Medication-related Side Effects Research Articles

Epidural Analgesia for Severe Chest Trauma: An Analysis of Current Practice on the Efficacy and Safety.

Background Adequate pain control is essential in the treatment of patients with traumatic rib fractures. Although epidural analgesia is recommended in international guidelines, the use remains debatable and is not undisputed. The aim of this study was to describe the efficacy and safety of epidural analgesia in patients with multiple traumatic rib fractures. Methods A retrospective cohort study was performed. Patients with ≥3 rib fractures following blunt chest trauma who received epidural analgesia between January 2015 and January 2018 were included. The main outcome parameters were the success rate of epidural analgesia and the incidence of medication-related side effects and catheter-related complications. Results A total of 76 patients were included. Epidural analgesia was successful in a total of 45 patients (59%), including 22 patients without and in 23 patients with an additional analgesic intervention. In 14 patients (18%), epidural analgesia was terminated early without intervention due to insufficient sensory blockade (n=4), medication-related side effects (n=4), and catheter-related complications (n=6). In 17 patients (22%), the epidural catheter was removed after one or multiple additional interventions due to insufficient pain control. Minor epidural-related complications or side effects were encountered in 36 patients (47%). One patient had a major complication (opioid intoxication). Conclusion Epidural analgesia was successful in 59% of patients; however, 30% needed additional analgesic interventions. As about half of the patients had epidural-related complications, it remains debatable whether epidural analgesia is a sufficient treatment modality in patients with multiple rib fractures.

Medial septal stimulation increases seizure threshold and improves cognition in epileptic rats

BackgroundTemporal lobe epilepsy is most prevalent among focal epilepsies, and nearly one-third of patients are refractory to pharmacological intervention. Persistent cognitive and neurobehavioral comorbidities also occur due to the recurrent nature of seizures and medication-related side effects. HypothesisElectrical neuromodulation is an effective strategy to reduce seizures both in animal models and clinically, but its efficacy to modulate cognition remains unclear. We hypothesized that theta frequency stimulation of the medial septum would increase septohippocampal oscillations, increase seizure threshold, and improve spatial learning in a rat model of pilocarpine-induced epilepsy. MethodsSham and pilocarpine rats were implanted with electrodes in the medial septum, hippocampus and prefrontal cortex. EEG was assessed days prior to and following stimulation. Sham and pilocarpine-treated rats received either no stimulation, continuous (throughout each behavior), or pre-task (one minute prior to each behavior) 7.7 Hz septal stimulation during the Barnes maze spatial navigation test and also during assessment of flurothyl-induced seizures. ResultsBoth continuous and pre-task stimulation prevented epilepsy-associated reductions in theta oscillations over time. Additionally, both stimulation paradigms significantly improved spatial navigation in the Barnes maze, reducing latency and improving search strategy. Moreover, stimulation led to significant increases in seizure threshold in pilocarpine-treated rats. There was no evidence of cognitive enhancement or increased seizure threshold in stimulated sham rats. ConclusionThese findings have profound implications as theta stimulation of the septum represents a single frequency and target that has the potential to both improve cognition and reduce seizures for patients with refractory epilepsy.

Postprocedure Intravenous Patient-Controlled Analgesia Compared to Epidural Patient-Controlled Analgesia Use after Uterine Fibroid Embolization: A Clinical Audit.

Purpose:Postprocedure epidural analgesia has a proven benefit over intravenous (i.v.) analgesia for pain management, but has not yet been demonstrated for uterine fibroid embolization (UFE). The objectives of this clinical audit were to determine if epidural patient-controlled analgesia (PCA) was beneficial to patient outcome as compared to i.v. PCA in decreasing parenteral opioid requirements and its associated side effects and determine if there is a difference in required oral opioids after the PCA is stopped.Materials and Methods:This manuscript audited postprocedural pain management of 51 patients after UFE was performed. 20 patients received an i.v. PCA for post-UFE pain control and 31 received an epidural PCA for post-UFE pain control. Total hydromorphone dose, the frequency of anti-nausea medication use, the frequency of anti-pruritus medication use, and patient pain satisfaction data was collected.Results:Total hydromorphone dose administered to patients post-UFE using epidural PCA was significantly less than patients using an i.v. PCA (P = 0.001). However, the frequency of nausea and pruritus between the two groups did not achieve statistical significance with (P = 0.663) and (P = 0.639) respectively.Conclusion:Our clinical audit found that parenteral opioid requirements administered after UFE can be significantly reduced by using epidural PCA instead of i.v. PCA. However, we found no statistically significant difference in medication related side effects or oral opioid use thereafter.

Sleep Abnormalities in Multiple Sclerosis.

This review summarizes the most well-documented sleep disorders seen in patients with multiple sclerosis (MS), with a special focus on the impact on quality of life. Sleep abnormalities in patients with MS are a multifactorial and relatively complex issue affecting approximately 60% of the patients while the pathophysiology of these symptoms is not fully understood. Circadian rhythm disorders and increased levels of pro-inflammatory cytokines have been recognized as potential players in affecting sleep homeostasis in MS patients. Medication-related side effects such as in immunotherapy and other factors such as lesion load can contribute to the disruption of normal sleep patterns. Most frequently encountered sleep disorders are insomnia, sleep-related movement disorders, sleep-related breathing disorders, and circadian rhythm disorders affecting both adults and paediatric MS populations. Aetiology still remains unknown with treatment options focusing on behavioural cognitive therapy and lifestyle modification including improvement in sleep hygiene as well as melatonin supplementation. Given MS prevalence is still rising affecting millions of people, more personalized medicine applications should possibly form the key approach for improving patients' quality of life and quality years.

Psychotherapy: Use in Persistent Anxiety and Depression.

Psychotherapy: Use in Persistent Anxiety and Depression.

1.5 Pharmacological Strategies for Managing Pediatric Depression

Increasingly difficult cases of children with MDD are presenting to child and adolescent psychiatrists, requiring practitioners to learn new strategies for the management of medication-related side effects, refractory core-depressive symptoms, and treatment of comorbidity(ies).

Lupus Nephritis: A Treatment Update.

Lupus nephritis (LN) is a common complication in many patients with systemic lupus erythematosus, although renal-limited lupus nephritis has been reported as well. Early diagnosis of lupus nephritis is critical as early detection and effective treatment can improve renal outcomes in such patients. The treatment of lupus nephritis is largely determined based on the histological class present on the renal biopsy specimen. In most cases, Class I and II of lupus nephritis do not require any specific treatment, but class III and IV lupus nephritis require immunosuppressive therapy. Treatment of Class V and VI remains controversial. In 2012, six guidelines were introduced for the management of lupus nephritis. These guidelines offer comprehensive treatment plans for each class of Lupus nephritis but differ from each other in many aspects. The purpose of this article is to review the current literature of the available pharmacological treatments used in the six classes of lupus nephritis as well as resistant lupus nephritis, strategies to address the problems of inadequate therapeutic response, medication related side effects, relapses of lupus nephritis, and some future treatment options. We reviewed the available literature and treatment guidelines on lupus nephritis in detail to present a comprehensive review of the available treatment options for different classes of lupus nephritis. Lupus nephritis which does not respond to initial treatment is associated with worse renal outcomes. Several therapeutic approaches are available for the induction and maintenance immunosuppression of the different classes of LN. Management of LN should be individualized for each patient based on their risk-benefit profile.

Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied. This study aimed to evaluate the effectiveness of preemptive analgesia in decreasing postoperative pain. This is a randomized, double-blinded, placebo-controlled trial. This study was conducted at the University of Vermont Medical Center, a tertiary care referral center in Burlington, Vermont. Patients who were over 18 years of age, ASA Physical Status Classes I, II, or III, and undergoing surgery for anal fissure, fistula or condyloma or hemorrhoids were selected. Preoperative oral acetaminophen and gabapentin followed by intravenous ketamine and dexamethasone were given before incision compared with oral placebos. The primary outcomes measured were postoperative pain scores, percentage of patients utilizing breakthrough narcotics, and rates of side effects. Ninety patients were enrolled. Because of patient withdrawal, screen failures, and loss to follow-up, 61 patients were analyzed (30 in the preemptive analgesia group and 31 in the control group). Patients in the active group had significantly less pain in the postanesthesia care unit and at 8 hours postoperatively. Significantly fewer participants in the active group used narcotics in the postanesthesia care unit and at 8 hours postoperatively. Average pain scores were excellent for both groups. There was no difference in the number of medication-related side effects between the 2 groups. This study was limited by the small sample size and excellent pain control in both groups. Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.

An Additive Mix? Acute Urinary Retention in a Patient With Benign Prostatic Hyperplasia Treated With Suboxone, Lurasidone, and Trazodone.

Treatment of psychiatric patients is frequently complicated by medical comorbidities, complex pharmacologic regimens, and side effects occurring secondarily to those regimens. Acute urinary retention is an infrequently discussed side effect of such regimens. This report describes the development of acute urinary retention (AUR) in a 60-year-old man with a history of benign prostatic hyperplasia. The patient developed AUR during treatment with combination buprenorphine/naloxone, trazodone, and lurasidone. We discuss the potential relationship of these agents to the development of this patient's AUR, the complicated neurochemical dynamic of the voiding process, and the pathologic consequences that psychotropic agents can have on that process.

Polypharmacy among HIV positive older adults on anti-retroviral therapy attending an urban clinic in Uganda

BackgroundPolypharmacy has not been investigated in patients living with HIV in developing countries. The aims of this study were to determine the prevalence of polypharmacy, the factors associated with polypharmacy and whether polypharmacy was associated with adverse effects among older adults on anti-retroviral therapy (ART).MethodsCross-sectional study in older adults aged 50 and over on ART attending an outpatient HIV/AIDS care centre in Uganda. Demographic and clinical data collected on number and type of medications plus supplements, possible medication related side-effects, comorbidity, frailty, cognitive impairment, current CD4 count and viral load.ResultsOf 411 participants, 63 (15.3, 95% C.I. 11.9, 18.8) had polypharmacy (≥ 4 non- HIV medications). In multivariate analyses, polypharmacy was associated with one or more hospitalisations in the last year (Prevalence Ratio PR = 1.8, 95% C.I. 1.1, 3.1, p = 0.02), prescription by an internist (PR = 3.6, 95% C.I. 1.3, 10.5, p = 0.02) and frailty index scores of 5 to 6 (PR = 10.6, 95% C.I. 1.4, 78, p = 0.02), and 7 or more (PR = 17.4, 95% C.I. 2.4, 126.5, p = 0.005). Polypharmacy was not associated with frequency and severity of possible medication related side effects and falls.ConclusionPolypharmacy is common among older HIV infected patients in sub-Saharan Africa. It’s more prevalent among frail people, who have been in hospital in the last year and who have been seen by an internist. We found no evidence that polypharmacy results in any harm but this is worth exploring further.

Tumor-related epilepsy: epidemiology, pathogenesis and management.

Seizure is a common comorbidity in patients with brain tumor. It may be the presenting symptom or develop after the tumor diagnosis. The underlying pathophysiology of brain tumor-related epilepsy remains poorly understood. A comprehensive literature review of Pubmed English articles from 1980-2017 was performed to summarize current knowledge and treatment options of brain tumor-related epilepsy. Multiple factors have been found to contribute to tumor-related epilepsy, including tumor type, speed of tumor growth, location, and tumor burden. The underlying pathogenesis of epilepsy is not clear but perturbations in the peri-tumoral regions, both structural and cellular communications, have been implicated. Surgical and medical treatments of tumor-related epilepsy remain challenging as additional factors such as the extent of surgical resection, interactions with tumor-related oncological treatments and anti-epileptic medication related side effects need to be considered.

Mechanisms Underlying Dopamine-Induced Risky Choice in Parkinson's Disease With and Without Depression (History).

Patients with Parkinson’s disease (PD) are often treated with dopaminergic medication. Dopaminergic medication is known to improve both motor and certain nonmotor symptoms, such as depression. However, it can contribute to behavioral impairment, for example, by enhancing risky choice. Here we characterize the computational mechanisms that contribute to dopamine-induced changes in risky choice in PD patients with and without a depression (history). We adopt a clinical–neuroeconomic approach to investigate the effects of dopaminergic medication on specific components of risky choice in PD. Twenty-three healthy controls, 21 PD patients with a depression (history), and 22 nondepressed PD patients were assessed using a well-established risky choice paradigm. Patients were tested twice: once after taking their normal dopaminergic medication and once after withdrawal of their medication. Dopaminergic medication increased a value-independent gambling propensity in nondepressed PD patients, while leaving loss aversion unaffected. By contrast, dopaminergic medication effects on loss aversion were associated with current depression severity and with drug effects on depression scores. The present findings demonstrate that dopaminergic medication increases a value-independent gambling bias in nondepressed PD patients. Moreover, the current study raises the hypothesis that dopamine-induced reductions in loss aversion might underlie previously observed comorbidity between depression and medication-related side effects in PD, such as impulse control disorder.

Glaucoma suspects: A practical approach.

Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects.

Expert’s Corner: When Should SAMe Be Considered for Major Depression?

Back to table of contents Previous article Next article PsychopharmacologyFull AccessExpert’s Corner: When Should SAMe Be Considered for Major Depression?Anup Sharma, M.D., Ph.D., David Mischoulon, M.D., Ph.D.Anup SharmaSearch for more papers by this author, M.D., Ph.D., David MischoulonSearch for more papers by this author, M.D., Ph.D.Published Online:21 Jul 2017https://doi.org/10.1176/appi.pn.2017.pp7b3AbstractThis nutraceutical can be used as both a monotherapy and an add-on treatment for major depressive disorder and comorbid medical illnesses.S-adenosyl-L-methionine (SAMe) was discovered by Giulio Cantoni, the late Italian scientist and biochemistry director of the National Institutes of Health. It is an intracellular amino acid metabolite and enzyme co-substrate involved in multiple crucial biochemical pathways, including the biosynthesis of hormones and neurotransmitters. SAMe serves as the universal methyl donor in more than 100 methyltransferase reactions, which regulate essential metabolic pathways. Methylation involves the transfer of a methyl group to an acceptor molecule, including DNA bases, proteins, phospholipids, amino acids, and neurotransmitters. Aberrant methylation has been implicated as a pathogenic mechanism in central nervous system disorders, including depression and dementia. Methyl group donation is a target mechanism to prevent disease, delay disease progression, and enhance therapeutic outcomes. SAMe deficiency in cerebrospinal fluid (CSF) has been reported in major depression as well as other neuropsychiatric conditions. As a dietary supplement, SAMe crosses the blood-brain barrier and increases CSF levels, hence its potential benefit to patients with depression. More than 50 clinical trials in the United States and Europe have evaluated SAMe in the treatment of depressive disorders, including 19 double-blind, randomized, placebo-controlled trials with more than 850 patients, and 21 controlled trials with more than 1,500 patients comparing SAMe with other antidepressants. A seminal meta-analysis commissioned by the Agency for Healthcare Research and Quality found that SAMe monotherapy was more effective than placebo and comparable to tricyclic antidepressants in treating depressive symptoms. A recent meta-analysis examining adjunctive nutraceuticals for depression demonstrated positive results for SAMe. While additional studies are needed, SAMe appears to be safe and efficacious both as a primary and add-on treatment for major depressive disorder (MDD). Depressed patients often present with a broad array of comorbid conditions, may take concurrent medications, and report medication-related side effects. Evidence suggests that SAMe can ameliorate symptoms associated with medical conditions such as hepatic disease (for example, alcoholic cirrhosis), osteoarthritis, fibromyalgia, and cognitive and memory decline. Compared with prescription medications, SAMe may cause fewer and less severe side effects and result in considerably fewer drug interactions. The evidence generally supporting the safety and efficacy of SAMe in psychiatric and comorbid illnesses offers opportunities for the use of SAMe in diverse clinical contexts. For example, patients with MDD and comorbid rheumatologic illnesses may find SAMe to be particularly beneficial. Careful consideration of pursuing treatment with SAMe as opposed to a registered antidepressant is required on the part of the clinician and the patient. Clinicians who recommend SAMe need to inform their patients that this compound has not been tested as rigorously as its FDA-approved counterparts. However, the risks of SAMe compare quite favorably with prescription antidepressants, particularly in that it does not cause sexual dysfunction or weight gain (two of the most common causes of antidepressant discontinuation), and it is less likely to be life-threatening in patients who are at risk for overdosing during suicide attempts. As with other antidepressants, SAMe can trigger hypomanic or manic symptoms in patients with bipolar disorder and cause gastrointestinal upset. SAMe is sensitive to moisture. Thus, clinicians are advised to instruct patients to purchase SAMe that is contained in foil blister packaging.Although the cost of SAMe is not covered by insurance companies and is among the more expensive natural antidepressants, when compared with the high copayments for many prescription medications, the cost is reasonable, and patients should weigh the costs against potential benefits. ■Back to Psychopharmacology Newsletter Table of ContentsAnup Sharma, M.D., Ph.D., is a research fellow in neuropsychiatry at the University of Pennsylvania Perelman School of Medicine. David Mischoulon, M.D., Ph.D., is director of the Depression Clinical and Research Program at Massachusetts General Hospital and an associate professor of psychiatry at Harvard Medical School. ISSUES NewArchived

The effect of structured education to patients receiving oral agents for cancer treatment on medication adherence and self-efficacy

Objective:This study was conducted to examine the effect of structured education on medication adherence and self-efficacy through the use of the MASCC Oral Agent Teaching Tool (MOATT) for patients receiving oral agents for cancer treatment.Methods:This quasi-experimental study has been conducted at two hospitals; 41 patients were included in the study. Data were obtained using a questionnaire, medication adherence self-efficacy scale (MASES), memorial symptom assessment scale, and a follow-up form (diary). Patients were educated through the use of the MOATT at a scheduled time; drug-specific information was provided along with a treatment scheme and follow-up diary. Phone interviews were completed 1 and 2 weeks after the educational session. At the next treatment cycle, the patients completed the same questionnaires.Results:Majority of the patients were receiving capecitabine (90.2%; n = 37) as an oral agent for breast (51.2%; n = 21) and stomach cancer (24.6%; n = 10) treatment. About 90.2% of patients (n = 37) stated that they did not forget to take their medication and experienced medication-related side effects (78%; n = 32). The total score of MASES was increased after the education (66.39 vs. 71.04, P < 0.05).Conclusions:It was shown that individual education with the MOATT and follow-up for patients receiving oral agents for cancer treatment increased patient medication adherence self-efficacy.

Effects of non-medical switching on outcomes among patients prescribed tumor necrosis factor inhibitors

Objective: To evaluate health care use and outcomes among patients who experienced a non-medical switch of their prescribed anti-tumor-necrosis-factor biological agent (anti-TNF) for cost containment reasons.Methods: Retrospective evaluation of Humedica electronic health records of patients ≥18 years old with anti-TNF treatment for immune conditions. Using natural language processing, stable patients who experienced a non-medical switch (for cost reasons) of their anti-TNF between 2007 and 2013 were identified (NMS cohort, n = 158) and matched to patients who did not (control cohort, n = 4804). Rates of office visits, emergency department visits, and hospitalizations at 30, 90, and 365 days following were evaluated. Medication-related adverse events, defined as subsequent medication change due to a side effect and/or efficacy-related reason were also compared.Results: Adjusted rates of office visits were higher among the NMS cohort than the control cohort at 30 (46.4% vs. 31.7%, p < .001), 90 (71.0% vs. 57.0%, p < .001), and 365 days (87.8% vs. 76.8%, p < .001). Rates of emergency department use and hospitalization were comparable between cohorts. The NMS cohort had higher adjusted rates of medication-related adverse consequences (both increased side effects and diminished efficacy) than the control cohort at 30 (13.8% vs. 4.0%, p = .003), 90 (31.6% vs 9.6%, p < .001), and 365 days (54.7% vs. 20.3%, p < .001). Compared with controls, the NMS cohort had higher adjusted rates of subsequent medication change within 1 year (27.82% vs. 13.9%, p = .001).Conclusion: Non-medical switching among patients prescribed anti-TNFs was associated with increased health care use, medication-related side effects, and reports of diminished efficacy.

Improved life expectancy of people living with HIV: who is left behind?

Improved life expectancy of people living with HIV: who is left behind?

Deconstructing Decisions to Initiate, Maintain, or Discontinue Adjuvant Endocrine Therapy in Breast Cancer Survivors: A Mixed-Methods Study

Adjuvant endocrine therapy (AET) has been shown to improve survival in hormone receptor-positive breast cancer survivors, but as many as half do not complete recommended treatment. Management of medication-related side effects and engagement with providers are two potentially modifiable factors, but their associations with adherence are not well understood. The aims were to build on survey results to qualitatively explore survivors' experiences with prescribed AET to (a) describe appraisal and management of AET side effects and (b) deconstruct decisions to initiate, discontinue, or maintain AET. . The authors used a mixed-methods explanatory sequence research design with a qualitative emphasis. . Survivors were recruited from a clinical cancer registry maintained at the University of Texas Southwestern Medical Center, which includes the Harold C. Simmons Comprehensive Cancer Center (National Cancer Institute-designated), in Dallas. . 452 survivors completed a survey, and 30 took part in telephone interviews. . Qualitative methods were used in which the authors recorded and transcribed interviews for analysis and used open coding to reduce data into themes. . Among adherent survivors, the themes of tolerance of side effects and perseverance were strong. Nonadherent survivors expressed more difficulty managing side effects and perceived fewer benefits when side effects were bothersome. The most common side effects mentioned by all survivors were menopausal symptoms and joint pain; less common side effects were cognitive decline and cardiac distress. Some sought advice from their oncology team. Nonadherent survivors appeared initially motivated to maintain AET but identified a tolerance limit for side effects after which a provider's recommendation was less influential in their decision to maintain or discontinue AET. . This study elucidated adherence as a complex continuum of behaviors, appraisals, and decision points. These insights may be particularly useful in counseling survivors taking AET and promoting timely delivery of clinical interventions to enhance adherence. . Nurses should be involved in the planning and implementation of clinical interventions to manage side effects and other barriers to AET adherence.

Informational needs and recall of in-hospital medication changes of recently discharged patients.

The need for information for patients and caregivers at the point of hospital discharge is paramount and potentially extensive. The objective of this study was to assess patients' informational needs at hospital discharge, patients' recall of medication changes implemented in the hospital and patients' medication related problems experienced one week after hospital discharge. The study was conducted in a teaching hospital where patients received structured discharge counseling. Patients were interviewed at hospital discharge regarding their informational needs. One week post-discharge, patients were interviewed by phone to assess any changes in informational needs, their recall regarding in-hospital medication changes and the medication related problems. Descriptive analysis and logistic regression were used to address study objectives. The 124 patients in the study regarded the following topics as most relevant for counseling: what the medicine is for (57%), side effects (52%), drug-drug interactions (45%), action of the drug (37%) and reimbursement (31%). In 9% of patients the informational needs changed post-discharge, e.g. the topic side effects increased in importance. Forty-nine percent could recall whether and which medication was changed during hospitalization. Medication-related problems and side effects were reported by respectively 27% and 15% of patients, whereas only 7% contacted their doctor or pharmacist. Patients' informational needs are very individual and can change post-discharge. Despite structured counseling, only half of the patients were able to recall the medication changes implemented in the hospital. Furthermore, patients reported several problems for which they did not consult a healthcare provider. This insight could help in smoothing the transition from hospital to the primary care setting.

Medical Expulsive Therapy: Is It Time to SUSPEND Judgement?

Medical expulsive therapy (MET) has been a matter of debate for many years. A number of randomised controlled trials (RCTs) and meta-analyses have been conducted, but outcomes have been varied. This makes it challenging to determine the benefit of using MET as an adjunct in patients with expectantly managed ureteric stones. This article aimed to summarize both the historic and the more contemporary literature in this area by focusing on published meta-analyses and recent RCTs. Studies of interest were those comparing either an α-blocker or a calcium channel blocker with a control. Outcome measures of interest were expulsion rates, expulsion times, and medication-related side effects. All systematic reviews included are in favour of MET versus controls. However, many of the component RCTs had limitations such as a high risk of bias, incomplete blinding and heterogeneous inclusion criteria. A recent well-powered RCT found no benefit of MET for the purpose of conservatively managed ureteric stones. This study had some limitations that stimulated further research in the area, adding to the uncertainty. The most recent RCT and meta-analysis indicates MET is more beneficial in both larger (>5mm) and distal stones. Uncertainty remains in this arena, and there is a need for a robust multi-institution study to assess MET in a cohort of patients who are expectantly managed with ureteric stones. This should serve to counter the marked heterogeneity and limitations of existing trials and meta-analyses.