    1. Bonnet MH, Arand D. Situational insomnia: consistency, predictors, and outcomes. Sleep. 2003;26:1029–36.
    1. de Souza L, Benedito-Silva AA, Pires ML, Poyares D, Tufik S, Calil HM. Further validation of actigraphy for sleep studies. Sleep. 2003;26:81–5.
    1. Johns M. 1997. Epworth Sleepiness Scale (accessed 28 October 2014)
    1. Advil PM Summary Basis of Approval – Medical Review. FDA, 21 December 2005. (accessed 20 August 2014)
    1. 21 CFR Part 341. Cold, Cough, Allergy, Bronchodilator, and Antiasthmatic Drug Products for Over-the-Counter Human Use; Final Monograph for OTC Antihistamine Drug Products (accessed 21 August 2014)
    1. McNeil. Combination of OTC Nighttime Sleep-Aid and OTC Internal Analgesic(s): Data Supporting Category 1 Designation, 31 March 2010 (accessed 26 November 2014)
    1. Bayer HealthCare. Safety Trial of Naproxen Sodium/Diphenhydramine (MUST). [Internet] 2000. Bethesda, MD: National Library of Medicine (US), NLM Identifier: NCT01365052 (accessed 26 February 2015)
    1. Gillin JC, Spinweber CL, Johnson LC. Rebound insomnia: a critical review. J Clin Psychopharmacol. 1989;9:161–72.
    1. Roehrs TA, Zorick FJ, Wittig RM, Roth T. Dose determinants of rebound insomnia. Br J Clin Pharmacol. 1986;22:143–7.
    1. Glass JR, Sproule BA, Herrmann N, Busto UE. Effects of 2-week treatment with temazepam and diphenhydramine in elderly insomniacs. J Clin Psychopharmacol. 2008;28:182–8.
    1. Borbely AA, Youmbi-Balderer G. Effect of diphenhydramine on subjective sleep parameters and on motor activity during bedtime. Int J Clin Pharmacol Ther Toxicol. 1988;26:392–6.
    1. Katayose Y, Aritake S, Kitamura S, et al. Carryover effect on next-day sleepiness and psychomotor performance of nighttime administered antihistaminic drugs: a randomized controlled trial. Hum Psychopharmacol Clin Exp. 2012;27:428–36.
    1. Kudo Y, Kurihara M. Clinical evaluation of diphenhydramine hydrochloride for the treatment of insomnia in psychiatric patients: a double-blind study. J Clin Pharmacol. 1990;30:1041–8.
    1. Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. 2005;28:1465–71.
    1. Mueleman JR, Nelson RC, Clark RL., Jr Evaluation of temazepam and diphenhydramine as hypnotics in a nursing-home population. Drug Intell Clin Pharm. 1987;21:716–20.
    1. Roth T, Roehrs T, Vogel G. Zolpidem in the treatment of transient insomnia: a double-blind, randomized comparison with placebo. Sleep. 1995;18:246–51.
    1. Drake C, Richardson G, Roehrs T, Scofield H, Roth T. Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep. 2004;27:285–91.
    1. Drake CL, Jefferson C, Roehrs T, Roth T. Stress-related sleep disturbance and polysomnographic response to caffeine. Sleep Med. 2006;7:567–72.
    1. Walsh JK, Schweitzer PK, Sugerman JL, Muehlbach MJ. Transient insomnia associated with a 3-hour phase advance of sleep time and treatment with zolpidem. J Clin Psychopharmacol. 1990;10:184–9.
    1. Bonnet MH, Dexter JR, Gillin JC, et al. The use of triazolam in phase-advanced sleep. Neurophsychopharmacology. 1988;1:225–34.
    1. Schweitzer PK, Koshorek G, Muehlbach MJ, et al. Effects of estazolam and triazolam on transient insomnia associated with phase-shifted sleep. Hum Psychopharmacol Clin Exp. 1991;6:99–107.
    1. Seidel WF, Roth T, Roehrs T, Zorick F, Dement WC. Treatment of a 12-hour shift of sleep schedule with benzodiazepine. Science. 1984;224:1262–4.
    1. Rosenberg R, Roth T, Scharf MB, Lankford DA, Farber R. Efficacy and tolerability of indiplon in transient insomnia. J Clin Sleep Med. 2007;3:374–9.
    1. Roth T, Heith Durrence H, Jochelson P, et al. Efficacy and safety of doxepin 6 mg in a model of transient insomnia. Sleep Med. 2010;11:843–7.

Source: PubMed

3
Iratkozz fel