Cardiotoxicity following Bupropion Overdose

2002 ◽  
Vol 36 (11) ◽  
pp. 1791-1795 ◽  
Author(s):  
Deon Druteika ◽  
Peter J Zed
Keyword(s):  
English Language ◽  
Data Sources ◽  
Qtc Interval ◽  
Cardiovascular Toxicity ◽  
Qrs Complex ◽  
Data Synthesis ◽  
Drug Intoxication ◽  
Search Terms ◽  
Acute Ingestion ◽  
Life Threatening

OBJECTIVE: To determine whether bupropion overdose has been associated with cardiovascular toxicity. DATA SOURCES: MEDLINE (1966–January 2002), EMBASE (1980–January 2002), Current Contents (January 2002), and PubMed (January 2002) databases for English-language human reports. Search terms included bupropion, overdose (drug), intoxication, poisoning, and acute ingestion. DATA SYNTHESIS: Articles describing toxicity following bupropion overdose were evaluated independently by both authors to identify cases of cardiotoxicity. RESULTS: Thirteen articles describing bupropion overdose in 116 patients were identified. Only 3 patients exhibited cardiotoxicity following acute ingestion; 2 of these patients also ingested other medications. All 3 patients experienced tachycardia and conduction delays (widened QRS complex and/or prolonged QTc interval), but none of these delays progressed to a life-threatening arrhythmia. All patients recovered, with resolution of cardiotoxicity within 2–4 days following ingestion. CONCLUSIONS: We recommend that all patients with an overdose of bupropion should have an electrocardiogram performed on admission and should be monitored for the development of conduction delays and/or life-threatening arrhythmias.

Levodopa Therapy and the Risk of Malignant Melanoma

2000 ◽  
Vol 34 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Jolene F Siple ◽  
Diana C Schneider ◽  
Wendy A Wanlass ◽  
Burton K Rosenblatt
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Malignant Melanoma ◽  
English Language ◽  
Case Reports ◽  
Levodopa Therapy ◽  
Data Sources ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms

OBJECTIVE: To evaluate the use of levodopa therapy in patients with Parkinson's disease and malignant melanoma. DATA SOURCES: A MEDLINE search (January 1966–September 1999) of English-language articles was conducted. Key search terms included levodopa, melanoma, and Parkinson's disease; 34 case reports were identified. DATA SYNTHESIS: Carbidopa/levodopa continues to be a mainstay in the treatment of Parkinson's disease. Since the late 1970s, a warning has appeared in the prescribing literature for levodopa regarding the risk of activating malignant melanoma. An evaluation was conducted of the case reports in which a causal relationship between levodopa and melanoma was suggested. CONCLUSIONS: There is an unlikely association between levodopa and induction or exacerbation of malignant melanoma.

Leukotriene Modifiers to Prevent Aspirin-Provoked Respiratory Reactions in Asthmatics

2002 ◽  
Vol 36 (9) ◽  
pp. 1457-1461 ◽  
Author(s):  
Julie A Volkman ◽  
Pamala J Pontikes
Keyword(s):  
Nasal Polyps ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Complete Inhibition ◽  
Data Sources ◽  
Antiinflammatory Drugs ◽  
Data Synthesis ◽  
Search Terms ◽  
Clinical Literature ◽  
Life Threatening ◽  
The Relationship

OBJECTIVE: To evaluate the use of leukotriene modifiers in preventing aspirin-provoked respiratory reactions in asthmatics. DATA SOURCES: Clinical literature accessed through MEDLINE (1965–February 2001). Key search terms included aspirin, asthma, leukotriene, and treatment. DATA SYNTHESIS: Aspirin-sensitive asthmatics experience a wide variety of symptoms, ranging from rhinitis to life-threatening bronchospasms, after the ingestion of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). The relationship between aspirin sensitivity, asthma, and nasal polyps was first reported in 1922. The exact mechanism of these reactions is not clearly understood. Four studies investigated the use of leukotriene modifiers to prevent aspirin-provoked respiratory reactions. The efficacy of these agents ranged from complete inhibition to no blockade. CONCLUSIONS: Patients who experience aspirin-sensitive asthma should be cautious when taking aspirin and NSAIDs, despite treatment with leukotriene inhibitors.

Pharmacologic Treatment of Opioid-Induced Sedation in Chronic Pain

2005 ◽  
Vol 39 (4) ◽  
pp. 727-731 ◽  
Author(s):  
James E Reissig ◽  
Amy M Rybarczyk
Keyword(s):  
Chronic Pain ◽  
Trial Design ◽  
English Language ◽  
Data Sources ◽  
Pharmacologic Treatment ◽  
Data Synthesis ◽  
Search Terms ◽  
Limited Support ◽  
Pharmacologic Management ◽  
Language Literature

OBJECTIVE: To review the literature for pharmacologic management of opioid-induced sedation (OIS) in patients with chronic pain. DATA SOURCES: A search of MEDLINE (1966–October 2004) for English-language literature and selected bibliographies was completed. Search terms included pain, opioid, sedation, psychostimulants, amphetamines, modafinil, and donepezil. DATA SYNTHESIS: Amphetamines and amphetamine-like agents, caffeine, donepezil, and modafinil have been evaluated for OIS. Available literature is limited by numbers of subjects, duration, and trial design; however, there is limited support for the use of methylphenidate, donepezil, and modafinil. CONCLUSIONS: Pharmacologic treatment of OIS should be utilized selectively, given the available literature. Methylphenidate, donepezil, and modafinil may be considered in appropriate patients.

Safety of Selegiline with Cold Medications

2003 ◽  
Vol 37 (3) ◽  
pp. 438-441 ◽  
Author(s):  
Jeena E Jacob ◽  
Mary L Wagner ◽  
Jacob I Sage
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Interaction Potential ◽  
Data Sources ◽  
Data Synthesis ◽  
Search Terms ◽  
Clinical Literature

OBJECTIVE: To evaluate the safety of the coadministration of selegiline with cold medications. DATA SOURCES: Clinical literature accessed through MEDLINE(1965–September 2002), IPA database, and Drug-Reax System. The following search terms were used: selegiline, pseudoephedrine, dextromethorphan, MAOI, and drug interactions. Somerset Pharmaceuticals, the marketers of Eldepryl (selegiline HCI), were also contacted. DATA SYNTHESIS: Despite a warning against its concomitant use with pseudoephedrine and dextromethorphan, interactions with selegiline have not been reported. However, there have been reports of patients experiencing adverse events with related agents. CONCLUSIONS: Patients taking selegiline should try to avoid pseudoephedrine and dextromethorphan or use drugs without interaction potential. If selegiline is used with these medications, watch for adverse events or replace selegiline with another drug.

A Review of Cyclic Antidepressant-Induced Blood Dyscrasias

1992 ◽  
Vol 26 (3) ◽  
pp. 378-383 ◽  
Author(s):  
Edward A. Hartshorn ◽  
Gary M. Levin ◽  
C. Lindsay DeVane
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Onset Time ◽  
Data Sources ◽  
Letters To The Editor ◽  
Data Synthesis ◽  
Chemical Structures ◽  
Study Selection ◽  
Pertinent Data

OBJECTIVE: To review the literature for cases of blood dyscrasias associated with cyclic antidepressants. Several types of blood dyscrasias are discussed. DATA SOURCES: All references were selected through the use of MEDLINE. Indexing terms were blood, abnormalities, dyscrasias, antidepressants, agranulocytosis, and eosinophilia. The only constraints were English language and human subjects. STUDY SELECTION: All cases were included except for letters to the editor of various journals when pertinent data such as doses and additional medications were omitted. DATA SYNTHESIS: The review provides a table listing the different blood dyscrasias and the drug the patient was receiving. The table also includes time of onset, time to recovery, and several symptoms for each patient. CONCLUSIONS: Common symptoms of various blood dyscrasias are discussed. The chemical structures of the antidepressants are related to phenothiazines, which are also implicated in causing blood dyscrasias. Recommendations for treatment of both the dyscrasia and depression are discussed.

Isoniazid-Associated Psychosis: Case Report and Review of the Literature

1993 ◽  
Vol 27 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Karen A. Pallone ◽  
Morton P. Goldman ◽  
Matthew A. Fuller
Keyword(s):  
Case Report ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Data Sources ◽  
Review Of The Literature ◽  
Data Synthesis ◽  
Medline Search ◽  
Study Selection ◽  
Language Literature

Objective To describe a case of isoniazid-associated psychosis and review the incidence of this adverse effect. Data Sources Information about the patient was obtained from the medical chart. A MEDLINE search of the English-language literature published from 1950 to 1992 was conducted and Index Medicus was manually searched for current information. Study Selection All case reports describing isoniazid-associated psychosis were reviewed. Data Extraction Studies were evaluated for the use of isoniazid, symptoms of psychosis, onset of symptoms, and dosage of isoniazid. Data Synthesis The case report is compared with others reported in the literature. The incidence of isoniazid-associated psychosis is rare. Conclusions The mechanism of isoniazid-associated psychosis is uncertain. It appears that isoniazid was associated with the psychosis evident in our patient and in the cases reviewed.

Dexrazoxane: A New Cardioprotective Agent

1998 ◽  
Vol 14 (5) ◽  
pp. 182-190 ◽  
Author(s):  
Beverly D Abbott ◽  
Cindy M Ippoliti
Keyword(s):  
Supportive Care ◽  
English Language ◽  
Bolus Dose ◽  
Cardiac Tissue ◽  
Data Extraction ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms ◽  
Study Selection ◽  
Clinically Significant

Objective: To review the literature discussing the use of dexrazoxane (e.g., Zinecard, ICRF-187) to prevent doxorubicin-induced cardiotoxicity. Data Sources: Pertinent English-language reports of studies in humans were retrieved from a MEDLINE search (January 1980-January 1997); search terms included chelating agents, razoxane, dexrazoxane, Zinecard, ICRF-187, ADR-529, and ICRF-159. Study Selection: Representative articles discussing the chemistry, pharmacology, pharmacokinetics, dosing, and administration of dexrazoxane and those discussing clinical trials were selected. Data Extraction: Data were extracted and analyzed if the information was relevant and consistent. Studies were selected for review in the text on the basis of study design and clinical end points. Data Synthesis: Dexrazoxane is a chemoprotective agent developed to prevent cardiac tissue toxicity. Dexrazoxane exerts a cardioprotective effect with some clinically significant toxicities; it may also interfere with the antitumor activity of doxorubicin. Until there are sufficient data to support its use in first-line supportive care therapy, dexrazoxane should be reserved for use in patients responding to doxorubicin-based chemotherapy but who have risk factors for cardiac toxicity or have received a cumulative doxorubicin bolus dose of 300 mg/m2. Conclusions: The management of doxorubicin-induced cardiotoxicity has led to the development of supportive care drugs that specifically counteract the dose-limiting toxicities. Dexrazoxane may not completely eliminate the concern about doxorubicin-induced cardiotoxicity, but it may open new avenues for continuing doxorubicin-based chemotherapy.

Clinical Toxicology of Yew Poisoning

2018 ◽  
Vol 52 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Alexander W. Labossiere ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Plant Materials ◽  
Search Terms ◽  
Life Threatening

Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

Defining and Measuring Functional Limitations and Disability in the Athletic Shoulder

2001 ◽  
Vol 10 (3) ◽  
pp. 221-231 ◽  
Author(s):  
Douglas R. Keskula ◽  
Jason Lott
Keyword(s):  
Outcome Measures ◽  
English Language ◽  
Functional Limitations ◽  
Self Report ◽  
Data Sources ◽  
Measurement Properties ◽  
Data Synthesis ◽  
Shoulder Dysfunction ◽  
Study Selection ◽  
Type Data

Objective:To define, identify, and briefly describe functional outcome measures for assessing functional limitations and disability in athletes with shoulder conditions.Data Sources:The MEDLINE and CINAHL databases were searched for English-language articles published from 1982 to 2000, using the termsfunctional outcomes, shoulder, questionnaires, disability,andfunctional limitations,among others.Study Selection:The authors identified disease-specific self-report questionnaires that assess functional limitations and disability in patients with shoulder dysfunction.Data Synthesis:When describing outcome measures, the authors considered the items to be assessed, the measurement properties, and the practicality of the test. They categorized the available measures designed to assess patients with shoulder instability or general shoulder conditions.Conclusions:The ability to define and measure function is a fundamental consideration in managing athletes with shoulder dysfunction. The measures described might be useful in assessing functional limitations and disability in such athletes.

Topical Tacrolimus in the Treatment of Atopic Dermatitis

2001 ◽  
Vol 35 (7-8) ◽  
pp. 943-946 ◽  
Author(s):  
Laura M Gianni ◽  
Maria Marzella Sulli
Keyword(s):  
Atopic Dermatitis ◽  
Skin Penetration ◽  
Data Sources ◽  
Cell Mediated Immunity ◽  
Efficacy And Safety ◽  
Data Synthesis ◽  
Topical Tacrolimus ◽  
Duration Of Therapy ◽  
Search Terms ◽  
Optimal Duration

OBJECTIVE: To review the efficacy of topical tacrolimus in the treatment of atopic dermatitis (AD). DATA SOURCES: Searches of MEDLINE (1966–October 2000), International Pharmaceutical Abstracts (1970–October 2000), and ScienceDirect (1994–October 2000) were performed using the key search terms tacrolimus, FK506, and atopic dermatitis. DATA SYNTHESIS: Since patients with AD have defects in cell-mediated immunity, the immunosuppressant properties of the macrolides (cyclosporine and tacrolimus) may prove to be beneficial in the treatment of AD. Topical tacrolimus has been frequently studied in the treatment of AD because it was found to have better skin penetration and higher potentency than topically applied cyclosporine. Studies evaluating the use of topical tacrolimus are presented and provide evidence that topical tacrolimus is effective in the treatment of AD with no evidence thus far of systemic adverse effects. CONCLUSIONS: There is a fair amount of documentation of the efficacy and safety of topical tacrolimus. Further trials are needed to determine the optimal duration of therapy and its efficacy and safety in children less than seven years of age.

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