Venlafaxine-Induced Orthostatic Hypotension in a Geriatric Patient

Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day) but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses.

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Cefazolin and rifampin: A coagulopathy-inducing combination

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab210 ◽

2021 ◽

Author(s):

Natalia E Castillo Almeida ◽

Ryan W Stevens ◽

Pooja Gurram ◽

Christina G Rivera ◽

Gina A Suh

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Assessment Tool ◽

International Normalized Ratio ◽

Medication Therapy ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Implant Retention ◽

History Of

Abstract Purpose To identify risk factors that may predispose patients to rifampin- and cefazolin-induced coagulopathy. Summary An 86-year-old man with a history of rheumatoid arthritis on chronic prednisone and stage 3 chronic kidney disease, notably not on warfarin, presented to the hospital with a 10-day history of right hip pain, swelling, and drainage after a recent right total-hip arthroplasty. The patient underwent a combination of surgical intervention and medication therapy with rifampin and ceftriaxone. After discharge and at postoperative day 9, ceftriaxone was changed to cefazolin due to increasing alkaline phosphatase levels. Four weeks after the initial debridement, antibiotics, and implant retention, the patient underwent a second irrigation and debridement due to persistent infection. Cefazolin and rifampin therapy was extended. Three days later, the patient presented to the emergency room with significant bleeding at the surgical site and a profoundly elevated prothrombin time and international normalized ratio (INR). No potential contributors were identified. The Naranjo adverse drug reaction probability scale identified cefazolin and rifampin as the probable cause of elevated INR. The Liverpool adverse drug reaction avoidability assessment tool classified this adverse event as “definitely avoidable.” Conclusion Rifampin-containing regimens are often recommended to treat staphylococcal prosthetic joint infections when the implant is retained. In methicillin-susceptible staphylococcal infections, cefazolin is routinely employed as the β-lactam backbone of definitive antimicrobial regimens. Although rifampin- and cefazolin-induced hypoprothrombinemia seems to be rare, adverse consequences of its occurrence may be prevented with appropriate monitoring.

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Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.135.suppl_1.p179 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Stephen P Juraschek ◽

Natalie Daya ◽

Andreea M Rawlings ◽

Lawrence J Appel ◽

Edgar R Miller ◽

...

Keyword(s):

Orthostatic Hypotension ◽

Standing Position ◽

Adverse Outcomes ◽

Cox Models ◽

Atherosclerosis Risk In Communities ◽

Adverse Health Outcomes ◽

History Of ◽

Risk Of Fall

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P <0.001), and mortality ( P < 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.

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Orthostatic hypotension in Parkinson disease

Neurology ◽

10.1212/wnl.0000000000008314 ◽

2019 ◽

Vol 93 (16) ◽

pp. e1526-e1534 ◽

Cited By ~ 13

Author(s):

Ylva Hivand Hiorth ◽

Kenn Freddy Pedersen ◽

Ingvild Dalen ◽

Ole-Bjørn Tysnes ◽

Guido Alves

Keyword(s):

Parkinson Disease ◽

Orthostatic Hypotension ◽

Standing Position ◽

Population Based ◽

Correlated Data ◽

Drug Naïve ◽

Clinically Significant ◽

Specific Symptoms ◽

State Examination

ObjectiveTo determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort.MethodsWe performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD.ResultsOH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6–5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4–10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03–1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85–0.97] per unit), and longer follow-up time (OR 1.12 [1.03–1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07–1.25] per 100 mg).ConclusionsIn this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.

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A Comprehensive Overview of Polypharmacy in Elderly Patients in Saudi Arabia

Geriatrics ◽

10.3390/geriatrics4020036 ◽

2019 ◽

Vol 4 (2) ◽

pp. 36 ◽

Cited By ~ 1

Author(s):

Aseel Alsuwaidan ◽

Norah Almedlej ◽

Sawsan Alsabti ◽

Omamah Daftardar ◽

Fawzi Al Deaji ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Adverse Drug Reaction ◽

Saudi Arabia ◽

Drug Reaction ◽

Elderly Patients ◽

Care Management ◽

Geriatric Patients ◽

Health Care Management ◽

Significant Difference

Background/Objectives: Saudi Arabia has a great percentage of geriatric patients associated with multiple chronic diseases who require close attention and monitoring for their medications. The purpose of this study is to develop a full-framed picture about the utilization of medications for geriatric patients and how to provide better health-care management. Methodology: A retrospective cross-sectional study targeting patients 65 years of age and older, who are taking multiple chronic medications for different indications. Descriptive analysis and frequency of the main variables were used as appropriate. Only qualified and professional candidates were chosen for data entry to present the quality and accuracy of data. Results: A total of 3009 patient profiles were analyzed, with the patients’ average age in years being 73.26 ± 6.6 (SD). It was found that 55% of the patients have polypharmacy. An average of 6.4 medications were prescribed for patients aged between 65 and 70 years compared with a significant difference for patients aged 71 years and above, while a linear correlation between age and comorbidity diseases associated with all elderly patients. Hypertension, hyperlipidemia, and diabetes mellitus are the most common comorbidity diseases for elderly patients aged 65 years and older. Conclusion: Polypharmacy in geriatrics is defined as a patient aged 65 years and older receiving five or more appropriate medications. It is the responsibility of health-care professionals to reduce the number of medications in elderly patients. Awareness of geriatric medications and diagnosed diseases will improve managing adverse drug reaction and other risk factors. Awareness of geriatric medications should elaborate on how to avoid adverse drug reaction and other risk factors. It is the responsibility of physicians and pharmacists to reduce the number of medications in elderly patients. We also prove that the number of medications will not necessarily increase with age. The main impact of this study is to follow the main recommendations to improve health care management in geriatrics.

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The role of electronic records in reporting adverse drug reactions.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.309 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 309-309

Author(s):

Alanna M. Poirier ◽

Paul Nachowicz ◽

Subhasis Misra

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Electronic Health Record ◽

Adverse Drug Reactions ◽

Improve Patient Safety ◽

Cancer Center ◽

Health Record ◽

Drug Reactions ◽

History Of ◽

Electronic Health

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]

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Methotrexate Central Nervous System Toxicity Identified in a Pharmacogenomics Pharmacist Consult Patient

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.595 ◽

2019 ◽

Vol 34 (9) ◽

pp. 595-599

Author(s):

Michael J. Schuh ◽

Sheena Crosby

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Cognitive Dysfunction ◽

Memory Loss ◽

Physician Service ◽

Medical Clinic ◽

Central Nervous System Toxicity ◽

Contributory Factors ◽

Caucasian Female ◽

System Toxicity

OBJECTIVE: To report a possible pharmacogenomics (PGx)-related, cognitive dysfunction, adverse drug reaction from methotrexate (MTX) that may be multifactorial in origin. SUMMARY: The patient subject is a 76-year-old Caucasian female of Russian ancestry suffering from rheumatoid arthritis and treated with MTX who presented to the diagnostic and consultative physician service in a medical clinic with advancing cognitive dysfunction, manifesting as memory loss, dizziness, and confusion. Components of this possible adverse drug reaction (ADR) may include ancestry, pharmacogenomics (PGx) characteristics of the patient, and a change in route of administration, among others. The case demonstrates how patients referred to a pharmacist consult service for a suspected ADR with possible PGx implications may uncover other contributory factors to the ADR. CONCLUSION: PGx testing may increase clinical pharmacist referrals to identify a PGx etiology to an ADR. However, they may also identify other non-PGx contributory factors to an ADR.

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Usefulness of drug provocation tests in children with a history of adverse drug reaction

Korean Journal of Pediatrics ◽

10.3345/kjp.2011.54.7.304 ◽

2011 ◽

Vol 54 (7) ◽

pp. 304 ◽

Cited By ~ 11

Author(s):

Hye Ran Na ◽

Jeong Min Lee ◽

Jo Won Jung ◽

Soo-Young Lee

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Provocation Tests ◽

History Of ◽

Drug Provocation Tests

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Epileptic Convulsions Probably Induced by Desloratadine, a Second-Generation H1-Antihistamine

10.22541/au.160570101.16535740/v1 ◽

2020 ◽

Author(s):

Xiaonian Han ◽

Xin Zan ◽

Fengmei Xiong ◽

Xiaojing Nie ◽

Lirong Peng

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Drug Therapy ◽

Side Effects ◽

Second Generation ◽

Healthy Children ◽

Probability Scale ◽

H1 Antihistamines ◽

History Of ◽

History Of Epilepsy

Second-generation H1-antihistamines are generally considered to be safe. Here we describe a healthy boy who developed left-arm convulsions after repeated exposure to a dry suspension of desloratadine combined with Huatengzi granules. The boy had no family or disease history of epilepsy, convulsions, or any other drug therapy. The Naranjo Adverse Drug Reaction Probability Scale was used to determine that the convulsions were probably related to desloratadine. Our findings suggest that desloratadine (a second-generation H1-antihistamine) can cause epileptic convulsions in healthy children, and so clinicians should be vigilant of the possibility of central side effects.

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A serious adverse drug reaction probably induced by clonazepam: a case report of myotoxicity

BMC Pharmacology and Toxicology ◽

10.1186/s40360-019-0366-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Xiaonian Han ◽

Jinping Wang

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Case Report ◽

Creatine Phosphokinase ◽

Combination Therapies ◽

Drug Reactions ◽

Unique Case ◽

Case Presentation ◽

History Of ◽

History Of Epilepsy

Abstract Background The adverse drug reactions (ADRs) related to clonazepam are mild, and only two cases of myotoxicity induced by clonazepam have been reported, with both patients recovering well. We present a unique case of a serious ADR outcome after taking clonazepam. Case presentation A 24-year-old woman with a long-standing history of polio and a 2-year history of epilepsy developed a serious ADR after repeated exposure to oral clonazepam combined with sodium valproate that manifested as myotoxicity and elevated levels of creatine phosphokinase. The patient is currently bedridden and unable to take care of herself. Conclusion Clinicians should be vigilant of the possibility of myotoxicity induced by clonazepam, especially in specific populations such as polio patients or when clonazepam is used in combination therapies.

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