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Responsible Pain Management with Theramine

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THERAMINE is a safe and effective option for the dietary management of pain without the adverse side effects associates with opioids, NSAIDs or acetaminophen. The efficacy and safety of THERAMINE is supported by two double blind clinical trials and over a decade of clinical use. To learn more about THERAMINE please call (844) 474-3111 or visit www.medicalfoods.com.

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Responsible Pain Management with Theramine

  1. 1. www.tmedpharma.com 2 Innovative Solutions for Improved Pain Management •Non-Addictive •No Reported GI Bleeds •Reduce Inflammation •Improve Pain Perception •Over 26 Million Doses Taken without a Reported Cardiac or GI Event* * Administrations is defined as number of pills sold in 2004
  2. 2. 3www.tmedpharma.com Theramine® is intended for the dietary management of pain syndromes that include: • Chronic Low Back Pain • Neck Pain • Inflammatory Pain • Joint Pain • Radicular Pain Recommended Dosing: 2 capsules b.i.d. Indication & Dosing
  3. 3. 4www.tmedpharma.com Theramine® can be prescribed as an adjunct to a low dose: • NSAID – naproxen, ibuprofen, diclofenac, meloxicam • Narcotic – hydrocodone, tramadol, oxycodone, fentanyl • Anti-Epileptic – gabapentin, pregabalin • SSRI/SNRI – duloxetine, Pristiq, Savella Opioid Dose Titration: Theramine can also be combined with opioid therapies as part of a dose titration and replacement strategy. Adjunct Therapy
  4. 4. 1. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163 2. Shell, et al., “A Double-Blind Controlled Trial of a Single Dose Ibuprofen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain; Publication pending, 2010. In a double blind, multicenter trial, subjects with pain syndromes showed decreased levels of the amino acids required for production of pain modulating neurotransmitters, despite having a sufficient intake of protein indicating that the need for these amino acids are selectively increased in these patients.1 5www.tmedpharma.com Theramine® Improves Amino Acid Levels 0 5 10 15 20 25 30 35 Arginine Serine Histidine Tryptophan Ug/ml Change in Blood Concentration of Amino Acids2 Day 1 Day 28 Normal N=25
  5. 5. In a 28 day double blind, randomized, controlled, multicenter trial of 127 subjects with chronic established back pain, subjects taking Theramine alone and as an adjunct to naproxen experienced a statistically significant reduction in pain compared to once daily naproxen (250mg)1 . 1. Shell, et al.,“A Double-Blind Controlled Trial of a Single Dose Naproxen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain”; American Journal of Therapeutics; 2012 108-114 6www.tmedpharma.com Significantly Reduce Pain with Theramine® 2.95 -44 -65 -80 -70 -60 -50 -40 -30 -20 -10 0 10 Percent(%) Reduction of Pain- Roland Morris Index Naproxen Theramine Both p<0.05 n=126
  6. 6. Data from a 28 day double blind, randomized, controlled trial of 127 subjects with chronic established back pain shows that a low dose NSAID can be more effective when co-administered with Theramine.1 1. Shell, et al.,“A Double-Blind Controlled Trial of a Single Dose Naproxen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain”; American Journal of Therapeutics; 2012 108-114 7www.tmedpharma.com Theramine® is an Effective Adjunct to NSAIDs1 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Baseline Day 7 Day 14 Day 28 LikertScale Sequential Changes in Back Pain Walking on Flat Surface Naproxen theramine theramine/naproxen n= 127 p<0.01
  7. 7. 8www.tmedpharma.com Reduce Inflammation with Theramine® In this double-blind multicenter trial of 127 subjects with chronic established back pain, a marked decrease in CRP was measured among subjects taking Theramine compared to subjects taking ibuprofen (400mg) once daily. 60.1 -47.05 -35.99 -60 -40 -20 0 20 40 60 80 Percent(%) Change in CRP Levls Ibuprofen n = 43 Theramine n = 41 Combination n = 38 p<0.01 Shelll WE; Pavlik St; Roth B; Silver M; Breitstein M; May L; Silver D “ Reduction in Pain and Inflammation Associated with Chronic Low Back Pain with the use of the Medical Food Theramine” American Journal of Therapeutics 2014.
  8. 8. Replace or Augment NSAID Therapies • Patients who are contraindicated for NSAIDs (High BP, Over 65, CVD, Taking Aspirin) • Patients taking Theramine can take a very low dose NSAID without loss of efficacy 1 Alternative to Opioid Pain Medications • Theramine can be used as an adjunct therapy to a low dose opioid pain medication • Theramine can be used as a replacement therapy for other ineffective or dangerous pain medications 10www.tmedpharma.com 1. Shell, et al. American Journal of Therapeutics; 2012 108-114 ; Theramine ibuprofen trial 2010, Unpublished.
  9. 9. Theramine is a source of amino acids, biogenic amines, and botanicals that is specially formulated to manage the increased nutritional requirements of pain syndromes. The altered metabolic processes associated with pain syndromes and inflammatory conditions increase the turnover rate of arginine, choline, GABA, glutamine, histidine, 5-hydroxytryptophan, and serine. Simple dietary modifications are not sufficient to satisfy cellular demand and restore homeostasis to the ascending and descending pain pathways and inflammatory processes.(1-4) 1. 1. Wurtman RJ. Nutrients affecting brain composition and behavior. Integr Psychiatry 1987;5:226-238. 2. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163. 3. Zeisel SH. Dietary influences on neurotransmission. Adv Pediatr 1986;33:23-47. 4. Fernstrom JD. Dietary precursors and brain neurotransmitter formation. Annu Rev Med 1981;32:413-425. 11www.tmedpharma.com Increased Nutritional Requirements
  10. 10. The Pharmacodynamic properties of Theramine® are directly related to the effects of amino acid and other precursors on neurotransmitter activity which are responsible for the induction, amplification, and mitigation of pain. The use of Theramine in management of pain syndromes is supported by experimental and clinical data which have identified specific roles for each ingredient in the mechanism of pain reduction. Theramine is formulated with Targeted Cellular Technology (TCT) a patented integrated molecular system that delivers milligram quantities of amino acids and other ingredients to targeted cells in a time sensitive manner and in specific ratios efficiently promote neurotransmitter production. Pharmacodynamics 12www.tmedpharma.com
  11. 11. PRECAUTIONS AND CONTRAINDICATIONS Theramine® is contraindicated in an extremely small number of patients with hypersensitivity to any of the nutritional components of Theramine. ADVERSE REACTIONS Ingestion of L-Tryptophan, L-Arginine, or Choline at high doses of up to 15 grams daily is generally well tolerated. The most common adverse reactions of higher doses — from 15 to 30 grams daily — are nausea, abdominal cramps, and diarrhea. Theramine contains less than 1 gram per dose of amino acids however, some patients may experience these symptoms at lower doses. The total combined amount of amino acids in each Theramine capsule does not exceed 300 mg. Safety Information 13www.tmedpharma.com
  12. 12. DRUG INTERACTIONS Theramine® does not directly influence the pharmacokinetics of prescription drugs. Clinical experience has shown that administration of Theramine may allow for lowering the dose of co-administered drugs under physician supervision. OVERDOSE There is a negligible risk of overdose with Theramine as the total amount of amino acids in a one month supply (90 capsules) is less than 30 grams. Overdose symptoms may include diarrhea, weakness, and nausea. www.tmedpharma.com Safety Information Cont. 14
  13. 13. 15 1. Fields HL, Heinricher MM, Mason P. Neurotransmitters in nociceptive modulatory circuits. Annu Rev Neurosci 1991;14:219-245. 2. Schaible HG, Ebersberger A, Von Banchet GS. Mechanisms of pain in arthritis. Ann N Y Acad Sci 2002;966:343-354. 3. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol 2001;429:23-37. 4. Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57:1-164. 5. Elenkov IJ, Chrousos GP. Stress hormones, proinflammatory and antiinflammatory cytokines, and autoimmunity. Ann N Y Acad Sci 2002;966:290-303. 6. Cuninkova L, Brown SA. Peripheral circadian oscillators: interesting mechanisms and powerful tools. Ann N Y Acad Sci 2008;1129:358-370. 7. Gaillard JM. Neurochemical regulation of the states of alertness. Ann Clin Res 1985;17:175-184. 8. McGinty D, Szymusiak R. The sleep-wake switch: A neuronal alarm clock. Nat Med 2000;6:510-511. 9. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms 2006;21:482-493. 10. Turek FW, Dugovic C, Zee PC. Current understanding of the circadian clock and the clinical implications for neurological disorders. Arch Neurol 2001;58:1781-1787. 11. Belousov AB, O'Hara BF, Denisova JV. Acetylcholine becomes the major excitatory neurotransmitter in the hypothalamus in vitro in the absence of glutamate excitation. J Neurosci 2001;21:2015-2027. 12. Farber L, Haus U, Spath M, Drechsler S. Physiology and pathophysiology of the 5-HT3 receptor. Scand J Rheumatol Suppl 2004;2-8. 13. Dickenson AH, Chapman V, Green GM. The pharmacology of excitatory and inhibitory amino acid-mediated events in the transmission and modulation of pain in the spinal cord. Gen Pharmacol 1997;28:633-638. 14. Ernberg M, Lundeberg T, Kopp S. Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals. Pain 2000;85:31-39. 15. Furst DE, Manning DC. Future directions in pain management. Clin Exp Rheumatol 2001;19:S71-S76. 16. Linderoth B, Stiller CO, Gunasekera L et al. Release of neurotransmitters in the CNS by spinal cord stimulation: survey of present state of knowledge and recent experimental studies. Stereotact Funct Neurosurg 1993;61:157-170. 17. Hogg RC, Raggenbass M, Bertrand D. Nicotinic acetylcholine receptors: from structure to brain function. Rev Physiol Biochem Pharmacol 2003;147:1-46. 18. Abbadie C, Brown JL, Mantyh PW, Basbaum AI. Spinal cord substance P receptor immunoreactivity increases in both inflammatory and nerve injury models of persistent pain. Neuroscience 1996;70:201-209. 19. Thomas RJ. Excitatory amino acids in health and disease. J Am Geriatr Soc 1995;43:1279-1289. 20. Dickenson AH. Plasticity: implications for opioid and other pharmacological interventions in specific pain states. Behav Brain Sci 1997;20:392-403. 21. Dickenson AH. NMDA receptor antagonists: interactions with opioids. Acta Anaesthesiol Scand 1997;41:112-115. 22. Oliverio A, Castellano C, Puglisi-Allegra S. Psychobiology of opioids. Int Rev Neurobiol 1984;25:277-337. 23. Ono T, Inoue M, Rashid MH, Sumikawa K, Ueda H. Stimulation of peripheral nociceptor endings by low dose morphine and its signaling mechanism. Neurochem Int 2002;41:399- 407. 24. Ribeiro JA, Sebastiao AM, de MA. Adenosine receptors in the nervous system: pathophysiological implications. Prog Neurobiol 2002;68:377-392. 25. Gallowitsch-Puerta M, Pavlov VA. Neuro-immune interactions via the cholinergic anti-inflammatory pathway. Life Sci 2007;80:2325-2329. 26. Hancock CM, Riegger-Krugh C. Modulation of pain in osteoarthritis: the role of nitric oxide. Clin J Pain 2008;24:353-365. 27. Holthusen H, Arndt JO. Nitric oxide evokes pain at nociceptors of the paravascular tissue and veins in humans. J Physiol 1995;487 ( Pt 1):253-258. 28. Wahl SM, McCartney-Francis N, Chan J, Dionne R, Ta L, Orenstein JM. Nitric oxide in experimental joint inflammation. Benefit or detriment? Cells Tissues Organs 2003;174:26- 33. 29. Efron DT, Barbul A. Modulation of inflammation and immunity by arginine supplements. Curr Opin Clin Nutr Metab Care 1998;1:531-538. 30. Mori M. Regulation of nitric oxide synthesis and apoptosis by arginase and arginine recycling. J Nutr 2007;137:1616S-1620S. 31. Budzinski M, Misterek K, Gumulka W, Dorociak A. Inhibition of inducible nitric oxide synthase in persistent pain. Life Sci 2000;66:301-305. 32. Pelligrino DA, Baughman VL, Koenig HM. Nitric oxide and the brain. Int Anesthesiol Clin 1996;34:113-132. 33. Cerra FB. Nutrient modulation of inflammatory and immune function. Am J Surg 1991;161:230-234. www.tmedpharma.com Select References
  14. 14. For More Information Visit www.tmedpharma.com 16www.tmedpharma.com

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