Antihypertensive medication use can be associated with a reduction in hemoglobin concentration. The magnitude of such a change is generally small, but in certain instances it can be extreme enough to produce a clinically significant degree of anemia. The mechanistic basis for antihypertensive medication-related changes in hemoglobin concentration include hemodilution, hemolytic anemia, and suppression of red blood cell production, as this occurs most commonly with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. A reduction in hemoglobin concentration in a patient who is receiving treatment for hypertension and does not have an obvious source of blood loss should account for potential antihypertensive therapy involvement.
Neuropathic pain is commonly seen in cancer patients, either as a direct result of the malignancy or as a consequence of the treatment rendered. In recent years, methadone has been utilized in the treatment of neuropathic pain because of its additional mechanism of action as an NMDA-receptor antagonist. In this paper we discuss the etiology of neuropathic pain in cancer patients, unique properties of methadone, and prior studies on methadone in this patient population. While methadone has been established as a cheap and effective agent in treating cancer pain, specific studies are needed comparing methadone to other opioids in the management of cancer-related neuropathic pain.
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