How Effective is the Standard Dose of Disulfiram? A Review of the Alcohol-Disulfiram Reaction in Practice

1984 ◽  
Vol 144 (2) ◽  
pp. 200-202 ◽  
Author(s):  
Colin Brewer
Keyword(s):  
Side Effects ◽  
Standard Dose ◽  
Recommended Dose ◽  
Significant Response ◽  
Drinking Alcohol ◽  
Current Maximum

SummaryThe current maximum recommended dose of disulfiram, 200 mg daily, is often inadequate. Of 63 patients taking disulfiram under supervision who either risked drinking alcohol or who had a medically supervised challenge with alcohol, only half produced a significant response on a dose of 200–300 mg daily. Some patients need as much as 1.5 g daily but even at high dosage significant side effects are uncommon, reversible and rarely serious.A modification to the recommended technique for a medically supervised alcohol challenge is described, which minimises distress.

scholarly journals High-Dose Adrenaline in Adult In-Hospital Asystolic Cardiopulmonary Resuscitation: A Double-Blind Randomised Trial

1993 ◽  
Vol 21 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J. Lipman ◽  
W. Wilson ◽  
S. Kobilski ◽  
J. Scribante ◽  
C. Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Side Effects ◽  
Cardiopulmonary Resuscitation ◽  
Standard Dose ◽  
Randomised Trial ◽  
High Dose ◽  
Double Blind ◽  
To Receive

Forty intensive care unit patients requiring cardiopulmonary resuscitation were randomised to receive either the standard dose of adrenaline (1 mg every five minutes) or high-dose adrenaline (10 mg every five minutes). In the majority of patients, overwhelming sepsis was the major contributing factor leading to cardiac arrest. In this group of patients no difference could be detected in response to high-dose adrenaline compared with the standard dose. Although no side-effects were noted with this high dose of adrenaline, more investigation is required prior to its routine use in cardiopulmonary resuscitation.

scholarly journals Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort

2020 ◽  
Vol 10 ◽  
pp. 204512532095711
Author(s):  
Caroline Hynes ◽  
Stephen McWilliams ◽  
Mark Clarke ◽  
Ita Fitzgerald ◽  
Larkin Feeney ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scales ◽  
Rating Scale ◽  
Standard Dose ◽  
Well Being ◽  
High Dose ◽  
Negative Consequences ◽  
Adherence Assessment ◽  
Dose Combination ◽  
Antipsychotic Side Effects

Background: Antipsychotics are associated with a range of side-effects that can influence patients’ subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales. Methods: Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically. Results: A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% ( n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy. Conclusion: Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.

scholarly journals Practical aspects of etomidate use in the management of hypercortisolaemia

2012 ◽  
Vol 167 (5) ◽  
pp. 729 ◽  
Author(s):  
Veronica A Preda ◽  
Ashley B Grossman
Keyword(s):  
Side Effects ◽  
Propylene Glycol ◽  
Cushing’S Syndrome ◽  
Dose Regimen ◽  
Cushing's Syndrome ◽  
Ease Of Use ◽  
Recommended Dose ◽  
Lipid Formulation ◽  
Starting Dose

We appreciate the letter from of Dr Soh et al. regarding our review on the use of etomidate in the treatment of Cushing's syndrome. We note that in their experience, our recommended dose regimen of 2.5 mg/h or thereabouts appears to be a safe and effective starting dose in most patients, and we note the utility and ease of use of the lipid formulation and its relative freedom from side effects compared with the more commonly used propylene glycol formulation; these are very helpful comments. Their experience in treating a further four patients is indeed further evidence of the usefulness of this agent.

Deliberate Vitamin C S elf-Administration by the Public

1983 ◽  
Vol 2 (3-4) ◽  
pp. 211-216
Author(s):  
Cedric W. M Wilson ◽  
Gillian C. Coffey
Keyword(s):  
Ascorbic Acid ◽  
Side Effects ◽  
Vitamin C ◽  
Dietary Intake ◽  
Medical Advice ◽  
Recommended Dose ◽  
Dietary Vitamin ◽  
The Public ◽  
Abdominal Symptoms ◽  
Daily Dose

A questionnaire was distributed to 38 organisations in Dublin to obtain information about the extent to which Vitamin C is deliberately taken by the public in the form of fruit, or tablets containing ascorbic acid, the reasons for its consumption and the side-effects attributed to it, in relation to the basic dietary intake of Vitamin C. Of the 950 subjects in the sample, 60% significantly more of whom were female, deliberately took supplementary Vitamin C. Of the Vitamin C takers, 70% took a daily dose of 50 mg, 7% took 1000 mg or more; 28% took the supplementary dose all the time, 12% took it only when ill, in the form of tablets. Subjects with a dialy dietary intake of more than 75 mg were more likely to take supplementary Vitamin C. 36% of takers took Vitamin C for control of cold symptoms. Only 5% took it on medical advice. 8% of the subjects attributed side-effects to Vitamin C, sleepiness, soreness of the tongue and constipation being the most common, and equally common after fruit or tablets. Only 4% experienced abdominal symptoms. The results indicate that females who normally have higher tissue ascorbic acid levels, and those individuals who have higher basic dietary Vitamin C intakes, tend to supplement themselves to a greater degree with extra Vitamin C in the form of fruit or tablets. It appears that a proportion of the population has a higher physiological requirement of Vitamin C than other individuals who exist on the recommended dose.

P3534Optimal dosing of initial bolus of intravenous furosemide in acute heart failure: insights from REALITY-AHF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Matsue ◽  
T Okumura ◽  
K Kida ◽  
S Oishi ◽  
E Akiyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Dose Group ◽  
Standard Dose ◽  
Length Of Hospital Stay ◽  
Loop Diuretics ◽  
Recommended Dose ◽  
Diuretic Response ◽  
Initial Bolus

Abstract Background Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated. Methods The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality. Results Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p<0.001) compared to the standard dose group after adjustment for covariates. During 60 days of admission, 91 deaths were observed, and 60-day mortality was significantly higher in the higher dose group (HR: 2.80, 95% CI: 1.49–5.26, p=0.001), but not in the lower dose group (HR: 1.18, 95% CI: 0.67–2.08, p=0.571) compared to the standard dose group after adjustment for other prognostic factors. Conclusion Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF. Acknowledgement/Funding This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.

Low Dose and Standard Dose of Imatinib Therapy for Patients with Chronic Myeloid Leukemia in Akita Prefecture, Japan.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4575-4575
Author(s):  
Naoto Takahashi ◽  
Yoshihiro Kameoka ◽  
Hirofumi Saitoh ◽  
Naohito Fujishima ◽  
Makoto Hirokawa ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Characteristics ◽  
Low Dose ◽  
Standard Dose ◽  
Point Mutations ◽  
Imatinib Therapy ◽  
Group I ◽  
Akita Prefecture ◽  
Group 2 ◽  
Group 1

Abstract The IRIS study for CML patients demonstrated the excellent clinical and cytogenetic/molecular effects of imatinib. Patients participating in the IRIS trial were selected according to strict eligibility criteria. The clinical features of patients are usually much more heterogeneous in practical situations than in clinical trials. Sometimes, patients cannot be treated with the standard dose of imatinib because of severe toxicity, especially older patients or patients who had already been treated with the other drugs. In this study, we analyzed whether patients could still be effectively treated using lower doses. Our study analyzed 86 CML patients from 17 hospitals in Akita prefecture. 80 patients were in CP, one patient was in AP, 4 patients were in BC, and one patient had cytogenetic relapse after allo-SCT. All patients were treated with imatinib between December 2001 and July 2007. Initially a dose of 400mg/day was given to almost all patients. Later the dose was decreased in a subset of patients experiencing imatinib-induced side effects. We classified patients into two groups according to the imatinib dosage and analyzed their clinical characteristics [Table 1] and the accumulation of CCR/MMR [Figure 1, 2]. In Group 1, we analyzed 55 patients received 300mg or more of imantiib per day. In Group 2, we analyzed 31 patients received less than 300mg of imatinib per day. Patients in Group 2 were older and had more histories of pretreatment and showed a higher frequency of adverse effects of imatinib than in Group 1. There were no significant differences of CCR/MMR rate between Group 1 and Group 2. This study reproduces the imatinib efficacy results described in the IRIS study, not only for patients treated with standard dose imatinib and for patients who could not take 400mg/day because of imatinib toxicity or other complications. We did not observe an increase in frequency of BCR-ABL point mutations in patients receiving a lower dose of imatinib, suggesting that the low dose imatinib treatment analyzed in our study does not enhance imatinib resistance by increasing BCR-ABL point mutations. In conclusion, we provide data supporting the use of lower doses of imatinib for CML patients that cannot be given sufficient dosage of imatinib for reasons such as severe hematological or non-hematological side effects or other complication. Clinical Characteristics of Patients in Group I and II Group 1(n=55) Group 2(n=31) P Average doseage 380 mg/day 185 mg/day Average age (% of over 70 yrs) 57.7 yrs (22 %) 68.0 yrs (58 %) .001 (.007) History of treatment with IFN/HU before imatinib therapy 16% 55%. 002 Adverse effect (Grade3/4) 16% 42% .009 PFS to AP/BC at 60 Mo 97.8% 89.6% .28 CCR /MMR rate 78% / 51% 61% / 39% .09 / .27 Point mutation of bcr-abl in patients without MMR 4/17 2/13 .99 Figure Figure Figure Figure

Evaluation of Low Dose Rasburicase In the Prevention of Renal Insufficiency and Dialysis After Chemotherapy

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2574-2574
Author(s):  
Aflonso Eirin ◽  
Maria V Irazabal ◽  
Heidi D Gunderson ◽  
Nelson Leung
Keyword(s):  
Multivariate Analysis ◽  
Uric Acid ◽  
Renal Insufficiency ◽  
B Cell ◽  
Lymphoproliferative Disorder ◽  
Low Dose ◽  
Cell Lymphoma ◽  
Standard Dose ◽  
B Cell Lymphoma ◽  
Recommended Dose

Abstract Abstract 2574 Rasburicase is a recombinant urate oxidase approved for the prevention of tumor lysis syndrome (TLS). In adults, the recommended dose is 0.2 mg/kg intravenously daily up to 5 days. For a 75 kg person, the cost is over $5100. Given the vast reduction of uric acid seen with this dose, it may be possible to use a reduce dose. The aim of this study is to evaluate the effectiveness of 0.1 mg/kg dose vs the recommended dose in the prevention of TLS. Between October of 2003 and February of 2009, all patients with a hematologic or oncologic diagnosis who received rasburicase were reviewed. Rasburicase had been dosed at either 0.1 mg/kg (low dose) or 0.2 mg/kg (standard dose) due to variations in practice among the practitioners. Rasburicase was given on the first day of chemotherapy and repeated as necessary. Renal insufficiency was defined by 0.5 mg/dl rise in serum creatinine (Scr) within 7 days of chemotherapy initiation. The need for dialysis was recorded separately. Labs were performed pretreatment and usually daily after chemotherapy until electrolytes stabilized. A multivariate analysis using pretreatment labs was performed to determine risk factors for renal insufficiency or failure. During the study period, 125 patients received rasburicase. Fifty-five patients received low dose rasburicase and 70 received the standard dose. The diagnoses are listed in Table 1. Lactate dehydrogenase (LDH) was similar between the two groups (604 U/l in low dose vs 665 U/l in standard dose, p = 0.69). Additional doses were required in 14.5% of the low dose patients vs 21.4% of the standard dose patients, p = 0.36. Renal insufficiency was noted only in the standard dose patients 7.4% vs 0%, p = 0.04. Rates of dialysis were similar between low dose patients 7.3% vs 17.4% in the standard dose patients, p = 0.10. Dialysis was often initiated for hyperkalemia and hyperphosphatemia. Only 12.5% were started for elevation in Scr. Uric acid reduction was higher in the standard dose patients (90.4 ± 15.8%) as compared with low dose patients (82.0 ± 19.0%, p = 0.01). Pretreatment Scr, uric acid and phosphorus levels were found to be significant variable for dialysis but only uric acid was found to be significant in the multivariate analysis. Pretreatment uric acid was a risk factor for dialysis (p < 0.001) but not for renal insufficiency (p = 0.24). Our results suggest that low dose rasburicase may be as effective as 0.2 mg/kg. While high dose rasburicase was more effective at reducing uric acid, it did not reduce the need for dialysis because dialysis was often needed for hyperkalemia and hyperphosphatemia which rasburicase did not affect. Despite bias, our results suggest low dose rasburicase may be a viable alternative and definitely support further study into its use. The potential savings could be enormous given that it would be $2550 per patient. Table 1. Baseline diagnosis of 125 patients with TLS Diagnosis Low dose Standard dose dose Diffuse large B-cell lymphoma 13 17 Chronic lymphocytic leukemia 3 12 Multiple myeloma 7 5 Non-Hodgkin's lymphoma 4 7 Acute myeloid leukemia 4 7 Burkitt's lymphoma 3 4 T-cell lymphoma 4 3 B-cell lymphoma 5 1 Solid Tumor 1 5 Myelofibrosis 3 2 Mantle cell lymphoma 3 1 Amyloidosis 0 2 Blast crisis in acute leukemia 1 1 B-cell lymphoproliferative disorder 0 1 Chronic myeloproliferative disorder 0 1 Follicular mixed lymphoma 0 1 Hodgkin's lymphoma 1 0 undifferentiated 1 0 Lymphoreticular myeloid malignancy 1 0 Post-transplant lymphoproliferative disorder 0 1 Splenic marginal cell lymphoma 1 0 Waldenstrom macroglobulinemia 1 0 Total 55 70 Disclosure: No relevant conflicts of interest to declare.

Influence of Dosing Interval and In-patient Versus Out-patient Status on Incidence of Side-effects of Niridazole

1986 ◽  
Vol 5 (4) ◽  
pp. 275-278 ◽  
Author(s):  
I. Abdu-Aguye ◽  
L. Sambo-Donga
Keyword(s):  
Side Effects ◽  
Standard Dose ◽  
Urinary Schistosomiasis ◽  
Dosing Interval ◽  
Patient Status ◽  
Male Patients ◽  
Cure Rates

The side-effects of niridazole used for urinary schistosomiasis were studied prospectively over a 3-month period in male patients receiving the standard dose of 25 mg day-1 kg-1 for 7 days. Side-effects were detected in 80% of in-patients but only in 33% of out-patients. The range of side-effects was greater in in-patients taking their daily doses in two portions than in those taking theirs in three. Cure rates and degree of schistosoma egg suppression were significantly lower in out-patients suggesting that compliance with treatment was poorer.

Quality of Life Outcomes Associated with Variable Posttransplant Prednisone Dosing Regimens

1996 ◽  
Vol 6 (2) ◽  
pp. 64-68 ◽  
Author(s):  
Donna K Hathaway ◽  
Rebecca P Winsett ◽  
E Jean Milstead ◽  
Mona N Wicks ◽  
A Osama Gaber
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Low Dose ◽  
Standard Dose ◽  
Graft Function ◽  
Transplant Recipients ◽  
Life Outcomes ◽  
Dosing Regimens ◽  
Dose Prednisone

Prednisone tapering has become more common in the management of transplant recipients. Benefits of this practice, however, must be weighed against the risks. This study identified outcomes associated with variable low dose prednisone protocols. The study sample included 98 kidney and kidney-pancreas transplant recipients 1 year after transplant. Graft function, side effects of steroid therapy, and quality of life were recorded on patients receiving 0 (n=5), 1 to 5 (n=4), 5 to 7.5 (n=5), 7.5 to 10 (n=21), and greater than 10 mg/d prednisone (n=63). Despite the fact that patients were assigned to the low dose groups because they were at risk for or already experiencing steroid induced side effects, the low dose groups presented side effect and quality of life profiles similar to or better than those of the standard dose group.

scholarly journals Imipramine in the Treatment of Nocturnal Enuresis of Childhood

1965 ◽  
Vol 10 (2) ◽  
pp. 141-151 ◽  
Author(s):  
Harvey R. Alderton
Keyword(s):  
Side Effects ◽  
Psychiatric Hospital ◽  
Mode Of Action ◽  
Nocturnal Enuresis ◽  
Blind Study ◽  
Significant Response ◽  
Double Blind Study ◽  
Double Blind ◽  
The Past ◽  
Spontaneous Improvement

A double-blind study of the use of imipramine in the treatment of nocturnal enuresis is reported. The subjects were twelve children aged six to 12 years in a children's psychiatric hospital. The drug (25 mg) or placebo was administered at 8.00 p.m. for two or four weeks at a time, the trial extending from 16 weeks to 32 weeks. For the group as a whole, the number of enuretic nights declined from 46.75% on placebo to 31.75% on drug, a reduction of 32.09%. The average enuresis per child declined from 47.25% to 30.75%, a reduction of 34.92%. Three children showed a significant response to placebo, one of these became virtually dry. Seven of the subjects showed a signficant response to the drug, with reduction of enuretic nights of 25% or more in all, of 50% or more in three and of 70% or more in two. Relapse occurred on discontinuing the drug. In addition to the fall in enuresis each time drug was given, an over-all decrease in enuresis occurred throughout the trial, not due to spontaneous improvement. It is suggested that this results from the full effects of the drug being somewhat delayed and taking some time to wear off. Observations on the time at which enuresis occurred showed that most commonly only incidents after 1 a.m. were reduced, suggesting that for this group earlier administration of the drug may be desirable. In only one subject was enuresis before 1 a.m. accompanied by an increase in incidents after 1 a.m. and for such cases an increased dosage may be effective. No side effects from the drug were observed. A consideration of the mode of action of the drug is presented and it is concluded that it may act by diminishing uninhibited bladder contractions by its autonomic diencephalic action. Previous reports on the treatment of enuresis by imipramine are reviewed together with a brief review of controlled studies of other drugs which have appeared in the past decade. It is concluded that imipramine is a useful drug in the treatment of enuresis in psychiatrically disturbed children.

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