Morphine 1mg/5ml / Peppermint oil 1.5microlitres/5ml oral solution

Peppermint oil (PO) has intrinsic properties that may benefit patients with irritable bowel syndrome (IBS) symptoms. The study objective was to determine the effect of peppermint oil in the treatment of the IBS. We systematically searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), ClinicalTrials.gov, EMBASE (Ovid), and Web of Science for randomized controlled trials (RCTs) of PO for IBS. We appraised the eligible studies by the Cochrane risk of bias tool. We performed random-effects meta-analysis on primary outcomes including global improvement in IBS symptoms and abdominal pain. A PRISMA-compliant study protocol is registered in PROSPERO Register [2016, CRD42016050917]. Twelve randomized trials with 835 patients were included. For global symptom improvement, the risk ratio (RR) from seven RCTs for the effect of PO (n = 253) versus placebo (n = 254) on global symptoms was 2.39 [95% confidence interval (CI): 1.93, 2.97], I2 = 0%, z = 7.93 (p < 0.00001). Regarding abdominal pain, the RR from six RCTs for the effect of PO (n = 278) versus placebo (n = 278) was 1.78 [95% CI: 1.43, 2.20], I2 = 0%, z = 5.23 (p < 0.00001). Overall, there were no differences in the reported adverse effects: PO (32 events, 344 total, 9.3%) versus placebo (20 events, 327 total, 6.1%) for eight RCTs; RR 1.40 [95% CI: 0.87, 2.26] I2 = 0%, z = 1.39 (p = 0.16). The number needed to treat with PO to prevent one patient from having persistent symptoms was three for global symptoms and four for abdominal pain. In the most comprehensive meta-analysis to date, PO was shown to be a safe and effective therapy for pain and global symptoms in adults with IBS.

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Mentha (also known as peppermint), a genus of plants in the taxonomic family Lamiaceae (mint family), is widely distributed throughout temperate regions of the world. Mentha contains various constituents that are classified as peppermint essential oil (PEO) and non-essential components. PEO, consisting mainly of menthol, menthone, neomenthol and iso-menthone, is a mixture of volatile metabolites with anti-inflammatory, antibacterial, antiviral, scolicidal, immunomodulatory, antitumor, neuroprotective, antifatigue and antioxidant activities. Mounting evidence indicates that PEO may pharmacologically protect gastrointestinal, liver, kidney, skin, respiratory, brain and nervous systems, and exert hypoglycemic and hypolipidemic effects. Clinically, PEO is used for gastrointestinal and dermatological diseases, postoperative adjuvant therapy and other fields. This review aims to address the advances in the extraction and isolation of PEO, its biological activities, pharmacological effects, toxicity and applications, with an emphasis on the efficacy of PEO on burn wounds and psoriasis, providing a comprehensive foundation for research, development and application of PEO in future.

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Opioid use disorder is classified as a chronic recurrent disease of the central nervous system (CNS) which leads to personality disorders, co-morbidities and premature death. It develops as a result of long-term administration of various abused substances, along with morphine. The pharmacological action of morphine is associated with its stimulation of opioid receptors. Opioid receptors are a group of G protein-coupled receptors and activation of these receptors by ligands induces significant molecular changes inside the cell, such as an inhibition of adenylate cyclase activity, activation of potassium channels and reductions of calcium conductance. Recent data indicate that other signalling pathways also may be involved in morphine activity. Among these are phospholipase C, mitogen-activated kinases (MAP kinases) or β-arrestin. The present review focuses on major mechanisms which currently are considered as essential in morphine activity and dependence and may be important for further studies.

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One of the problems of cancer patients is sleep disorder. Given the absence of studies on comparing the effect of inhalation aromatherapy with lavender and peppermint on the sleep quality of the cancer patients, this study was performed to compare the effect of inhalation aromatherapy with lavender and peppermint essential oils on the sleep quality of cancer patients. For this purpose, 120 patients were randomly allocated to three groups of lavender, peppermint, and control. The intervention groups received three drops of the essential oil for 7 days. In the control group, aromatic distilled water was used instead. Pittsburgh Sleep Quality Inventory (PSQI) was used. Before the intervention, no significant difference was observed between the mean PSQI scores of three groups, while the difference was statistically significant after the intervention. The mean PSQI scores were lower in lavender and peppermint groups than in the control group. Aromatherapy can improve the sleep quality of cancer patients. To confirm the findings, more studies should be done.

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PURPOSE: Oral Morphine Equivalent (OME) doses are increasingly being used as a metric to represent opioid use. Driven by a growing need from pharmacoepidemiological studies, the objective of this study was to develop a comprehensive OME conversion table that can be used by researchers to calculate OMEs in a consistent and systematic way. METHODS: Clinical guidelines and literature sources were collated and synthesised to develop recommended OME conversion factors that can be used for research studies on opioids (including different formulations and routes of administration) currently available internationally including Australia, the United Kingdom, Europe, the United States and Canada. RESULTS: No single resource includes all opioids that are currently available. Although there was some variation in conversion factors reported in different sources, overall, suggested conversion factors were mostly consistent across national and international sources. CONCLUSIONS: The use of the OME metric appears optimal for opioid utilisation studies as it facilities both interpretation and comparison between opioids and geographical locations. We have presented a synthesis of published OME conversion factors that can be applied to pharmacoepidemiological studies of opioids, in addition to a discussion of the considerations and caveats in using OME as a metric for opioid use. Copyright © 2015 John Wiley & Sons, Ltd.

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