scholarly journals Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review

2019 ◽  
Vol 44 (7) ◽  
pp. 721-729 ◽  
Author(s):  
David Anthony Provenzano ◽  
Zachary Pellis ◽  
Leonard DeRiggi
Keyword(s):  
Contrast Agents ◽  
Significant Risk ◽  
Intrathecal Administration ◽  
Evidence Based ◽  
Safe Alternative ◽  
Off Label ◽  
Safety Research ◽  
Small Doses ◽  
Fluoroscopic Imaging ◽  
Acute Neurotoxicity

Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration.

An Evidence-Based Review of Off-Label Uses of Polidocanol

2018 ◽  
Vol 12 (4) ◽  
pp. 223-230
Author(s):  
Seyyed Reza Sadat Ebrahimi ◽  
Elgar Enamzadeh ◽  
Hossein Babaei
Keyword(s):  
Evidence Based ◽  
Off Label

Intrathecal administration of nitroxides as potential contrast agents for MR imaging.

Radiology ◽  
1987 ◽  
Vol 163 (1) ◽  
pp. 239-243 ◽  
Author(s):  
G M Rosen ◽  
L K Griffeth ◽  
M A Brown ◽  
B P Drayer
Keyword(s):  
Mr Imaging ◽  
Contrast Agents ◽  
Intrathecal Administration

scholarly journals An evidence‐based systematic review of the off‐label uses of lisinopril

2018 ◽  
Vol 84 (11) ◽  
pp. 2502-2521 ◽  
Author(s):  
Seyyed‐Reza Sadat‐Ebrahimi ◽  
Neda Parnianfard ◽  
Nafiseh Vahed ◽  
Hossein Babaei ◽  
Morteza Ghojazadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Evidence Based ◽  
Off Label

Off-label use of contrast agents

2008 ◽  
Vol 18 (6) ◽  
pp. 1096-1101 ◽  
Author(s):  
P. Reimer ◽  
R. Vosshenrich
Keyword(s):  
Contrast Agents ◽  
Off Label Use ◽  
Off Label ◽  
Label Use

Acute Painful Radiculopathy After Intrathecal Rituximab

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4920-4920
Author(s):  
Jacoline Bromberg ◽  
Jeanette Doorduyn ◽  
Johanna W. Baars ◽  
Gustaaf Van Imhoff ◽  
Roelien Enting ◽  
...  
Keyword(s):  
Side Effects ◽  
Research Funding ◽  
Phase Ii Study ◽  
Intrathecal Administration ◽  
Intrathecal Methotrexate ◽  
Intraventricular Administration ◽  
Off Label Use ◽  
Off Label ◽  
Prospective Phase ◽  
Higher Doses

Abstract Abstract 4920 Within a prospective phase II study (HOVON 80) of patients with recurrent diffuse large B-cel lymphoma in the CNS, three of 13 patients treated with intrathecal rituximab developed an acute, transient, extremely painful lumbosacral radiculopathy. All were treated with systemic R-DHAP every 4 weeks with i.v. HD-MTX on day 15 for three cycles. In addition intrathecal Rituximab was administered twice weekly via lumbar puncture starting on day -1. According to protocol the first administration consisted of 10 mg of rituximab after premedication with acetaminophen, thereafter the dose was increased to 25 mg. No patient experienced side effects of the first intrathecal administration of rituximab. However, after the first administration of 25 mg rituximab three of 13 treated patients reported extremely painful tingling sensations in the buttocks, legs and feet immediately after administration and lasting 30–60 minutes. Concomitantly a temporarily increased bloodpressure was documented. Premedication with an antihistaminic in the third patient was ineffective. No neurologic deficits occurred and the pain resolved completely. The patients refused further treatment with intrathecal rituximab, and therapy was changed to intrathecal methotrexate, without any side effects. After these events the rituximab was diluted in saline to 5 mg/ml, the dose reduced to 10 mg per administration, and 4 mg dexamethasone was administered concomitantly in all subsequent patients. Twelve additional patients were thus treated and no further incidents of painful radiculopathy were observed. This serious, though completely transient, adverse effect of intrathecal rituximab precludes intrathecal administration of higher doses of rituximab via lumbar route. It has never been described after intraventricular administration. Disclosures: Bromberg: Roche: Research Funding. Off Label Use: rituximab administration intrathecally. Doorduyn: Roche: Research Funding. van den Bent: Roche: Consultancy, Research Funding.

Developing a paediatric drug formulary for the Netherlands

2016 ◽  
Vol 102 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Tjitske M van der Zanden ◽  
Saskia N de Wildt ◽  
Yves Liem ◽  
Martin Offringa ◽  
Matthijs de Hoog
Keyword(s):  
Drug Therapy ◽  
Drug Use ◽  
The Netherlands ◽  
Evidence Based ◽  
Drug Formulary ◽  
Concerted Effort ◽  
Off Label ◽  
Registration Data ◽  
Current Content ◽  
Professional Guidelines

As many drugs in paediatrics are used off-label, prescribers face a lack of evidence-based dosing guidelines. A Dutch framework was developed to provide dosing guidelines based on best available evidence from registration data, investigator-initiated research, professional guidelines, clinical experience and consensus. This has clarified the scientific grounds of drug use for children and encouraged uniformity in prescribing habits in the Netherlands. The developed framework and the current content of the Dutch Paediatric Formulary could be used as basis for similar initiatives worldwide, preferably in a concerted effort to ultimately provide children with effective and safe drug therapy.

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