From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient

Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient’s physicians is suggested.

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A Single Drop in the Eye – Effects on the Whole Body?

The Open Ophthalmology Journal ◽

10.2174/1874364101711010305 ◽

2017 ◽

Vol 11 (1) ◽

pp. 305-314 ◽

Cited By ~ 5

Author(s):

Anu Vaajanen ◽

Heikki Vapaatalo

Keyword(s):

Adverse Effects ◽

Whole Body ◽

Systemic Absorption ◽

Eye Drops ◽

Allergic Reactions ◽

Single Drop ◽

Active Components ◽

Life Threatening ◽

Systemic Side Effects ◽

Kinetics Of

Introduction: Although the local adverse effects of ophthalmic drugs, including allergic reactions, are well recognized, less is known about the systemic side- effects of eye drops, especially during pregnancy, breast-feeding and early childhood. Ophthalmologists should also be aware of unusual, in some cases even life-threatening, effects of commonly used eye drops. Conclusion: This brief review outlines the routes of systemic absorption and the kinetics of active components present in eye drops, and identifies the clinically relevant systemic adverse effects.

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Ritka szisztémás gyógyszer-interakció: timololtartalmú szemcsepp és lerkanidipintabletta együttes alkalmazása során ismétlődően jelentkező syncope

Orvosi Hetilap ◽

10.1556/650.2019.31310 ◽

2019 ◽

Vol 160 (8) ◽

pp. 309-313 ◽

Cited By ~ 1

Author(s):

Edit Kun ◽

Lóránt Dienes ◽

Gábor Simonyi ◽

Ervin Finta

Keyword(s):

Side Effects ◽

Beta Blockers ◽

Channel Blockers ◽

Eye Drops ◽

Negative Results ◽

Blood Pressure Fall ◽

Systemic Side Effects ◽

Systemic Drug ◽

Pressure Fall

Abstract: The control and planning of the treatment of hypertensive patients need specific attention. As regards concomitant diseases and treatments, glaucoma and the use of eye drops should be taken into consideration. The ingredients of the administered eye drops get through the nasolacrimal canal and can be absorbed by the nasal mucosa. Because of the lack of enterohepatic ‘first pass’ effect, they can act systemically – like after intravenous administration. This way they can cause systemic side effects. The authors present a case of a patient, too, who was examined and medically checked regularly for years with negative results because of repeated syncope. It became clear only at the Hypertension Centre that the timolol-containing combined eye drops caused the symptoms. The authors draw attention to the fact that in the case of systemic side effects which can be connected to beta-blocking agents (blood pressure fall, bradycardia, breathing disturbance, depression), the role of the eye drops should be taken into consideration. At the same time, the possibility of the systemic drug interactions should not be forgotten either. The interaction with dihydropyridine-type calcium-channel blockers can be of great importance. In these cases, after consultation with an ophthalmologist, the glaucoma treatment with eye drops containing beta-blockers should be modified. Orv Hetil. 2019; 160(8): 309–313.

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Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life

Journal of Ophthalmology ◽

10.1155/2019/4146124 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Letizia Negri ◽

Antonio Ferreras ◽

Michele Iester

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Beta Blockers ◽

The Other ◽

Visual Field Defects ◽

Market Beta ◽

Systemic Side Effects ◽

The Impact ◽

Preservative Free

Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients’ quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.

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Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol

Drug Metabolism and Personalized Therapy ◽

10.1515/dmdi-2014-0027 ◽

2015 ◽

Vol 30 (1) ◽

Cited By ~ 4

Author(s):

Anuradha Ganigara ◽

Chandrakala Ravishankar ◽

Chandrika Ramavakoda ◽

Madhavi Nishtala

Keyword(s):

Drug Interaction ◽

Case Report ◽

Side Effects ◽

Drug Combination ◽

Neuromuscular Block ◽

Severe Effect ◽

Adrenergic Blocker ◽

Life Threatening ◽

Adrenergic Blockers ◽

Oral Propranolol

AbstractSuccinylcholine is one of the most commonly used drugs by anesthesiologists worldwide for rapid access to airway both in emergency and elective situations. Nonetheless, the very mention of succinylcholine generates the most energetic high decibel debate between its users and nonusers. Despite its potential to produce a short-acting, ultra-intense neuromuscular block rapidly in seconds, it is surrounded by a plethora of side effects and drug interactions. This case report is about one such drug interaction of this innocent yet malicious drug, which resulted in the death of a 14-year-old girl. Both β-adrenergic blockers and succinylcholine are known to cause hyperkalemia. Life-threatening hyperkalemia in susceptible individuals who have been administered succinylcholine has the most severe effect on the myocardium and can result in asystole with minimal chances of resuscitation. Both succinylcholine and a nonselective β-adrenergic blocker, propranolol, have the propensity to affect the transcellular redistribution of potassium which can result in hyperkalemia. We advocate cautious use of this drug combination till further studies confirm the drug interaction and find the potential triggering factors involved.

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Olanzapine-induced leucopaenia and thrombocytopaenia in an elderly patient: a case report and review of the evidence

General Psychiatry ◽

10.1136/gpsych-2018-000013 ◽

2018 ◽

Vol 31 (2) ◽

pp. e000013 ◽

Cited By ~ 2

Author(s):

Yogender Kumar Malik ◽

Swapnajeet Sahoo ◽

Ajit Avasthi

Keyword(s):

Elderly Patient ◽

Case Report ◽

Side Effects ◽

Case Reports ◽

The Elderly ◽

Elderly Individual ◽

Psychotic Symptoms ◽

Elderly Individuals ◽

Second Generation Antipsychotics ◽

Life Threatening

Haematological adverse effects of antipsychotics are rare but life threatening. Existing literature is limited to case reports, which are mostly reported on second generation antipsychotics (clozapine, olanzapine, risperidone, quetiapine). Elderly individuals are at risk of developing side effects with any psychotropics. Olanzapine is commonly used for the management of psychotic symptoms as well as for the management of behavioural and psychological problems with dementia in the elderly. In this case report, we report thrombocytopaenia and leucopaenia in an elderly individual with schizophrenia which developed after initiation of olanzapine and reverted back after stoppage of the drug. This case report highlights that the elderly are susceptible to develop haematological side effects with olanzapine and hence monitoring may be essential.

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Ocular and systemic side effects of brimonidine 0.2% eye drops (Alphagan®) in children

Eye ◽

10.1038/sj.eye.6700520 ◽

2004 ◽

Vol 18 (1) ◽

pp. 24-26 ◽

Cited By ~ 46

Author(s):

R J C Bowman ◽

J Cope ◽

K K Nischal

Keyword(s):

Side Effects ◽

Eye Drops ◽

Systemic Side Effects

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pH-Responsive Alginate-Based Microparticles for Colon-Targeted Delivery of Pure Cyclosporine A Crystals to Treat Ulcerative Colitis

Pharmaceutics ◽

10.3390/pharmaceutics13091412 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1412

Author(s):

Murtada A. Oshi ◽

Juho Lee ◽

Jihyun Kim ◽

Nurhasni Hasan ◽

Eunok Im ◽

...

Keyword(s):

Ulcerative Colitis ◽

Drug Delivery ◽

Side Effects ◽

Drug Delivery System ◽

Delivery System ◽

Cyclosporine A ◽

Targeted Delivery ◽

Drug Loading ◽

Systemic Absorption ◽

Systemic Side Effects

Cyclosporine A (CsA) is a potent immunosuppressant for treating ulcerative colitis (UC). However, owing to severe systemic side effects, CsA application in UC therapy remains limited. Herein, a colon-targeted drug delivery system consisting of CsA crystals (CsAc)-loaded, Eudragit S 100 (ES)-coated alginate microparticles (CsAc-EAMPs) was established to minimize systemic side effects and enhance the therapeutic efficacy of CsA. Homogeneously-sized CsAs (3.1 ± 0.9 μm) were prepared by anti-solvent precipitation, followed by the fabrication of 47.1 ± 6.5 μm-sized CsAc-EAMPs via ionic gelation and ES coating. CsAc-EAMPs exhibited a high drug loading capacity (48 ± 5%) and a CsA encapsulation efficacy of 77 ± 9%. The in vitro drug release study revealed that CsA release from CsAc-EAMPs was suppressed under conditions simulating the stomach and small intestine, resulting in minimized systemic absorption and side effects. Following exposure to the simulated colon conditions, along with ES dissolution and disintegration of alginate microparticles, CsA was released from CsAc-EAMPs, exhibiting a sustained-release profile for up to 24 h after administration. Given the effective colonic delivery of CsA molecules, CsAc-EAMPs conferred enhanced anti-inflammatory activity in mouse model of dextran sulfate sodium (DSS)-induced colitis. These findings suggest that CsAc-EAMPs is a promising drug delivery system for treating UC.

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Systemic side effects of eye drops: a pharmacokinetic perspective

Clinical Ophthalmology ◽

10.2147/opth.s118409 ◽

2016 ◽

Vol Volume 10 ◽

pp. 2433-2441 ◽

Cited By ~ 53

Author(s):

Andre Farkouh ◽

Peter Frigo ◽

Martin Czejka

Keyword(s):

Side Effects ◽

Eye Drops ◽

Systemic Side Effects

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Viscosified Solid Lipidic Nanoparticles Based on Naringenin and Linolenic Acid for the Release of Cyclosporine A on the Skin

Molecules ◽

10.3390/molecules25153535 ◽

2020 ◽

Vol 25 (15) ◽

pp. 3535

Author(s):

Sonia Trombino ◽

Camilla Servidio ◽

Annarita Stella Laganà ◽

Filomena Conforti ◽

Mariangela Marrelli ◽

...

Keyword(s):

Side Effects ◽

Linolenic Acid ◽

Skin Permeation ◽

Systemic Absorption ◽

Psoriasis Treatment ◽

Potential Applications ◽

In Vitro Skin Permeation ◽

Systemic Side Effects ◽

Lipophilicity Potential

Psoriasis is one of the most common human skin disorders. Although its pathogenesis is complex and not completely know, the hyperactivation of the immune system seem to have a key role. In this regard, among the most effective systemic therapeutics used in psoriasis, we find cyclosporine, an immunosuppressive medication. However, one of the major problems associated with the use of cyclosporine is the occurrence of systemic side effects such as nephrotoxicity, hypertension, etc. The present work fits in this context and its aim is the design of suitable platforms for cyclosporine topical release in psoriasis treatment. The main objective is to achieve local administration of cyclosporine in order to reduce its systemic absorption and, consequently, its side effects. In order to improve dermal penetration, solid lipid nanoparticles (SLNs) are used as carriers, due to their lipophilicity and occlusive properties, and naringenin and linolenic acid are chosen, due to their properties, as starting materials for SLNs design. In order to have dermatological formulations and further modulate drug release, SLNs are incorporated in several topical vehicles obtaining gels with different degree of lipophilicity. Potential applications for psoriasis treatment were evaluated by considering the encapsulation efficiency, release profiles, in vitro skin permeation, and anti-inflammatory effects.

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