Side Effects of Drugs

References

Rycroft RJG, Frosch PJ, Menne T, editors. Textbook of Contact Dermatitis. 3rd ed. Berlin Springer-Verlag, 1999. 2. Rietschel RL, Fowler JF Jr, editors. Fisher's Contact Dermatitis. 4th ed. Baltimore Williams and Wilkins, 1995. 3. De Groot AC. Patch Testing. Test Concentrations and Vehicles for 3700 Allergens. Amsterdam Elsevier, 1994. 4. De Groot AC, Weyland JW, Nater JP. Unwanted Effects of Cosmetics and Drugs used in Dermatology. 3rd ed. Amsterdam Elsevier, 1994. 5. Fischer T. Design...

Drug contamination

Unregulated Chinese herbal products adulterated with glu-cocorticoids have been detected (357). Dexamethasone was present in eight of 11 Chinese herbal creams analysed by UK dermatologists. The creams contained dexametha-sone in concentrations inappropriate for use on the face or in children (64-1500 micrograms g). The cream with the highest concentration of dexamethasone was prescribed to treat facial eczema in a 4-month-old baby. In all cases, it had been assumed that the creams did not...

Drug Administration Drug contamination

There have been reports of herbal remedies adulterated with fenfluramine. There was public health concern in the UK after the referral of a 44-year-old woman with new-onset hypertension, palpitation, anxiety, and a body mass index of 19 kg m2. It became apparent that an alarming number of the local population had been attending a particular Chinese herbalist for weight loss remedies. Most had been taking multiple formulations and described spectacular'' results. Several reported considerable...

Laurus nobilis

Laurus nobilis (laurel) has well-known analgesic, diaphoretic, antipyretic, and diuretic effects (10), and is widely used in rheumatic, pyrexial, and infective disorders (11), as well as in the perfume and soap industries (10). Laurel oil obtained from the berries of L. nobilis is a potent skin sensitizer, owing to the presence of allergenic sesquiterpene lactones, and is usually seen in aromathera-pists or their clients (12-14). A 55-year-old woman developed erythema and edema over her knees...

Chelidonium majus

Chelidonium majus (celandine, common celandine, greater celandine) contains a number of alkaloids, including chelidonine, chelerythrine, chelidocystatin, coptisine, sanguinarine, berberine, and sparteine. Greater celandine was traditionally used to improve eyesight and in modern times has been used as a mild sedative, and antispasmodic in the treatment of bronchitis, whooping cough, asthma, jaundice, gallstones, and gallbladder pain. The latex is used topically to treat warts, ringworm, and...

Marijuana Detox

Rosenbaum MB, Chiale PA, Halpern MS, Nau GJ, Przybylski J, Levi RJ, Lazzari JO, Elizari MV. Clinical efficacy of amiodarone as an antiarrhythmic agent. Am J Cardiol 1976 38(7) 934-44. 2. McGovern B, Garan H, Ruskin JN. Serious adverse effects of amiodarone. Clin Cardiol 1984 7(3) 131-7. 3. Latini R, Tognoni G, Kates RE. Clinical pharmacokinetics of amiodarone. Clin Pharmacokinet 1984 9(2) 136-56. 4. Heger JJ, Prystowsky EN, Miles WM, Zipes DP. Clinical use and pharmacology of amiodarone. Med...

General adverse effects

Several reviews have focused on herbal medicines and have covered the toxicity of medicinal plants 32-34 the safety of herbal products in general 35-46 adverse effects in specific countries, for example the USA 47 and Malaysia 48 adverse effects on specific organs 49 , such as the cardiovascular system 50 , the liver 51,52 , and the skin 53,54 the safety of herbal medicines in vulnerable populations elderly patients 55 , pregnant women 56 , and surgical patients 57,58 the adverse effects of...

Aminaphtone

Experiments in the 1970s with aminaphtone suggested that it could significantly shorten the bleeding time in both normal and heparinized rabbits and mice 1 . Subsequent clinical experiments showed no adverse effects and toxicological studies in animals showed no evidence of acute or long-term toxicity, even at quite high doses 1 . No adverse effects were noted when patients who had initially been involved in an efficacy study of limited duration were treated with aminaphtone for a further year...

Aristolochia species

Plants belonging to the genus of Aristolochia are rich in aristolochic acids and aristolactams. In the UK, the long-term (2 and 6 years) use of Aristolochia species in Chinese herbal mixtures, taken as an oral medication or herbal tea, resulted in Chinese-herb nephropathy with end-stage renal insufficiency (1). In reaction to these reports, the erstwhile Medicines Control Agency banned all Aristolochia species for medicinal use in the UK. In June 2001, the FDA issued a nationwide alert,...

Other topical antifungal drugs

5-Bromo-4-chlorosalicylamide (multifungin) 5-Bromo-4-chlorosalicylamide is one of a group of local antiseptics and fungistatics that can cause photosensitiza-tion (25). There is cross-sensitization with bithionol, fenticlor, and tribromosalicylanide. Buclosamide (N-butyl-4-chlorosalicylamide) Photocontact dermatitis has been described with buclosa-mide (25). There is cross-reactivity with a number of other drugs, notably oral hypoglycemic drugs, diuretics, and sulfonamides. Because of these...

Teratogenicity

Benzodiazepines readily pass from the mother to fetus through the placenta (115). There may be a risk of congenital malformations, particularly oral cleft, if a pregnant woman takes a benzodiazepine during the first trimester, but the data are inconsistent across drugs (alprazolam having the most clearly defined risk), and any overall effect is probably small (27,28). The risk of benzodiazepine-induced birth defects thus remains uncertain (116), despite two cases of fetal-alcohol syndrome...

Long Term Effects Drug abuse

Abuse of buprenorphine has been reported in many countries and it is now widely dealt with under psychotropic drug legislation. Although sublingual buprenorphine has been used in the management of heroin addiction (SEDA-16, 88), widespread abuse of buprenorphine by addicts is known (SEDA-16, 88), including the snorting of crushed sublingual tablets (SEDA-16, 88). Buprenorphine is increasingly being used as a substitute for other opioids in the treatment of opioid abuse and is generally...

Second Generation Effects Fertility

It has been suggested that the use of caffeine to improve the mobility of human sperm used in artificial insemination may be very risky, owing to the potential for chromosome damage and also possible damage to the fertilized ovum (SEDA-5, 32). Another study suggested that a high daily intake of caffeine may predispose women to reproductive difficulties (SEDA-9, 2). Although delayed mitosis and excessive chromatid breaks have been noted in human lymphocytic cultures to which caffeine was added...

Catha edulis

Chewing the leaves of Catha edulis (khat, qat) results in subjective mental stimulation, increased physical endurance, and increased self-esteem and social interaction. Until recently, this habit was confined to Arabian and East African countries, because only fresh leaves are active, but because of increased air transportation, khat is now also chewed in other parts of the world. Although cathine (norpseudoephedrine) is quantitatively the main alkaloid, the amphetamine-like euphorigenic and...

Infection risk

The use of betamethasone for the treatment of premature rupture of membranes during pregnancy is associated with an increased prevalence of maternal and neonatal infections. Two reports have described the risk of infections associated with the use of glucocorticoids during pregnancy. Of 374 patients with preterm premature rupture of membranes, 99 received a single course of glucocorticoids, 72 received multiple courses, and 203 were not treated with glucocorticoids (324). Only multiple courses...

Second Generation Effects Teratogenicity

Dicycloverine was formerly combined with doxylamine succinate and sometimes with pyridoxine in Debendox (Bendectin) tablets, which were used in certain countries for the treatment of nausea and vomiting in pregnancy. There has been a widely discussed suggestion that Debendox might cause a range of fetal malformations, but numerous studies have failed to confirm this (1). For example, in a survey of 22 977 pregnant women in Great Britain 620 of whom had been given Debendox and 743 other women...

Organs and Systems Cardiovascular

The cardiovascular complications of oral contraceptives include venous thrombosis and thromboembolism, arterial damage, and hypertension. A central issue almost from the beginning of the oral contraceptive era has been the undoubted ability of these products to increase the risk of thromboembolic and allied complications. It was the dominant reason for the progressive reduction in hormonal content of these products during their first 20 years it led at one point to a precipitate and poorly...

Iodinecontaining medicaments

Iodine must be present in the normal diet to prevent iodine-deficiency goiter or cretinism, and iodine deficiency-related disorders are still a worldwide (although preventable) group of diseases that affect about 150 million people in at least 40 countries. The WHO sponsored a program to control these disorders by the year 2000 (1,2), and since 1990 there has been a remarkable progress in prevention of iodine deficiency disorders. However, by the year 2000 one-third of the population affected...

Endocrine

It has been estimated that in 1990 iodine deficiency affected almost one-third of the world's population and represented the greatest single cause of preventable brain damage and mental retardation. Fortification of all salt for animal and human consumption has been chosen as the preferred method for the prevention of iodine deficiency disorders, and this approach is effective in reducing the incidence of such disorders. However, iodine supplementation is not without risk, particularly...

Fetotoxicity

Large quantities of iodine reduce the organic binding of iodine (the Wolff-Chaikoff effect). Thus, the regular use of iodide during pregnancy can cause development of a goiter in the fetus. The size of the goiter in the child can be large enough to cause difficulty during delivery. Treatment of vagi-nitis with iodine-containing solutions in pregnant women can lead to goiter and hypothyroidism in the infant (17). Neonatal goiter caused by the use of potassium iodine as an expectorant during...

Second Generation Effects Pregnancy

Cervical laceration associated with misoprostol has been reported in a 33-year-old woman who received four doses of vaginal misoprostol (total dose 100 micrograms) for labor induction. Uterine rupture has occurred during induction of labor with misoprostol, usually in women who have had a previous cesarean section (16,17). Uterine dehiscence occurred in one and uterine rupture in three of 48 women with prior cesarean sections treated with intravaginal misoprostol 50 micrograms for cervical...

Organs and Systems Respiratory

Bronchospasm may be a consequence of penicillin allergy (7-12). Acute severe dyspnea with cyanosis has also been observed without symptoms of bronchial obstruction or pulmonary edema (13). Specific mechanisms for such cases have yet to be identified. Allergic pneumonitis and transient eosinophilic pulmonary infiltrate (Loeffler's syndrome) are rare. These syndromes have also been observed with penicillin hyper-sensitivity (14-16). In one case, an alveolar allergic reaction, probably due to...

Povidoneiodine

Povidone-iodine is a macromolecular complex (poly-I(I-vinyl-2-pyrrolidinone)) that is used as an iodophor. It is formulated as a 10 applicator solution, a 2 cleansing solution, and in many topical formulations, for example aerosol sprays, aerosol foams, vaginal gels, ointments, and mouthwashes. Because it contains very little free iodine (less than 1 ppm in a 10 solution), its antibacterial effectiveness is only moderate compared with that of a pure solution of iodine. The extent of systemic...

Neuromuscular function

The depolarization of the motor end-plate receptors produced by suxamethonium (either directly or via repetitive discharge generation by the motor nerve terminals) (40) results in generalized and desynchronized contraction of skeletal muscle fibers. These fasciculations result in aching muscle pain (in up to 90 of patients), most commonly in the neck, pectoral region, shoulders, and back. The pain is most often experienced the day after operation and is worse in ambulatory patients. It is more...

See also Vitamins and Vitamin A Retinoids General Information

The carotenoids are a class of hydrocarbons (carotenes) and their oxygenated derivatives (xanthophylls) that consist of eight isoprenoid units joined in such a manner that the arrangement of the units is reversed at the center of the molecule, so that the two central methyl groups are in a 1,6-positional relationship and the remaining nonterminal methyl groups are in a 1,5-positional relationship. Their nomenclature has been standardized by IUPAC and their formal names are all based on the term...

Use of methadone in opioid withdrawal

A widely used technique for opioid detoxification, pioneered by Isbell and Vogel (43), involves the substitution of methadone for the illicit opioid, followed by a gradual reduction in the amount of methadone taken. Methadone maintenance treatment was established in 1964 in New York City by Vincent Dole and Marie Nyswander. In the initial studies, subjects who were heavily addicted to heroin were evaluated and stabilized on daily methadone doses as inpatients before transfer to an outpatient...

Intrathecal Pentazocin

Peripheral and central mechanisms of pain. Br J Anaesth 1998 81(1) 8-11. 2. Jordan B, Devi LA. Molecular mechanisms of opioid receptor signal transduction. Br J Anaesth 1998 81(1) 12-19. 3. Harrison C, Smart D, Lambert DG. Stimulatory effects of opioids. Br J Anaesth 1998 81(1) 20-8. 4. Collett BJ. Opioid tolerance the clinical perspective. Br J Anaesth 1998 81(1) 58-68. 5. Elliott K, Kest B, Man A, Kao B, Inturrisi CE. N-methyl-D-aspartate (NMDA) receptors, mu and kappa opioid...

Monitoring Therapy

There is evidence that predose concentrations of teicopla-nin are related to clinical outcome the evidence is less conclusive for vancomycin. Predose concentrations can be linked to some toxic effects (nephrotoxicity for vanco-mycin and thrombocytopenia to teicoplanin) (55,56). In severe infections monitoring serum teicoplanin concentrations is indicated to assure adequate trough concentrations (over 10 mg ml) (57). For the treatment of S. aureus endocarditis trough concentrations should exceed...

Drug dependence

The role of dopamine in the addictive process has been explored (76). The authors raised the possibility that the orbitoprefrontal cortex is linked to compulsive drug abuse. They recruited 15 metamfetamine users and 20 non-drug user controls. The metamfetamine abusers had significantly fewer dopamine D2 receptors than the controls. There was an association between lower numbers of dopamine D2 receptors and metabolism in the orbitofrontal cortex in the metamfetamine users. These findings are...

Nervous system

Delayed onset oculogyric crisis and generalized dystonia occurred in a 19-year-old man after intranasal heroin use, possibly due to bilateral hypoxic infarction of the palli-dum and pallidothalamic tracts (10). There has been one report of mixed transcortical aphasia attributed to heroin (11). Myoclonic spasm has been reported about 24 hours after withdrawal of an epidural infusion of diamorphine (SEDA-16, 81). Demyelination has been attributed to diamorphine (12). A 41-year-old chronic...

Drug Administration Drug formulations

Precipitates can develop in parenteral nutrition admixtures because of a number of factors such as the concentration, pH, and phosphate content of the amino acid solutions, the calcium and phosphorus additives, the order of mixing, or the mixing process. The consequences can be serious. In one cohort study of hospitalized patients who received peripheral parenteral nutrition, a subgroup developed unexplained chest pain, dyspnea, cardiopulmonary arrest, or new interstitial infiltrates on chest...

Polio vaccines as a possible cause of AIDS

There is a hypothesis that the HIV virus might have jumped the species barrier from monkey to people via a contaminated polio vaccine because the vaccine was manufactured in primary monkey kidney tissue known to be sometimes contaminated with monkey viruses. The existing evidence, including tests of poliovirus seed stocks, more than 20 vaccine lots, and serum samples from vaccine recipients makes this hypothesis highly improbable (6,7). Contamination of polio vaccines with simian papovavirus 40...

General Information

Radioactive substances may be used in medicine as tracers, the quantities used in this case being merely sufficient to enable them to be detected, or as therapeutic agents, in which case the quantities employed and the amount of radiation emitted may be considerable. Risks resulting from the radiation itself fall outside the scope of this volume. Radio-iodine is covered in a separate monograph. General adverse effects Radiopharmaceuticals have a good safety record. The prevalence of adverse...

Tricyclic antidepressants

Inhibition of CYP2D6 by terbinafine has been evaluated by assessing 48-hour concentration-time profiles of the tricyclic antidepressant desipramine in 12 healthy volunteers identified as extensive CYP2D6 metabolizers by genotyping and phenotyping (70). The pharmacokinetics were evaluated at baseline (50 mg oral desipramine given alone), steady state (after 250 mg oral terbinafine for 21 days), and 2 and 4 weeks after terbinafine withdrawal. The pharmacodynamics were evaluated before and 2 hours...

Psychological psychiatric

Depression and psychosis have been observed in respectively 15 and 3 of patients taking topiramate (SEDA-22, 91) (17). Three patients taking topiramate for bipolar disorder developed substantial depression (25). The symptoms began or increased within 1 week of topiramate treatment (25 mg day) or with an increase in dosage to 50 mg day. All had significant relief from depression 1-2 weeks after withdrawal of topiramate. The close association with the onset of the most severe depression these...

National compensation programs for vaccinerelated injuries

The need for some form of compensation when an individual is seriously injured by vaccination, particularly when the immunization has been compulsory or recommended by the health authority, has been accepted in many countries. Table 6 shows details of compensation programs in Canada (the province of Quebec), Denmark, France, Germany, Italy, Japan, New Zealand, Norway, Sweden, Switzerland, Taiwan, the UK, and the USA (37). In the USA, the National Childhood Vaccine Injury Act of 1986 established...

Www.ar-r.comside Effects

Effects of crystalline nicotinic acid-induced hepatic dysfunction on serum low-density lipoprotein cholesterol and lecithin cholesteryl acyl trans-ferase. Am J Cardiol 1998 81 6 805-7. 2. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained-vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994 271 9 672-7. 3. Lasagna L. Over-the-counter niacin. JAMA 1994 271 9 709-10. 4. Gibbons LW, Gonzalez...

See also Vaccines General Information

Haemophilus influenzae causes several infectious diseases in man, the most serious being meningitis. Most cases of Haemophilus influenzae infection are due to type b of the organism (Hib). Two types of Hib vaccines have been developed Hib capsular polysaccharide (PRP) vaccines are first-generation Hib vaccines, while Hib conjugate vaccines are second-generation vaccines. The capsular polysaccharide vaccines do not protect infants and children under 18 months, whereas Hib conjugate vaccines have...

Cassia species

The leaves and fruits of Cassia angustifolia and Cassia senna (senna) contain laxative anthranoid derivatives. Mutagenicity testing of sennosides has produced negative results in several bacterial and mammalian systems, except for a weak effect in Salmonella typhimurium strain TA102 (1,2). No evidence of reproductive toxicity of sennosides has been found in rats and rabbits (3). Senna is widely used in fairly low doses without serious problems it has also been used in a very high dosage form to...

Stimulant laxatives

All of the anthraquinones can cause cramping and abdominal discomfort. Chronic use can be associated with melanosis coli. The urine can be colored red. The possibility of colonic injury has been discussed (see General adverse effects of laxatives in this monograph). Hepatitis, confirmed by rechallenge, has been reported, possibly due to re-absorption of rhein anthron produced in the intestine (SEDA-16, 425). The Food and Drug Administration (FDA) has ruled that the stimulant laxatives aloe...

Drug withdrawal

Like many other agents that act at the GABA receptor, abrupt termination of long-term administration of baclo-fen can result in withdrawal symptoms, even after intrathecal administration (17,18). Patients can present with different symptoms, not all of which would be considered classical of drug withdrawal. Common presenting features are muscular hyperactivity, hyperthermia, metabolic derangements, and rhabdomyo-lysis when baclofen therapy is abruptly discontinued, and several deaths have...

Second Generation Effects Fetotoxicity

Convulsions have been attributed to withdrawal of baclo-fen after in utero exposure (28). A 7-day-old baby was admitted to hospital with generalized convulsions, which did not respond to phenobarbital, phenytoin, clonazepam, lidocaine, or pyridoxine. A variety of investigations all gave negative results. Electroencephalography 4 days later showed prolonged episodes of epileptic activity. At that time baclofen withdrawal was suspected, as the paraplegic mother had been taking baclofen 20 mg tds...

Rattlesnake meat

Dried rattlesnake meat SEDA-14, 442 SEDA-18, 2 is a well-known folk remedy that can be purchased without prescription in Mexico, El Salvador, and the South-western part of the USA. It is available as such and in the form of powder, capsules, or pills, which may be labeled in Spanish as v bora de cascabel,'' ''pulvo de v bora,'' or carne de v bora. All of 16 different formulations of rattlesnake powder capsules, obtained in six different cities in Mexico, were significantly contaminated with...

Molsidomine

See also Antianginal drugs General Information Molsidomine is a vasodilator that acts as a nitric oxide donor and has been used in angina pectoris, heart failure, and after myocardial infarction. In a multicenter, randomized, double-blind, crossover, placebo-controlled study of the efficacy of two regimens of molsidomine in 90 patients with stable angina, beneficial effects on exercise load did not seem to be reduced by 6 weeks of continuous therapy, suggesting lack of tolerance (1). The most...

Brugmansia species

Brugmansia Candida Datura Candida, angel's trumpet and Brugmansia suaveolens Datura suaveolens, angel's tears are ornamental flowers that have been used for hallucinogenic effects. Both contain tropane alkaloids, such as hyoscine, hyoscyamine, meteloidine, and nor-hyoscine, which have anticholinergic properties. Acnistus acnistus Atropa belladonna Bouchetia bouchetia Browallia browallia Brugmansia brugmansia Brunfelsia rain tree Calibrachoa calibrachoa Capsicum pepper Cestrum jessamine...

Senecio species

Many species of Senecio, such as Senecio jacobaea (ragwort) and Senecio longilobus (thread leaf groundsel), contain hepatotoxic amounts of pyrrolizidine alkaloids (which are covered in a separate monograph). Honey made from Senecio plants also contains pyrrolizidine alkaloids (32). Veno-occlusive disease has been attributed to Senecio after chronic use (33,34). Hepatic veno-occlusive disease occurred in a 38-year-old woman who had occasionally consumed Huamanrripa'' (Senecio tephrosioides) as a...

Tussilago farfara

Tussilago farfara (coltsfoot) has hepatotoxic potential owing to the presence of pyrrolizidine alkaloids (see separate monograph). An 18-month-old boy who had regularly consumed a herbal tea mixture since the 3rd month of life developed veno-occlusive disease with portal hypertension and severe ascites (46). Histology of the liver showed centrilobular sinusoidal congestion with perivenular bleeding and parenchymal necrosis without cirrhosis. The child was given conservative treatment only and...

Pharmacokinetics

As far as is currently known, benzodiazepines and similar drugs (zopiclone, zolpidem) act by a single mechanism, interacting at the GABA receptor complex to enhance the ability of GABA to open a chloride ion channel and thereby hyperpolarize the neuronal membrane. It is usual, therefore, to classify benzodiazepines, and recommend their clinical use, on the basis of their duration of action or their half-life. While this is without doubt a useful classification, it is simplistic and does not...

Acorus calamus

Acorus calamus calamus root, sweet flag, rat root, sweet sedge, flag root, sweet calomel, sweet myrtle, sweet cane, sweet rush, beewort, muskrat root, pine root contains several active constituents called asar-ones.'' The basic structure is 2,4,5-trimethoxy-1-propenyl-benzene, which is related to the hallucinogen 3,4-methylenedioxyphenylisopropylamine MDA . The amounts of the asarones in calamus rhizomes vary considerably with the botanical variety. For example, there are high concentrations in...

Hematologic

Myelosuppression, principally neutropenia, occurs in 60-80 of patients who receive conventional doses of anthracyclines (single-agent standard doses doxorubicin 60-75 mg m2, epirubicin 60-90 mg m2 given 3-weekly) (53). On an equimolar basis, in both the single-agent and combination regimens, epirubicin causes less hema-tological toxicity than doxorubicin (24). The incidence and severity of myelosuppression is related to dose it has been suggested that severe neutropenia occurs in all patients...

See also Individual agents General Information

Vasopressin, a hypothalamic octapeptide that is secreted by the neurohypophysis, has both antidiuretic and vasoconstrictor properties. Its short half-life (about 10 minutes) necessitates continuous intravenous infusion or frequent nasal application. Because its vasoconstrictor effects limit the use of the native hormone, analogues with greater or lesser affinity for vasopressin V2 receptors and more selective antidiuretic effects have been developed argipressin (8-arginine vasopressin)...

Sensory systems

The reported frequency of sensorineural toxicity of defer-oxamine varies. Some degree of visual and auditory toxicity can occur in about one-third of patients (40), and impairment of vision and hearing can occur simultaneously (41). A 25-year-old woman with beta-thalassemia, who had received subcutaneous deferoxamine 2 g day (50 mg kg) for 7 days a week for 3 years, developed visual loss. Her best-corrected visual acuity was 20 60 bilaterally. Automated perimetry showed bilateral central...

Use in patients with HIV infection

The use, benefits, and adverse effects of aldesleukin in HIV-infected patients have been extensively reviewed (8). Aldesleukin significantly increased the CD4+ cell count without an increase in viral load. However, many questions remain unanswered. In particular, it is still not known whether immunological improvements translate into clinical benefit. Regardless of how aldesleukin is administered intravenously, subcutaneously, or as polyethylene glycol-modified (pegylated) aldesleukin adverse...

Selective cyclooxygenase2 COX2 inhibitors

Non-selective non-steroidal inflammatory drugs can attenuate the antihypertensive effects of ACE inhibitors and increase the risk of renal insufficiency. In 2278 patients taking NSAIDs, 328 taking ACE inhibitors, and 162 taking both, no nephrotoxicity was found in patients taking monotherapy, but there were three cases of reversible renal insufficiency in patients taking the combination (120). This effect is more prominent in patients with low renin concentrations. The interaction of COX-2...

Pharmacodynamic interactions

The pharmacodynamic interactions of the beta-adrenoceptor antagonists can mostly be predicted from their pharmacology. The antihypertensive effect of beta-blockers can be impaired by the concurrent administration of some non-steroidal anti-inflammatory drugs (NSAIDs), possibly because of inhibition of the synthesis of renal vasodilator prostaglandins. This interaction is probably common to all beta-blockers, but may not occur with all NSAIDs for example, sulindac appears to affect blood...

Metabolism

Biguanides cause hypoglycemia in 0.24 cases per 100 patient-years and it is more common when they are used in combination with a sulfonylurea (29). In 102 consecutive patients with drug-induced hospital-related hypoglycemic coma, 13 were taking metformin + glibenclamide and 3 were taking metformin + insulin (30). Adverse effect Lactic acidosis due to biguanides Dose-relation toxic effect Time-course time-independent Susceptibility factors genetic (slow phenformin meta-bolizers) age disease...

Other features of the patient

Susceptibility factors for bleeding with oral anticoagulants, apart from age, include (29) endogenous coagulation defects a history of gastrointestinal bleeding (peptic ulcer disease alone without past bleeding is not associated with an increased risk of bleeding) an inability to adhere to the regimen. Patients with hypothyroidism and hyperthyroidism should all be carefully monitored because the response is greatly reduced in hypothyroidism and greatly enhanced in hyperthyroidism (103). The...

Ritonavir

Ritonavir has been reported to potentiate the effects of ergotamine. A 28-year-old woman was taking triple therapy for HIV infection, including the protease inhibitor ritonavir (35). She had also started to take a combined formulation containing ergotamine (0.6 mg day), phenobarbital (40 mg day), and belladonna extract (0.4 mg day). Four days later she noted pain in both legs and all her extremities were cold, pale, and pulseless. She had diffuse arterial spasm in the aorta and all four limbs....

Immunologic

Starch derivatives are relatively safer in terms of adverse reactions than other colloid plasma substitutes, but there is an incidence of anaphylactic reactions of 4-6 per million. An anaphylactic reaction has been attributed to ether-ified starches during re-infusion of autologous bone marrow in a man treated for malignant lymphoma (6). The re-infused material had been processed using etherified starches. The patient reported pruritus and carpal spasm. Edema and erythema of the hands were...

Ebert Pharmadynamics Of Sevo

Drug interactions and anaesthesia. Curr Anaesth Crit Care 1995 6 103-12. 2. McAuliffe MS, Hartshorn EA. Anesthetic drug interactions. CRNA 1995 6(2) 103-7. 3. McAuliffe MS, Hartshorn EA. Anesthetic drug interactions. CRNA 1995 6(3) 139-42. 4. Stoltzfus DP. Advantages and disadvantages of combining sedative agents. Crit Care Clin 1995 11(4) 903-12. 5. Whitwam JG. Co-induction of anaesthesia day-case surgery. Eur J Anaesthesiol Suppl 1995 12 25-34. 6. Amrein R,...

See also Progestogens General Information

Hormonal formulations for implantation contain proges-togens, including the following For a complete account of the adverse effects of proges-togens, readers are urged to consult the following monographs as well as this one Hormonal contraceptives progestogen injections Hormonal contraceptives intracervical and intravaginal Hormonal contraceptives oral Hormone replacement therapy estrogens + progesto-gens Subdermal implanted silastic rods containing levonor-gestrel (Norplant) have been widely...

Urinary tract

Renal insufficiency has been attributed to irbesartan. A 77-year-old woman took captopril 25 mg tds and furosemide 40 mg day for decompensated heart failure (4). Irbesartan 75 mg day then replaced captopril, and 3 days later she developed renal insufficiency. Irbesartan was withdrawn and her renal function normalized within 5 days. It was not stated whether her blood pressure also changed. A 78-year-old Caucasian man with insulin-treated type II diabetes, hypertension, and stable mild renal...

Drug Drug Interactions Clozapine

Raised clozapine blood concentrations have been reported after the introduction of lisinopril (10). A 39-year-old man with schizophrenia and diabetes, who had taken clozapine 300 mg day and glipizide 10 mg day for a year, took lisinopril 5 mg day for newly diagnosed hypertension. On several occasions afterwards he had roughly a doubling of his blood concentrations of clozapine and norclozapine. He had typical effects of clozapine toxicity. After replacement of lisinopril by diltiazem, the blood...

Susceptibility Factors Age

Neonates and infants absorb local anesthetics more rapidly after topical application to the airways, and peak plasma concentrations can be reached within 1 minute of application. In the first few months of life they have a larger volume of distribution, reduced hepatic clearance, and lower concentrations of albumin and alpha1-acid glycoprotein (47). Drug Administration Drug administration route Local anesthetics can be given by many different routes, each of which has its own particular adverse...

Organs and Systems Nervous system

An isolated case of migraine occurring after a single dose of losartan was reported (5). The temporal association during challenge and rechallenge, although in unblinded conditions, argues for a possible causal relation. There have been reports of taste disturbance in patients taking ACE inhibitors, tentatively attributed to chelation of metal ions. However, no mechanism for taste loss due to angiotensin-II receptor blockers has been proposed. Reversible loss of taste discrimination has been...

Sumatriptan

The combination of methysergide with sumatriptan has been associated with vasospasm in the coronary arteries (6). A 43-year-old woman with controlled hypertension, but no other known coronary risk factors, had an acute myocardial infarction. She took two oral doses of methysergide 2 mg 12 hours apart, followed by sumatriptan 6 mg subcutaneously. About 10 minutes after the sumatriptan, she complained of chest pain, and on arrival in hospital, an anterior myocardial infarction was diagnosed....

Susceptibility Factors Renal disease

A fatal nephrotic syndrome occurred in a 33-year-old man with renal glomerular disease dependent on pentazocine SEDA-17, 88 . There is evidence that heavy smoking can increase the elimination of pentazocine thus heavy smokers may require larger doses than non-smokers. Drug Administration Drug administration route Fibrous myopathy and necrotic ulceration can occur at the injection site after repeated parenteral administration 1 . Myocutaneous sclerosis and extensive calcinosis at the injection...

Rhamnus purshianus

The bark of Rhamnus purshiana (cascara sagrada) contains laxative anthranoid derivatives, which occur primarily in various laxative herbs (such as aloe, cascara sagrada, Adolphia (prickbush) Alphitonia (alphitonia) Auerodendron (auerodendron) Berchemia (supplejack) Ceanothus (ceanothus) Colubrina (nakedwood) Condalia (snakewood) Frangula (buckthorn) Gouania (chewstick) Hovenia (hovenia) Karwinskia (karwinskia) Krugiodendron (krugiodendron) Maesopsis (umbrella-tree) Paliurus (Jeruselem thorn)...

Hematologic Side Effects Of Streptokinase

Hemorrhage is the major risk of the use of thrombolytic agents and can result from the lysis of thrombi at other sites where hemostasis is required. Hemostatic incompetence related to thrombolysis is also related to reductions in circulating fibrinogen and factors V and VIII and to the generation of fibrin and fibrinogen degradation products with anticoagulant properties. The most serious complication is intracranial hemorrhage, which has a high mortality (60 in the GUSTO-1 trial) and a high...

Drug overdose

Paracetamol is one of the most commonly ingested medications in deliberate self-poisoning and accidental ingestion by children. Fulminant hepatic failure occurs in 1-5 of cases of paracetamol overdosage 3-6 days after ingestion (71), with frequent deaths in people who take 20-25 g. There is only a narrow margin between the normal maximum 24-hour dosage and that which can cause liver damage and acute hepatic failure. Undoubtedly, some people are more susceptible than most to paracetamol...

Gastrointestinal

Abdominal discomfort is frequent with metformin (15-25 ), and nausea, vomiting, and diarrhea occur even in the absence of lactic acidosis. Other effects include flatulence, abdominal bloating, anorexia, and a metallic taste. Anorexia and weight loss are often seen at the beginning of treatment. Phenformin can cause hemorrhagic gastritis (65). The gastrointestinal adverse effects of metformin can be reduced by giving the metformin during or immediately after meals, starting with a low dose and...

Susceptibility Factors

Accumulation of morphine-6-glucuronide is a risk factor for opioid toxicity during morphine treatment. However, it does not occur in all patients with renal insufficiency, which is the most common reason for accumulation of morphine-6-glucuronide this suggests that other risk factors can contribute to morphine-6-glucuronide toxicity. Two men, aged 87 and 65 years, both with renal insufficiency, took oral morphine 30 mg day for pain management (30). While the 65-year-old tolerated morphine well...

Contact allergy

Topical glucocorticoids are well-known contact sensiti-zers. Immediate allergic or allergic-like reactions to systemic glucocorticoids also occur, but less often. Two atopic patients developed urticaria, possibly IgE-mediated, from a hydrocortisone injection or infusion (152) and other reactions have been reported. A 50-year-old woman developed contact dermatitis on her legs after she applied hydrocortisone aceponate cream (Efficort) to psoriatic lesions on her lower back (153). Similar lesions...

Intralesional injection

Intralesional triamcinolone acetonide has been used extensively for the treatment of hypertrophic and keloid scars. Complications are few, usually being local skin color changes, prominent vascular markings, or subcutaneous atrophy. Cushing's syndrome after intralesional administration of triamcinolone acetate has been described in two adults and two children aged 10 years and 21 months after treatment of hypertrophic burn scars with intralesional triamcinolone acetonide SEDA-21, 419 350 ....

Drug Drug Interactions

Neuroleptic drugs can reduce or block the pressor effects of alpha-adrenoceptor agonists. When using drugs with both alpha- and beta-adrenoceptor activity, neuroleptic drug blockade of alpha-adrenoceptors can lead to unopposed beta predominance, resulting in severe hypotension (508). A neuroleptic malignant-like syndrome occurred when norephedrine was combined with neuroleptic drugs (338). Alcohol-induced CNS and respiratory depression is enhanced by neuroleptic drugs (509), but enhancement can...

Drug Drug Interactions General

Drug interactions with lithium have been reviewed (454-458) another review focused on interactions in the elderly (458). A review of drug interactions with lithium considered both pharmacokinetic interactions for example diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs) and pharmacodynamic interactions (for example antipsychotic drugs, SSRIs) and summarized the most important ones in tabular form (454). Excessive use of alcohol can interfere with adherence to lithium therapy. Alcohol...

Reproductive system

There is a risk of ovarian hyperstimulation when an ovulation-inducing drug is followed by rapid ovarian enlargement with peritoneal effusion. The incidence of these complications varies with the product and dosage schedule used in experienced hands, the frequency of complications may be no more than about 4 . In an unusual case reported in detail from Saudi Arabia, a 28-year-old woman receiving gonadotropins developed acute respiratory distress, abdominal pain, and severe hyponatremia...

Specific allergens

The incidence of adverse systemic reactions during immunotherapy for perennial allergic rhinitis using standardized extracts of Dermatophagoides farinae has been estimated in 386 patients who received 22 722 injections. The incidence of systemic reactions was 6.22 per patient and 0.12 per injection. Systemic reactions began 3-30 minutes after an injection (average 11 minutes). Asthma, atopic dermatitis, and a high concentration of IgE (but not specific IgE) in serum were identified as important...

Inorganic salts

Chronic mercurialism with nervous system involvement, renal insufficiency, and progressive colitis has been described after the long-term use of remedies containing inorganic mercury. Such remedies may also explain the persistence of other unexplained disorders, such as pink disease. Inorganic and organic mercury compounds may cause allergic dermatitis (SEDA-22, 247) (28). Frank poisoning from these sources, although uncommon today, is still possible, and occasional case reports appear...

Ricinus communis

Castor oil is the fixed oil obtained from the seeds of Ricinus communis castor by cold expression. The whole beans contain a variety of substances that are not expressed with the oil, including the toxin ricin 6,7 . When taken by mouth, especially in large doses, castor oil can cause violent purgation with nausea, vomiting, colic, and a risk of miscarriage. Transdermal exposure to ricin is not serious, since it is not well absorbed through the skin. Oral exposure, for example by ingestion of...

Comparative studies

Comparisons of different formulations of amphotericin Amphotericin deoxycholate in glucose versus amphotericin deoxycholate in Intralipid The safety of two formulations of intravenous amphotericin deoxycholate has been investigated in a randomized, open comparison in neutropenic patients with refractory fever of unknown origin or pulmonary infiltrates (43). Amphotericin deoxycholate was given in a dose of 0.75 mg kg day either in 250 ml of a 5 glucose solution or mixed with 250 ml of a 20 lipid...

Sweat glands

Zonisamide can cause lack of sweating (11). A 10-year-old boy who had taken zonisamide for about 9 months noticed that he had a dry skin and that he seldom sweated. His zonisamide blood concentration was very high. He discontinued zonisamide and became able to sweat. The authors suggested that this effect was due to ion channel blockade. In 16 patients taking zonisamide, acetylcholine stimulation testing after about 1 month was normal in four cases and reduced in 12 (12). There was reduced...

Alkylating cytostatic agents Nlost derivatives

Park DS, Vassilopoulou Sellin R, Tu S. Estramustine-related hypocalcemia in patients with prostate carcinoma and osteoblastic metastases. Urology 2001 58(1) 105. 13. Zackheim HS, Epstein EH Jr, McNutt NS, Grekin DA, Crain WR. Topical carmustine (BCNU) for mycosis fun-goides and related disorders a 10-year experience. J Am Acad Dermatol 1983 9(3) 363-74. 14. Ellis ME, Weiss RB, Kuperminc M. Nephrotoxicity of lomustine. A case report and literature review. Cancer Chemother Pharmacol 1985...

Substances that affect the skin Photocontact dermatitis

Photocontact dermatitis can be toxic or allergic in nature 1-4 . Phototoxicity can occur in anybody if enough light energy and photosensitizer are present in the skin. Photoallergy is due to a cell-mediated hypersensitivity response, and therefore occurs in sensitized individuals only. Compared with contact allergy, photocontact allergy is uncommon, although many chemicals have been responsible for photoallergic reactions. The British Photodermatology Group has provided a summary of the methods...

Specific propellants

The multidose pressurized aerosols using chlorofluoro-carbon propellants have been widely used. In animal experiments, plasma concentrations of Freon 11 and Freon 12 of 20-35 mg ml sensitized the heart to adrenaline and exercise. Severely ill asthmatic subjects (mean oxygen tension 55mmHg, range 50-80) were studied following therapeutic doses of a beta2-adrenoceptor agonist pressurized aerosol. Plasma concentrations of Freon 11 up to 4.53 mg ml and of Freon 12 up to 4.73 mg ml were measured...

Coppercontaining intrauterine contraceptive devices

Copper-containing intrauterine contraceptive devices (10-12) became popular because local inflammatory reactions in the endometrium are more marked and the contraceptive effect is thus more pronounced (SEDA-21, 234) (13). In addition, copper ions released from intrauterine contraceptive devices reach concentrations in the luminal fluids of the genital tract that are toxic to spermatozoa and embryos. The ability of copper to induce the generation of free radicals and the formation of...

Organs and Systems Hematologic

Methemoglobinemia is a classical complication of benzocaine (SEDA-12, 256) (SEDA-21, 135) (SEDA-22, 141). The problem arises in both adults and children (1-4), and the risk has led to criticism of its free availability. It has, amongst other things, been suggested that it should be eliminated from products for use in children, that concentrations in over-the-counter products should be limited, and that there should be explicit label warnings of the hematological risk (SED-12, 256) (SEDA-17,...

See also Alphaadrenoceptor antagonists General Information

Alfuzosin is a uroselective alpha1-adrenoceptor antagonist used to relieve the symptoms of prostatic hyperplasia (1). Its safety has been investigated in a large prospective 3-year open trial in 3228 patients with benign prostatic hyperpla-sia. There were no unexpected adverse effects. Only 4.2 of the patients dropped out owing to adverse effects. In a large database of 7093 patients with lower urinary tract symptoms related to benign prostatic hyperplasia treated for up to 3 years with...

Long Term Effects Drug withdrawal

On withdrawal of amantadine after long-term therapy, acute delirium with confusion, disorientation, agitation, and paranoia occurred in three patients (20). Reintroduction of the drug returned the patients to the baseline status. In four patients, amantadine withdrawal was associated with delirium and confusion (21). The patients, three of them women, were aged 70-83 years and all but one were considered to have early dementia. Amantadine exposure was 1-5 years and the symptoms occurred within...

Croton tiglium

The oil of Croton tiglium (croton) has a violent purgative action and contains tumor-promoting phorbol diesters and triesters. Croton oil has been used as a peeling agent in phenol as a carrier its use in concentrations of 2 and over is almost always associated with depigmentation of the skin and delays in healing in areas other than the thick skin of the lower nose and around the mouth (4). Croton is also the name given to Codiaeum variegatum, a highly decorative potted plant. Handling this...

Salvia species

In China, the root of Salvia miltiorrhiza (danshen) has been used traditionally for the treatment of coronary diseases. The leaf of Salvia officinalis (sage) contains 1.0-2.5 of essential oil, consisting of 35-60 of thujone. A patient taking warfarin and who had taken a decoction of S. miltiorrhiza presented with a prolonged bleeding time and melena (12) and other cases have been reported (13). Pharmacodynamic and pharmacokinetic studies in rats have shown that danshen increases the absorption...

Electrolyte balance

ACE inhibitors can cause hyperkalemia because they inhibit the release of aldosterone. The effect is usually not significant in patients with normal renal function. However, in patients with impaired kidney function and or in patients taking potassium supplements (including salt substitutes) or potassium-sparing diuretics, and especially aldosterone antagonists, hyperkalemia can occur. In two cases, hypoaldosteronism with diabetes was implicated (53,54). Hyponatremia, defined as a plasma sodium...

Cyamopsis tetragonoloba

Guar gum, which is covered in a separate monograph, comes from the endosperm of the seeds of Cyamopsis tetragonoloba (cluster bean). It has a small hypolipi-demic effect (20) and a small blood glucose-lowering effect (21). Guar gum causes abdominal pain, flatulence, diarrhea, and cramps (22). It has been repeatedly associated with esophageal obstruction (23). Guar gum can cause occupational rhinitis and asthma. Of 162 employees at a carpet-manufacturing plant, in which guar gum is used to...

See also Neuroleptic drugs General Information

Ziprasidone is a dibenzotheolylpiperazine compound with a receptor binding profile similar to that of other atypical antipsychotic drugs, and a high affinity for serotonin (5-HT2A) receptors and a lower affinity for dopamine (D2) receptors it also has high affinities for 5-HT1A, 5-HT1D and 5-HT2C receptors and inhibits serotonin and noradrenaline reuptake. Two extensive reviews of the clinical pharmacology of ziprasidone have appeared (1,2). On February 5, 2000, the FDA approved ziprasidone for...

Gangliosides

Gangliosides extracted from bovine brain tissue Cronassial, Sygen have been widely used in Western Europe and South America for several neurological disorders. Reported adverse effects of gangliosides, other than discomfort at the injection site, include a motor neuron diseaselike illness, cutaneous erythema with or without fever and nausea , and anaphylaxis. After evaluation of reported associations between the use of gangliosides and Guillain-Barr syndrome 20,21 , the Committee for...

Organs and Systems Immunologic

Contact allergic reactions to lauromacrogol 400 have been reported (1). Patch-testing can yield irritant reactions. In a retrospective study of 8739 patients tested with a topical drug patch test series, 3186 patients were tested with 0.5 lauromacrogol 400 in water (2). There was slight irritation in 0.88 , weakly positive reactions in 0.97 , and strongly positive reactions in 0.25 . In 6202 patients tested with a 3 solution of lauromacro-gol 400 in petrolatum, there was slight skin irritation...

Papaver somniferum

Papaver somniferum opium poppy contains a variety of opioid and related alkaloids, including codeine, morphine, noscapine, papaverine, and thebaine. Crude opium is the air-dried latex obtained by incising the unripe capsules of P. somniferum. Paregoric is ammoniated tincture of opium Scotch paregoric or camphorated tincture of opium English paregoric . The use of these formulations has largely been replaced by use of the purified compounds. The adverse effects of opium are generally the same as...

Ecballium elaterium

Ecballium elaterium squirting cucumber contains toxic cucurbitacins, which are violent purgatives. It is used in the Mediterranean as a purgative and in treating sinusitis. Intranasal use of E. elaterium has been associated with Quincke's edema 4 and with fatal cardiac and renal failure 5 . A report from a poisons unit in Israel included 13 patients who had used the juice of the squirting cucumber, either orally or topically, for unreported reasons 6 . They subsequently had edema of the...

See also Tricyclic antidepressants General Information

Noxiptiline is a tricyclic compound that differs from ami-triptyline in having a longer side-chain, containing an oxyimino-group. In a double-blind comparison of noxiptiline (n 30) and amitriptyline (n 32) in hospitalized patients with primary depressive illness for 3-6 weeks there were no significant differences, but noxiptiline had a faster onset of action (1). A comparison with imipramine also showed no difference in therapeutic efficacy (2). As regards adverse effects, noxiptiline seemed to...

Antifungal azoles

In evaluating possible antagonism between amphoter-icin and antifungal azoles, details of the experimental set-up are crucial. When filamentous fungi were exposed to subfungicidal concentrations of azoles, before exposure to an amphotericin + azole combination, antagonism could always be shown both in vitro and in vivo (148-150). In vitro studies and experiments in animals have given conflicting results relating to potential antagonism between the effects of fluconazole and amphotericin on...