scholarly journals Therapeutic Aspects of Dogs with Presumptive Diagnosis of Idiopathic Epilepsy

2017 ◽  
Vol 45 (1) ◽  
pp. 9
Author(s):  
Graciane Aiello ◽  
Amanda Oliveira de Andrades ◽  
Angel Ripplinger ◽  
Dakir Polidoro ◽  
Rafael Oliveira Chaves ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Side Effects ◽  
Adverse Effects ◽  
Antiepileptic Drugs ◽  
Liver Damage ◽  
Potassium Bromide ◽  
Idiopathic Epilepsy ◽  
Biochemical Tests ◽  
Presumptive Diagnosis

Background: Epilepsy is a chronic neurological condition characterised by recurrent epileptic seizures. Various antiepileptic drugs are used for the management of canine idiopathic epilepsy. Phenobarbital is the drug of choice for long-term treatment in dogs. Although it is well tolerated, phenobarbital can cause liver injury if administered alone or in combination with other drugs. Therefore, the main of this study was to identify dogs with presumptive diagnosis of idiopathic epilepsy and information about the antiepileptic drugs, the dose and frequency of administration, period of treatment, frequency of the seizure before and after start the treatment, complementary exams and adverse effects.Materials, Methods & Results: In this study were included 21 dogs with idiopathic epilepsy. All dogs were examined and having blood taken for blood count, biochemical tests (ALT, AST, AP, total protein, albumin, creatinine, urea, amylase, lipase, cholesterol and triglycerides), measurement of serum phenobarbital and/or potassium bromide and, some dogs, free T4 by dialysis and canine TSH. In this study, it was observed monotherapy (phenobarbital) in 76.19% (16/21), double therapy (phenobarbital and potassium bromide) in 19.05% (4/21) and triple therapy (phenobarbital, potassium bromide and gabapentin) in 4.76% (1/21) of dogs. The phenobarbital was used as monotherapy with dose between 1.4 and 12 mg kg-1 and the median of serum concentration was 26.41 μg kg-1. There was significant reduction in the frequency of the seizure after start the treatment. There was refractory to antiepileptic drugs in two dogs (9.5%). In blood analysis, there was increase serum activities of AP (23.81%) and ALT (14.20%), decrease total protein (42.29%), hypoalbuminemia (9.5%) and it was not increased AST activities. The main adverse effects were nodularliver damage and hypothyroidism.Discussion: In most cases of dogs with idiopathic epilepsy, monotherapy is preferred, because it tends to avoid complications that may arise from drug interactions and may also improve compliance by providing a simple treatment regimen. In this study, the phenobarbital controlled the seizures when used as monotherapy. It is considered success of an antiseizure drug when there is a reduction of seizure frequency by at least 50%, with minimal drug side effects. Approximately 20-30% of dogs with epilepsy do not have satisfactory seizure control or experience intolerable adverse effects with appropriate conventional medical treatment. In this study, there was refractory to antiepileptic drugs in 9.5%, one dog treated with phenobarbital and other with phenobarbital and potassium bromide. The long-term use of phenobarbital causes increase in liver enzymes, ALT and, mainly, ALP, these are attributed to enzymatic induction and to low degree of liver damage. ALT and AP increased the values and this does not necessarily indicate clinically significant liver damage or the need to stop therapy. The risk of liver toxicity appears to be greater with concentrations higher than 35 μg mL-1 or when multiple potentially hepatotoxic drugs are used. Other factors associated to the long-term use of anticonvulsant, such phenobarbital, potassium bromide or both, for the treatment of idiopathic epilepsy in dogs is acute pancreatitis and hypothyroidism. In this study, it was not observed acute pancreatitis, but there were two dogs with hypothyroidism. The long-term use of phenobarbital did not cause significant side effects, even with changes in the biochemical tests.

scholarly journals The vulnerability of tidal flats and multi-channel estuaries to dredging and disposal

2021 ◽  
Vol 4 (1) ◽  
pp. 36-60
Author(s):  
Wout M. van Dijk ◽  
Jana R. Cox ◽  
Jasper R.F.W. Leuven ◽  
Jelmer Cleveringa ◽  
Marcel Taal ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Tidal Flats ◽  
Main Channel ◽  
Channel System ◽  
Adverse Side Effects ◽  
Limited Effectiveness ◽  
Physical Scale ◽  
Large Vessels

Shipping fairways in estuaries are continuously dredged to maintain access for large vessels to major ports. However, several estuaries worldwide show adverse side effects to dredging activities, in particular affecting morphology and ecologically valuable habitats. We used physical scale experiments, field assessments of the Western Scheldt estuary (the Netherlands), and morphodynamic model runs to analyse the effects of dredging and future stresses (climate and sediment management) on a multi-channel system and its ecologically valuable intertidal flats. All methods indicate that dredging and disposal strategies are unfavourable to long-term morphology because dredging creates and propagates the imbalance between shallow and deeper parts of the estuary, causing a loss of valuable connecting channels and fixation of the tidal flats and main channel positions, while countering adverse effects by disposal strategy has limited effectiveness. Changing the disposal strategy towards main channel scour disposal can be economically and ecologically beneficial for the preservation of the multi-channel system. Further channel deepening will accelerate the adverse side effects, whereas future sea-level rise may revive the multi-channel system.

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (> 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

scholarly journals The impact of side effects on long-term retention in three new antiepileptic drugs

Seizure ◽  
2009 ◽  
Vol 18 (5) ◽  
pp. 327-331 ◽  
Author(s):  
Hans P. Bootsma ◽  
Lukas Ricker ◽  
Yechiel A. Hekster ◽  
Jacques Hulsman ◽  
Danielle Lambrechts ◽  
...  
Keyword(s):  
Side Effects ◽  
Antiepileptic Drugs ◽  
New Antiepileptic Drugs ◽  
Term Retention ◽  
Long Term Retention ◽  
The Impact

scholarly journals Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

2019 ◽  
Vol 14 (3) ◽  
pp. 173-181 ◽  
Author(s):  
John Read ◽  
James Williams
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Antipsychotic Medication ◽  
Online Survey ◽  
Negative Effects ◽  
Duration Of Treatment ◽  
Direct To Consumer ◽  
Poor Outcomes

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

scholarly journals Side effects of drug treatments for gastro-oesophageal reflux disease: current controversies

2020 ◽  
pp. flgastro-2019-101386
Author(s):  
Anjan Dhar ◽  
Frances Maw ◽  
Helen Jane Dallal ◽  
Stephen Attwood
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Clinical Significance ◽  
Proton Pump ◽  
Reflux Disease ◽  
Critical Review ◽  
Oesophageal Reflux ◽  
Oesophageal Reflux Disease ◽  
Drug Treatments

The two main drugs used in the treatment of gastro-oesophageal reflux disease are proton pump inhibitors and histamine-2 receptor antagonists and both these agents have been implicated in a number of adverse effects, leading to considerable controversies related to their long-term use. This paper is aimed at a critical review of the published literature and the clinical significance of these reported side effects, most of which are associations rather than causal.

scholarly journals Effectiveness of Tocilizumab in the Treatment of Fasciitis with Eosinophilia: Two Case Reports

2020 ◽  
Author(s):  
Guiomar Pinheiro ◽  
Ana Rita Costa ◽  
Ana Campar ◽  
Teresa Mendonça
Keyword(s):  
Side Effects ◽  
Partial Response ◽  
Adverse Effects ◽  
Large Scale ◽  
Case Reports ◽  
Immunosuppressive Drugs ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Symptom Relapse

Fasciitis with eosinophilia (FE) is a rare connective tissue disease. Due to its rarity, large-scale studies are lacking, which makes its treatment challenging. Systemic corticosteroids (SCSs) are the cornerstone of treatment; however, additional immunosuppressive drugs (ISDs) are frequently necessary (usually methotrexate). We report 2 patients, for whom an SCS and methotrexate were not a viable long-term option. In the first case, we were unable to taper the SCS dose without symptom relapse, the patient showed only a partial response to methotrexate and presented side effects. The second case never fully responded to the SCS and methotrexate and demonstrated serious SCS adverse effects. Both patients were started on tocilizumab with extremely favourable results, making this drug a potential therapeutic weapon for these patients.

scholarly journals Antiepileptic Drugs’ Tolerability and Safety – a Systematic Review and Meta-analysis of Adverse Effects in Dogs

2016 ◽  
Vol 1 (4) ◽  
Author(s):  
Marios Charalambous
Keyword(s):  
Systematic Review ◽  
Open Access ◽  
Adverse Effects ◽  
Antiepileptic Drugs ◽  
Safety Profile ◽  
Case Reports ◽  
Meta Analysis ◽  
Idiopathic Epilepsy ◽  
Third Place ◽  
Regulatory Bodies

<p>Various anti-epileptic drugs (AEDs) are used for the management of idiopathic epilepsy (IE) in dogs. Their safety profile is an important consideration for regulatory bodies, owners and prescribing clinicians. However, information on their adverse effects still remains limited with most of it derived from non-blinded non-randomized uncontrolled trials and case reports.</p><p><span>This poster won third place, which was presented at the Veterinary Evidence Today conference, Edinburgh November 1-3, 2016. </span></p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals POS1156 INFECTIONS AND OTHER ADVERSE EFFECTS WITH BIOLOGICAL THERAPIES OVER THE PAST 10 YEARS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 856.3-857
Author(s):  
G. Alvarez ◽  
A. Perez Jaen ◽  
A. Uribe Luna ◽  
M. Rexach Fumaña ◽  
L. Peries Reverter ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Total Sample ◽  
Biological Therapies ◽  
Long Term Effects ◽  
Biological Drugs ◽  
Hematological Disorders ◽  
The Past

Background:Biological therapies have marked a difference in the treatment of many autoimmune conditions. As all treatments, they have their side effects although little evidence of long-term effects has been reported.Objectives:Analyze retrospectively the appearance of infections that required hospitalization and other side effects in patients treated with biological therapies over the past 10 years.Methods:Biological drugs dispensed in our center to non-cancer patients from 2008 to 2018 were reviewed. Health records were collected from our database and all statistical analyzes were performed with the SPSS program.Results:24 different biological drugs applied to 34 medical conditions; 847 treatments were dispensed over a total of 555 patients. The median age was 44 years with a mean duration of 3.6 years of treatment. The most commonly used drug were adalimumab (n = 280, 33%), infliximab (n = 119, 12%), etanercept (n = 97.13%), rituximab (n = 63, 7%), vedolizumab (n = 47, 5.5%) and omalizumab (n = 43.5%). The rest of the drugs were administered <30 times each (ustekinumab, golimumab, certolizumab, tocilizumab, secukinumab and abatacept), representing <4% of the total sample.The underlying conditions included Crohn’s Disease (n = 262, 31%), rheumatoid arthritis (n = 133, 16%), ulcerative colitis (n = 118, 14%), spondyloarthropathies (n = 86, 10%), psoriatic arthritis (n = 56, 7%), psoriasis (n = 49, 6%), asthma (n = 34, 4%), nephropathies (n = 19, 2%) and vasculitis (n = 13, 1.5%). The rest were pathologies with <10 cases.During treatment, infection requiring hospitalization occurred in 10.2% (n = 86). The most frequent focus of infection was respiratory (n = 23, 27%), abdominal (n = 19, 22%), soft tissue-bone (n = 17 cases, 20%), urinary (n = 7, 8%) and tuberculosis (n = 4, 5%). No case of hepatitis reactivation was observed. At the time of hospital admission, 46% of patients were only under biological therapy, 21% had another non-corticosteroid immunosuppressant, 17% were associated with corticosteroid, and 15% had triple therapy (corticosteroids, another immunosuppressant and the biological drug). The drugs associated with more infections were: abatacept 20%, rituximab 16% and adalimumab 13%.During the study period, 14 deaths (1.7%) were observed; being the cause cancer-related (n=5), infection (n=5), the disease itself for which was receiving biological treatment (n=2), and endocrine metabolic causes (n=2).At the end of the review, 48% of the treatments were still in use, while 52% had stopped for various reasons: 20% ineffectiveness, 12% side effects, 12% maintained complete remission. The remaining low percentage was due to death, pregnancy, or study entry.The side effects that led to a change in treatment was: non-immune hematological disorders in 4.1% (14% of tocilizumab, 7% of rituximab and 6% of vedolizumab), immune disorders in 3.8% (6% of secukinumab, 5% of tocilizumab and 4.5% of certolizumab), nervous system involvement in 2.4% (11.5% of golimumab,10% of abatacept, 5% of tocilizumab), debut or worsening of heart failure in 1.4% (9, 5% of tocilizumab, 2.5% of etanercept and 1.4% of adalimumab) and cancer-related in 0.7% (2% of infliximab, 1.7% of etanercept).Conclusion:In these 10 years of follow-up and and evaluating 847 treatments, there were 10% hospitalizations due to infections (n = 86) causing death in 5 patients. In light of these results, and pending an exhaustive statistical analysis, we did not find high frequencies of serious side effects in our series. Very little long-term evidence exists on the safety of these drugs.References:[1]Singh JA, Wells GA, Christensen R, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;2011(2):CD008794. Published 2011 Feb 16.Disclosure of Interests:None declared.

Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia

2015 ◽  
Vol 23 (3) ◽  
Author(s):  
Abdulmaged M. Traish ◽  
Karim Sultan Haider ◽  
Gheorghe Doros ◽  
Ahmad Haider
Keyword(s):  
Erectile Dysfunction ◽  
Benign Prostatic Hyperplasia ◽  
Side Effects ◽  
Adverse Effects ◽  
Erectile Function ◽  
Prostatic Hyperplasia ◽  
Continuous Treatment ◽  
Plasma Testosterone ◽  
The Impact

Abstract5α-reductase inhibitors (5α-RIs) (finasteride and dutasteride) have been proven useful in treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). However, these inhibitors exert undesirable sexual side effects and, in some cases, these effects are persistent. There is considerable disagreement with regard to whether the adverse side effects resolve with continuous treatment.To investigate the long-term adverse effects of finasteride treatment in men with BPH on erectile function and to compare these adverse effects in men treated with the α1-adrenergic receptor blocker, tamsolusin.In this retrospective registry study, a cohort of 470 men aged between 47 and 68 years (mean 57.78±4.81) were treated with finasteride (5 mg/day). A second cohort of 230 men aged between 52 and 72 years (mean 62.62±4.65) were treated with tamsulosin (0.4 mg). All men were followed up for 45 months. At intervals of 3 months and at each visit, plasma testosterone (T) levels and the international index of erectile function (IIEF-EF) questionnaire scores were determined.Long-term treatment with finasteride therapy is associated with worsening of erectile dysfunction (ED) as shown by the significant decrease in the IIEF-EF scores in men treated with finasteride. No worsening of ED was observed in men treated with tamsulosin. The increase in ED due to finasteride did not resolve with continued treatment with finasteride. Most importantly, long-term finasteride therapy resulted in reduction in total T levels, contributing to a state of hypogonadism. On the contrary, no changes in T levels were noted in men treated with tamsolusin.Our findings suggest that in men with BPH, long-term finasteride therapy but not tamsulosin results in worsening of ED and reduces total T concentrations. Clinicians are urged to discuss the impact of 5α-RIs therapy on sexual function with their patients before commencing this therapy.

Long-term effectiveness and side effects of acetazolamide as adjunct to other antiepileptic drugs in treatment of refractory epilepsies

1994 ◽  
Vol 11 (2) ◽  
pp. 124-125
Author(s):  
Ken-ichi Abo ◽  
Hisao Miura ◽  
Sakae Takanashi ◽  
Hiroyuki Shirai ◽  
Wataru Sunaoshi ◽  
...  
Keyword(s):  
Side Effects ◽  
Antiepileptic Drugs
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