scholarly journals Adverse Oral Reactions Associated with Low Doses of Methotrexate

2020 ◽  
Vol 8 (4) ◽  
pp. 205-210
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
E. F. Gaysina ◽  
M. N. Dobrinskaya ◽  
V. M. Bakhtin ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Drug Withdrawal ◽  
Symptomatic Therapy ◽  
Oral Lesions ◽  
Low Doses ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Medical Specialties ◽  
Potential Development ◽  
Lichenoid Reactions ◽  
Drug Pharmacokinetics

Doctors of various medical specialties often encounter adverse drug reactions in their clinical practice. Methotrexate (MTX) can cause adverse reactions in the oral cavity, primarily erosions and ulcerations. The aim of the study was to analyse scientific literature on the prevalence, pathophysiological mechanisms, risk factors for oral lesions associated with low doses of MTX, their prevention and treatment. It was demonstrated that the most frequent oral adverse reactions associated with low doses of MTX are hard-to-heal painful necrotic and often irregularly shaped lesions of the oral mucosa (including aphthae and ulcers). The spectrum of histopathological changes ranges from nonspecific ulcerations to lichenoid reactions. Treatment of oral lesions induced by low doses of MTX consists in drug withdrawal or dose tapering. Folic acid and local symptomatic therapy can also be used, if necessary. Practitioners should be aware of the potential development of MTX-induced oral lesions, and specific aspects of the drug pharmacokinetics and pharmacodynamics in order to be able to ensure timely detection of adverse reactions and their effective treatment.

Patient-specific issues

2017 ◽  
Author(s):  
Philip Wiffen ◽  
Marc Mitchell ◽  
Melanie Snelling ◽  
Nicola Stoner
Keyword(s):  
Older People ◽  
Drug Users ◽  
Perioperative Period ◽  
Injecting Drug Users ◽  
Surgical Patients ◽  
Patient Specific ◽  
Dose Calculations ◽  
Pharmacokinetics And Pharmacodynamics ◽  
The Impact ◽  
Drug Pharmacokinetics

This chapter covers patient-specific issues related to children, older people, injecting drug users, and surgical patients. For children, drug pharmacokinetics and pharmacodynamics and dose calculations are reviewed. The specific concerns around adherence and also medicines licensing in children are covered. For older people, the topics include pharmacokinetics, pharmacokinetics, and medication review. Guidance is given on managing injecting drug users, especially in an in-patient setting, including a suggested regimen for titration of methadone to avoid opioid withdrawal. For surgical patients, the topics covered include management of regular medicines during the nil-by-mouth period, drug interactions with perioperative drugs, and a brief description of the impact of selected drugs in the perioperative period.

scholarly journals Postmarketing Safety Surveillance and Reevaluation of Danhong Injection: Clinical Study of 30888 Cases

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Xue-Lin Li ◽  
Jin-Fa Tang ◽  
Wei-Xia Li ◽  
Chun-Xiao Li ◽  
Tao Zhao ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Drug Withdrawal ◽  
Main Type ◽  
Cerebrovascular Diseases ◽  
Incidence Rates ◽  
Joint Disease ◽  
Severe Illness ◽  
Danhong Injection ◽  
Safety Surveillance ◽  
Clinical Emergency

Traditional Chinese medicine injections (TCMIs) have played an irreplaceable role for treating some clinical emergency, severe illness, and infectious diseases in China. In recent years, the incidence rates of adverse drug reactions (ADRs) of TCMIs have increased year by year. Danhong injection (DHI) is one representative TCMI comprised of Danshen and Honghua for treating cardiovascular and cerebrovascular diseases in clinic. In present study, the postmarketing safety surveillance and reevaluation of DHI were reported. Total 30888 patients in 37 hospitals from 6 provinces participated in the study. The results showed that the ADR incidence rate of DHI was 3.50‰. Seventeen kinds of new adverse reactions of DHI were found. The main type of ADRs of DHI was type A (including sweating, dizziness, headache, flushing, vasodilation, eye hemorrhage, faintness, chest pain, palpitations, breathlessness, anxious, nausea, flatulence, vomiting, hypotension, hypertension, local numbness, dyspnea, joint disease, and tinnitus) accounting for 57.75%. The severities of most ADRs of DHI were mild and moderate reactions accounting for 25.93% and 66.67%, respectively. The main disposition of ADRs of DHI was drug withdrawal and without any treatments. The results can provide basis for amendment and improvement of the instructions of DHI, as well as demonstration and reference for the postmarketing safety surveillance and reevaluation of other TCMIs. And the rationality, scientificity, and safety of clinical applications of TCMIs could be improved.

scholarly journals Treatment of ankylosing spondylitis during pregnancy

2021 ◽  
Vol 59 (3) ◽  
pp. 288-295
Author(s):  
O. A. Krichevskaya ◽  
T. V. Dubinina ◽  
E. V. Ilinykh ◽  
S. I. Glukhova ◽  
A. B. Demina
Keyword(s):  
New York ◽  
Ankylosing Spondylitis ◽  
Drug Withdrawal ◽  
Low Doses ◽  
Drug Of Choice ◽  
Tnf Α ◽  
Tnfα Inhibitors ◽  
Inflammatory Bowel ◽  
Inflammatory Drugs ◽  
Therapeutic Possibilities

Aims of the trial – to study the frequency of drug use in pregnant women with ankylosing spondylitis (AS), to determine the effect of discontinuation of drugs of various groups, as well as the dose of non-steroidal anti-inflammatory drugs (NSAIDs) used, on AS activity during gestation.Material and methods. 50 pregnancies in 49 patients with AS that met the modified New York criteria of 1984. The average age of the patients was 31.7±4.9 years, the duration of the disease was 134.4±85.8 months. The visits were conducted at 10–11, 20–21 and 31–32 weeks of gestation. The BASDAI in the month of conception and in the I, II and III trimesters of pregnancy was: 1.4 [0.6; 3.3], 2.3 [1.2; 4.4], 2.8 [1.4; 4.2] and 2.2 [1.6; 4.0], respectively. The total dose of NSAIDs was determined by the NSAID intake index (Dougados M., 2011).Results and discussion. NSAIDs. After inclusion in the study, the drug of choice was ibuprofen, which was canceled for all women not later than on 32 week of gestation. At the time of conception and in the first, second and third trim. NSAIDs were taken by 23 (46%), 20 (40%), 30 (60%) and 21 (43.8%) women, respectively. NSAIDs intake index in I trimester (5.8 [2.9; 11.8]) was lower than before pregnancy (28.6 [16.7; 50]) and in II (15.5 [4.7; 30.9]) and III trimesters (24.4 [9.5; 50]) (p<0.05). No relationship between the index of ibuprofen intake, as well as the fact of withdrawal of NSAIDs and AS activity throughout gestation was found. Sulfasalazine (SS) in correspondence with arthritis was taken 3 months before conception by 11 (22%) women, during pregnancy – by 6 (12%) women at a dose of 1.25±0.25 g. Withdrawal of SS was not associated with recurrence of arthritis. Glucocorticoids (GC) at a dose of 7.5±2.5 mg 3 months before pregnancy and in the I, II and III trimesters of pregnancy were taken by 1 (2%), 4 (8%), 8 (16%) and 10 (20.8%) women, of whom 1 patient had arthritis and 1 had inflammatory bowel disease. The rest of the patients received GC due to high AS activity due to axial manifestations and the unavailability of TNFα inhibitors. Against the background of taking GC, the AS activity did not decrease: BASDAI in the II and III trimesters was 5.5±0.6 and 5.8±1.3 (p>0.05). TNFα inhibitors: 3 months before pregnancy and in the trim. of pregnancy were taken by 11 (22%), 7 (14%), 6 (12%) and 2 (4.2%) patients. In those who canceled therapy (both independently and on the recommendation of a rheumatologist) on the eve of pregnancy, an increase in AS activity was noted; BASDAI in the month of conception and in I, II, III trimesters was: 2.7 [0.8; 3.5], 5.1 [3.1; 5.9], 5.5 [5; 6] and 6.7 [5.3; 7.3] (p<0.05) compared to the month of conception. Cancellation of TNF-α in the month of conception was a risk factor for high AS activity (BASDAI>4) in the II trimester (OR=30.4; 95% CI: 1.5–612.3; p=0.03) and in the III trimester (OR=32.7; 95% CI: 1.6–662.2; p=0.02).Conclusion. NSAIDs and GC in low doses do not reduce the activity of AS. Withdrawal of TNF-α inhibitors on the eve of pregnancy is a predictor of high AS activity. It is necessary to increase the knowledge of rheumatologists and patients about the therapeutic possibilities during pregnancy to avoid unjustified drug withdrawal.

Advanced Age as a Risk Factor of Drug-Induced Diseases

2021 ◽  
Vol 9 (1) ◽  
pp. 15-24
Author(s):  
D. A. Sychev ◽  
O. D. Ostroumova ◽  
A. P. Pereverzev ◽  
A. I. Kochetkov ◽  
T. M. Ostroumova ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Healthcare Professionals ◽  
Scientific Literature ◽  
Liver Volume ◽  
Natural Aging ◽  
Older Age ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Drug Induced ◽  
Age Related ◽  
Filtration Capacity

Some patients are more likely to have drug-induced diseases due to a number of risk factors, such as older age. The aim of the study was to analyse the effect of older age on pharmacokinetics and pharmacodynamics of medicines and the risk of developing drug-induced diseases. The analysis of scientific literature demonstrated that changes in the functions of body organs and systems caused by natural aging processes may potentially affect pharmacokinetics and pharmacodynamics of medicines and increase the risk of adverse drug reactions. For instance, older people have a decreased cardiac output both at rest and during exercise, weight loss, loss of elasticity of elastic vessels, a reduced number of functioning nephrons, poorer renal filtration capacity, decreased liver volume, a reduced number of functioning hepatocytes, decreased hepatic blood flow. These changes directly affect absorption, metabolism, distribution, and excretion of medicines, which in turn can affect their safety profiles. Consideration of age-related changes in the functions of body organs and systems, regular monitoring of the efficacy and safety of the prescribed medicine, changing the dosage regimen, and revision of the treatment sheet by healthcare professionals will help optimize pharmacotherapy and reduce the risk of adverse reactions and drug-induced diseases in older patients.

The effectiveness of UVB (311 nm emission) therapy and cyclosporine treatment in the patients with poor responsiveness to TNF-a blockers

2016 ◽  
Vol 15 (6) ◽  
pp. 310-314
Author(s):  
Dmitry Nikolaevich Serov ◽  
L. S Kruglova ◽  
E. N Ponich
Keyword(s):  
Adverse Reactions ◽  
Narrow Band ◽  
Combined Treatment ◽  
Severity Index ◽  
Tnf Alpha ◽  
Low Doses ◽  
Combined Approach ◽  
Alpha Blockers

The authors present data concerning the effectiveness of the application of UVB (311 nm emission) therapy and the treatment using low doses of cyclosporine in the patients receiving therapy with TNF-alpha blockers that resulted in the 50% reduction of the Psoriasis Area and Severity Index (PASI 50). The study has demonstrated that the introduction of narrow-band phototherapy into the combined treatment can make it possible to reach the PASI values of 75 and even 100%. Monitoring of the safety of the application of the combined approach has revealed the absence of early adverse reactions within 1 year after the treatment.

scholarly journals Gut Microbiome and Response to Cardiovascular Drugs

2019 ◽  
Vol 12 (9) ◽  
Author(s):  
Sony Tuteja ◽  
Jane F. Ferguson
Keyword(s):  
Gut Microbiome ◽  
Drug Response ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Antihypertensive Medications ◽  
Complex Interactions ◽  
Toxic Metabolites ◽  
Drug Pharmacokinetics ◽  
Metabolism Of Xenobiotics

The gut microbiome is emerging as an important contributor to both cardiovascular disease risk and metabolism of xenobiotics. Alterations in the intestinal microbiota are associated with atherosclerosis, dyslipidemia, hypertension, and heart failure. The microbiota have the ability to metabolize medications, which can results in altered drug pharmacokinetics and pharmacodynamics or formation of toxic metabolites which can interfere with drug response. Early evidence suggests that the gut microbiome modulates response to statins and antihypertensive medications. In this review, we will highlight mechanisms by which the gut microbiome facilitates the biotransformation of drugs and impacts pharmacological efficacy. A better understanding of the complex interactions of the gut microbiome, host factors, and response to medications will be important for the development of novel precision therapeutics for targeting CVD.

The next generation of machine learning in DDIs prediction

2021 ◽  
Vol 27 ◽  
Author(s):  
Wei Huang ◽  
Chunyan Li ◽  
Ying Ju ◽  
Yan Gao
Keyword(s):  
Drug Interactions ◽  
Adverse Reactions ◽  
Computational Method ◽  
New Drugs ◽  
Computational Techniques ◽  
Data Sets ◽  
Review Of The Literature ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Challenges And Opportunities ◽  
Drug Assays

: Drug-drug interactions may occur when to combine two or more drugs and may cause some adverse events such as Cardiotoxicity, Central neurotoxicity, Hepatotoxicity, etc. Although a large number of researchers who are proficient in pharmacokinetics and pharmacodynamics have been engaged in drug assays and trying to find out the side effects of all kinds of drug combinations. However, at the same time, the number of new drugs is increasing dramatically, and the drug assay is an expensive and time-consuming process. It is impossible to find all the adverse reactions through drug experiments. Therefore, new attempts have risen in using computational techniques to deal with this problem. In this review, we conduct a review of the literature on applying the computational method for predicting drug-drug interactions. We first briefly introduce the widely used data sets. After that, we elaborate on the existing state-of-art deep learning models for drug-drug interactions prediction. We also discussed the challenges and opportunities of applying the computational method in drug-drug interactions prediction.

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