1418Adverse effects of spironolactone in long-term treatment of resistant arterial hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Vaclavik ◽  
L Jelinek ◽  
J Jarkovsky ◽  
K Benesova ◽  
D Tavacova ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Arterial Hypertension ◽  
Adverse Reactions ◽  
Term Treatment ◽  
Kaplan Meier ◽  
Long Term Treatment ◽  
The Mean ◽  
Resistant Arterial Hypertension

Abstract Background Spironolactone is recommended as a fourth line antihypertensive drug by current hypertension guidelines. This drug had relatively few adverse effects in short term clinical trials, but data about their occurrence during long-term treatment of resistant hypertension are scarce. Purpose To evaluate the occurrence and type of adverse effects of spironolactone during long-term treatment and their possible clinical and laboratory predictors. Methods We prospectively followed 274 patients with resistant arterial hypertension who started treatment with spironolactone between September 2007 and December 2016. The duration of spironolactone use, its dose, the incidence of adverse events, blood pressure, and laboratory findings were recorded at baseline and during the last clinical examination. Results Patients were followed for an average of 35 (± 29) months, the mean dose of spironolactone was 27.5 mg/day. Adverse effects occurred in 72 patients (26.3%) and in 61 (84.7%) lead to discontinuation of spironolactone. The most common adverse reactions were gynaecomastia (30.6%), hyperkalaemia (30.6%) and symptomatic hypotension (26.4%). The mean duration of spironolactone treatment before their occurrence was 25 (± 27) months. According to the Kaplan-Meier curve, the median for the incidence of adverse events would be 97 months (91.5–102.5 months), i.e. 50% of patients could be treated with no adverse events for more than 8 years. Adverse events were more common in the elderly (hazard ratio – HR 1.38, P=0.007), patients with higher baseline serum creatinine (HR 1.12, P=0.035) and patients taking angiotensin receptor blockers (HR 1.65, P=0.040). Kaplan-Meier estimate – adverse events Conclusion During long-term treatment of resistant hypertension with spironolactone, more than a quarter of patients experience adverse reactions that usually require discontinuation of spironolactone. Acknowledgement/Funding Supported by the grants of Palacký University in Olomouc Nr. IGA_LF_2016_038 and IGA_LF_2017_029.

High-dose desvenlafaxine in outpatients with major depressive disorder

CNS Spectrums ◽  
2012 ◽  
Vol 17 (3) ◽  
pp. 121-130 ◽  
Author(s):  
James M. Ferguson ◽  
Karen A. Tourian ◽  
Gregory R. Rosas
Keyword(s):  
Major Depressive Disorder ◽  
Adverse Events ◽  
Depressive Disorder ◽  
Dose Range ◽  
Term Treatment ◽  
High Dose ◽  
Major Depressive ◽  
Long Term Treatment ◽  
The Mean

ObjectiveThis study investigated the safety and efficacy of long-term treatment with high-dose desvenlafaxine (administered as desvenlafaxine succinate) in major depressive disorder (MDD).MethodsIn this multicenter, open-label study, adult outpatients with MDD aged 18–75 were treated with flexible doses of desvenlafaxine (200–400 mg/d) for ≤ 1 year. Safety assessments included monitoring of treatment-emergent adverse events (TEAEs), patient discontinuations due to adverse events, electrocardiograms, vital signs, and laboratory determinations. The primary efficacy measure was mean change from baseline in the 17-item Hamilton Rating Scale for Depression [HAM-D(17)] total score.ResultsThe mean daily desvenlafaxine dose range over the duration of the trial was 267–356 mg (after titration). The most frequent TEAEs in the safety population (n = 104) were nausea (52%) and headache (41%), dizziness (31%), insomnia (29%), and dry mouth (27%). All TEAEs were mild or moderate in severity. Thirty-four (33%) patients discontinued from the study because of TEAEs; nausea (12%) and dizziness (9%) were the most frequently cited reasons. The mean change in HAM-D(17) total score for the intent-to-treat population (n = 99) was −9.9 at the last on-therapy visit in the last-observation-carried-forward analysis and −14.0 at month 12 in the observed cases analysis.ConclusionHigh-dose desvenlafaxine (200–400 mg/d) was generally safe and effective in the long-term treatment of MDD.

Intravitreal bevacizumab monotherapy in myopic choroidal neovascularisation: 5-year outcomes for the PAN-American Collaborative Retina Study Group

2017 ◽  
Vol 102 (4) ◽  
pp. 455-459 ◽  
Author(s):  
Jay Chhablani ◽  
Remya Mareen Paulose ◽  
Andres F Lasave ◽  
Lihteh Wu ◽  
Cristian Carpentier ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Adverse Events ◽  
Real Life ◽  
Intravitreal Bevacizumab ◽  
Term Treatment ◽  
Choroidal Neovascularisation ◽  
Long Term Treatment ◽  
The Mean

PurposeTo report the long-term anatomical and visual outcomes of intravitreal bevacizumab (IVB) monotherapy in naive choroidal neovascularisation (CNV) caused by myopia.MethodsRetrospective analysis of naive CNV secondary to myopia that underwent antivascular endothelial growth factor monotherapy was performed. Collected data included demographic details, clinical examination details including visual acuity at presentation and follow-up with imaging and treatment details. Main outcome measures were resolution of CNV activity at the last visit. Secondary outcomes included change in visual acuity, number of injections and adverse events.ResultsThirty-three eyes of 31 subjects with a mean age of 51.48±16.4 years were included. The mean follow-up was 66.47 months. 27 eyes had type 2 CNV and the rest seven eyes had type 1 CNV. The mean number of IVB injections per eye was 4.9. Mean visual acuity at baseline reduced from 0.65±0.33 logMAR units (Snellen equivalent=20/89) to 0.73±0.50 logMAR units (20/107) at final follow-up (p=0.003). The mean central macular thickness decreased from 309.31±86 µm at baseline to 267.5±70.89 µm at the last visit (p=0.03). However, visual acuity was maintained (±1 line of baseline) in 13 eyes (39.4%), ≥2 line improvement in nine (27.3%) eyes and more than two lines worsening in 11 eyes (33.3%). Foveal atrophy was observed at baseline and last visit in 6 (12.5%) and 14 (29.1%), respectively (p=0.007). No systemic adverse events were observed.ConclusionIVB monotherapy is safe and effective for long-term treatment of CNV secondary to myopia in real life.

Long-term treatment of macroprolactinomas with CV 205-502

1993 ◽  
Vol 128 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Anette Kvistborg ◽  
Johan Halse ◽  
Soren Bakke ◽  
Trine Bjøro ◽  
Egill Hansen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Adverse Reactions ◽  
Well Being ◽  
Term Treatment ◽  
Gonadal Function ◽  
Serious Adverse Events ◽  
Receptor Affinity ◽  
Discontinuation Of Treatment ◽  
Long Term Treatment

The long-term efficacy and tolerability of CV 205-502, a non-ergot dopamine agonist with D-2 receptor affinity, were studied for up to 36 months in 16 patients with macroprolactinomas. Prolactin values were reduced in all cases, becoming either normalized or suppressed in 12. The pituitary tumor size was reduced in the 13 patients with an obvious tumor and visual function normalized in all six patients with initial defects. Concomitantly we observed improvement in gonadal function, galactorrhea, headache, libido and general well-being. Adverse reactions were experienced by 1 5 patients during dosage increment and caused one patient to discontinue the medication. Seven patients had persistent adverse effects which prohibited a dosage increase of CV 205-502, sufficient to normalize PRL levels in three. Two patients experienced serious adverse events, causing the discontinuation of treatment in one case. In eight patients treatment with CV 205-502 and bromocriptine could be compared. Three patients responded better to CV 205-502 than to bromocriptine treatment. Only one patient preferred bromocriptine to CV 205-502 for long-term treatment. We conclude that CV 205-502 is an effective and in most cases well-tolerated treatment for patients with macroprolactinomas. CV 205-502 is preferable to bromocriptine as an initial treatment and should also be tried in patients where treatment with bromocriptine has failed.

A Case of Gastric Cancer in Which Long-Term Administration of 5′-Deoxy-5-Fluorouridine Proved Effective

1989 ◽  
Vol 17 (2) ◽  
pp. 179-184
Author(s):  
T. Koda ◽  
T. Kurahori ◽  
N. Iwao ◽  
S. Sumi ◽  
T. Sonoda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adverse Reactions ◽  
Substantial Improvement ◽  
Term Treatment ◽  
Borrmann Type ◽  
Long Term Treatment ◽  
Term Administration ◽  
Stopping Treatment ◽  
Lesser Curvature

A patient diagnosed with Borrmann type 4 gastric cancer (mucinous adenocarcinoma), who had refused surgery, was treated by oral administration of 1200 mg/day 5′-deoxy-5-fluorouridine for about 23 weeks. This resulted in substantial improvement of her condition, i.e. the tumour almost completely disappeared, distensibility improved between the central region of the corpus ventriculi and the angulus, and only small protrusions remained on the anterior and posterior walls and the pars pylorica of the lesser curvature. Mild anorexia and diarrhoea were noted as adverse reactions although these symptoms subsided by reducing the dose or temporarily stopping treatment, thereby allowing long-term treatment. Long-term use of 5′-deoxy-5-fluorouridine proved temporarily effective in this patient. The patient died about 3 years and 7 months after starting therapy. Examination showed that the cancer had been mainly in the stomach and that it had metastasized to the colon and pancreas. The liver was free of metastasis.

scholarly journals The Effects of Long-Term Administration of Sodium Nedocromil on Bronchial Hypereactivity

2003 ◽  
Vol 1 (3) ◽  
pp. 119-123 ◽  
Author(s):  
G. Ilonidis ◽  
G. Anogianakis ◽  
CH. Trakatelli ◽  
A. Anogeianaki ◽  
M. Chomatidis ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Term Treatment ◽  
Bronchial Hyperreactivity ◽  
Methacholine Challenge ◽  
Intrinsic Asthma ◽  
Group I ◽  
Long Term Treatment ◽  
The Mean ◽  
Group Ii

The effect of long-term treatment with sodium nedocromil on airway hypereactivity was investigated in two groups of 20 patients each. Group I patients presented with allergic asthma while Group II patients presented with intrinsic asthma. For each subject of the two groups, the base FEV1 was measured and nebulized methacholine was administrated in consecutively higher concentrations until a decrease in FEV1 of >20 % was observed. Following measurement, all patients included in the study were treated with 12 mg of sodium nedocromil per day for 12 months. At the end of the treatment, bronchial hyperreactivity was evaluated for a second time by administering the same dosage of methacholine that originally produced a decline in FEV1 of >20 %. In Group I patients (allergic asthma) mean FEV1 was 3126 ml, before challenge, while after methacholine challenge FEV1 was 2400ml. Following 1-year of sodium nedocromil administration the FEV1 was 2601ml (P<0.05). Before treatment, the mean fall in FEV1, following methacholine challenge, was 23.67% while following a 1-year-long sodium nedocromil administration this value reduced to 15.70% (P<0.05). Correspondingly, PC20 was 5.59 while after sodium nedocromil administration it increased to 11.66 (P<0.05). In Group II patients (intrinsic asthma) mean FEV1 was 2750 ml, before challenge, while after methacholine challenge FEV1 was 2066ml. Following 1-year of sodium nedocromil administration the FEV1 was 2223ml (P<0.05). Before treatment, the mean fall in FEV1, following methacholine challenge, was 27.65 % while following a 1-year-long sodium nedocromil administration this value reduced to 21.92 % (P<0.05). Correspondingly, PC20 was 5.91 while after sodium nedocromil administration it increased to 6.19 (P<0.05). The results suggest a positive effect of long-term sodium nedocromil administration in bronchial hyperreactivity for both groups of patients.

Methenamine Hippurate (‘Hiprex’)† in the Treatment of Chronic Urinary Tract Infections: A Trial in a Geriatric Hospital

1976 ◽  
Vol 4 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Salme Parvio
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Adverse Reactions ◽  
Bacterial Resistance ◽  
Term Treatment ◽  
Chronic Urinary Tract Infection ◽  
Long Term Treatment ◽  
Geriatric Hospital ◽  
Tract Infections

Fifty-two patients, all of whom were more than 66 years-old and who were hospitalized for periods in excess of two years were treated for chronic urinary tract infection. All patients received a course of antibiotic treatment for seven to ten days and were then put onto treatment with methenamine hippurate 1 g twice daily for six months. Of the original fifty-two patients, twelve did not complete the six month course. During the six month period with ‘Hiprex’ there were far fewer re-infections than in the previous six months during which time they had received intermittent antibiotic therapy and other long-term treatment. There were no adverse reactions and bacterial resistance did not occur.

scholarly journals Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis

2020 ◽  
Vol 22 (12) ◽  
Author(s):  
Andriko Palmowski ◽  
Frank Buttgereit
Keyword(s):  
Adverse Events ◽  
Takayasu Arteritis ◽  
Term Treatment ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
Serious Adverse Events ◽  
Glucocorticoid Treatment ◽  
Long Term Treatment ◽  
Higher Doses

Abstract Purpose While glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need long-term treatment with GCs; therefore, toxicity needs to be expected and countered. Recent Findings GCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab) GC-sparing agents, as well as monitoring, prophylaxis, and treatment of GC-related AEs. Several drugs are currently under investigation to expand the armamentarium for the treatment of LVV. Summary GC treatment in LVV is effective but associated with toxicity. Strategies to minimize this toxicity should be applied when treating patients suffering from LVV.

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (&gt; 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

INFLUENCE OF THIAZIDES ON THYROID PARAMETERS IN MAN

1978 ◽  
Vol 89 (4) ◽  
pp. 673-678 ◽  
Author(s):  
Karine Bech ◽  
Lis Skovsted ◽  
Kaj Siersbæk-Nielsen ◽  
Jens Mølholm Hansen
Keyword(s):  
Arterial Hypertension ◽  
Urinary Iodine ◽  
Iodine Intake ◽  
Term Treatment ◽  
Distribution Volume ◽  
Long Term Treatment ◽  
Thyroid Uptake ◽  
Iodine Metabolism ◽  
Normal Controls

ABSTRACT Iodine metabolism and thyroid hormones in blood were studied in 19 men and 11 women who had been treated with thiazides for arterial hypertension from 1 month to 15 years. The results were compared with the findings from age-matched normal controls. No differences were found regarding 24-h 131I-thyroid uptake, thyroid iodide clearance, renal iodide clearance, plasma inorganic iodide, absolute iodine uptake (AIU), serum thyroxine (T4 (D)), resin T3 test (T3U) and TSH after TRH. Twenty-four-hour urinary iodine was higher in the patients treated with diuretics which could be explained by increased iodine intake. The findings of increased serum triiodothyronine (T3 (RIA)) and reverse T3 (rT3) might be due to changes in distribution volume in the thiazide-treated patients. Long-term treatment with thiazides in man do not lead to iodine depletion.

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