scholarly journals Tacrolimus versus Cyclosporine- Comparative Evaluation as First line drug in Vernal keratoconjuctivitis

2018 ◽  
Vol 9 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Rashmi Kumari ◽  
Bhawesh Chandra Saha ◽  
Bibhuti Prasanna Sinha ◽  
Nilesh Mohan
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Comparative Study ◽  
Comparative Evaluation ◽  
Subjective Symptom ◽  
First Line ◽  
Symptom Scores ◽  
Double Blinded ◽  
Line Drug ◽  
Ocular Sign

Introduction: The aim of the study was to evaluate and compare the efficacy, side effects and recurrence rate of vernal kerato conjunctivitis (VKC) with 0.03% tacrolimus and 0.05% cyclosporin.Material and method: A prospective randomised double blinded comparative study was conducted at a tertiary eye center. 46 Patients of VKC between March 2015- August 2015 were randomly divided into two groups and treated for 6weeks with either Tacrolimus(0.03%) eye ointment BD or Cyclosporine (0.05%) eyedrops QID.The main outcome measures were scoring and comparison of Total subjective symptom scores (TSSS) and Total objective ocular sign scores (TOSS) within and between the Groups at each follow up.Thirty two patients, sixteen from each group, with comparable baseline characters were analysed.Results: With treatment both TSSS and TOSS decreased consistently in both groups without any adverse effects but an increase in scores was noticed within two weeks after drug withdrawal.Conclusion: Both drugs are equally effective and safe in VKC but with short lasting effect.

Elucidating the Potential Side Effects of Current Anti- Seizure Drugs for Epilepsy

2021 ◽  
Vol 19 ◽  
Author(s):  
Enes Akyüz ◽  
Mohd. Farooq Shaikh ◽  
Betül Köklü ◽  
Cansu Ozenen ◽  
Alina Arulsamy
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Effects ◽  
Side Effect ◽  
First Line ◽  
Epileptic Patients ◽  
Life Threatening ◽  
Visual Problems ◽  
Gaba Transmission

: Over the decades, various interventions have been developed and utilized to treat epilepsy. However, majority of epileptic patients are often first prescribed with anti-epileptic drugs (AED), now known as anti-seizure drugs (ASD), as a first line of defense to suppress their seizures and regain their quality of life. ASDs exert their anti-convulsant effects through various mechanisms of action including regulation of ion channels, blocking of glutamate-mediated stimulating neurotransmitter interaction, and enhancing the inhibitory GABA transmission. About one third of epileptic patients are often resistant to anti-convulsant drugs, while others develop numerous side effects which may lead to treatment discontinuation and further deterioration of quality of life. Common side effects of ASDs include headache, nausea and dizziness. However, more adverse effects such as auditory and visual problems, skin problems, liver dysfunction, pancreatitis and kidney disorders may also be witnessed. Some ASDs may even result in life-threatening conditions as well as serious abnormalities, especially in patients with comorbidities and in pregnant women. Nevertheless, some clinicians had observed a reduction in the development of side effects post individualized ASD treatment. This suggest that a careful and well-informed ASD recommendation to patients may be crucial for an effective and side-effect free control of their seizures. Therefore, this review aimed to elucidate the anticonvulsant effects of ASDs as well as their side effect profile, by discussing their mechanism of action and reported adverse effects based on clinical and preclinical studies, thereby providing clinicians with a greater understanding of the safety of current ASDs.

scholarly journals Methotrexate Toxicity: Molecular Mechanisms and Management

2021 ◽  
pp. 204-217
Author(s):  
Riyadh S. Almalki ◽  
Hala Eweis ◽  
Fatemah Kamal ◽  
Dina Kutbi
Keyword(s):  
Side Effects ◽  
Cancer Chemotherapy ◽  
Pulmonary Toxicity ◽  
Molecular Mechanisms ◽  
Hematological Toxicity ◽  
Comprehensive Understanding ◽  
First Line ◽  
Cutaneous Toxicity ◽  
Gi Toxicity ◽  
Line Drug

Methotrexate (MTX) is the most widely used drug in cancer chemotherapy and is considered to be the first-line drug for the treatment of a number of rheumatic and non-rheumatic disorders. The pulmonary toxicity, hepatotoxicity of MTX are two of its major side effects. Other toxicities such as endocrinological toxicity, GI toxicity, cutaneous toxicity, hematological toxicity, fatal malfunction or loss, and malignancy can also occur, but at a significantly lower rate of prevalence. This review aims to provide a comprehensive understanding of the molecular mechanisms of methotrexate toxic effects and Lastly, we discussed the management of this toxicity.

scholarly journals A Systematic Review on Lamotrigine Induced Skin Rashes

2021 ◽  
Vol 11 (1) ◽  
pp. 146-151
Author(s):  
T.T. Muhammed Anwar ◽  
P.P. Muhamed Faris ◽  
, Thansiha
Keyword(s):  
Adverse Effects ◽  
Adverse Reactions ◽  
First Line ◽  
Blurred Vision ◽  
Generalized Seizures ◽  
Anti Epileptic Drug ◽  
Generalized Epilepsy ◽  
Patients Experience ◽  
Paediatric Epilepsy ◽  
Line Drug

Lamotrigine is a newer anti-epileptic drug synthesised in 1980s and approved by USFDA in 1994. It is mainly used for treating paediatric epilepsy and one of the frequently prescribing newer anti- epileptic drugs in European countries. In English scenario, lamotrigine is suggested as monotherapy for recently identified partial seizures (localized seizure) in children as its first line drug. Lamotrigine is recommended for generalized seizures as second line drug and as add on therapy in intractable generalized epilepsy. It is a treatment option after sodium valproate and ethosuximide for petit-mal epilepsy. It can be used as either single or in combination with other anti-epileptic drugs. It has lot of adverse effects like other anti-epileptic drugs. Major adverse effect associated with lamotrigine is skin rashes in newly administered patients up to 8 weeks. About 3-10 % of the patients experience skin rashes in their therapy with lamotrigine. Lamotrigine doses should be titrated properly in combination with other anti-epileptic drugs especially with valproic acid. Other less common adverse effects with lamotrigine include dizziness, ataxia, blurred vision, headache, nausea and diplopia. Moreover, lamotrigine has a safe drug profile and effective in both children and adults for the treatment of various types of seizures. The dose escalation should be monitored regularly to avoid serious adverse reactions.

A case report of the efficacy and usefulness of asenapine in the treatment of a cancer patient with delirium and aphagia

2018 ◽  
Vol 17 (04) ◽  
pp. 488-491 ◽  
Author(s):  
Kyoko Osawa ◽  
Satoshi Ukai ◽  
Toshiyuki Kuriyama
Keyword(s):  
Palliative Care ◽  
Case Report ◽  
Drug Therapy ◽  
Side Effects ◽  
Cancer Patient ◽  
First Line ◽  
Sublingual Tablet ◽  
Oral Medications ◽  
End Stage ◽  
Line Drug

AbstractObjectiveControlling hyperactive and mixed delirium is extremely important for the continuation of cancer treatment in palliative care. In general, oral antipsychotics are the first-line drug therapy for delirium; however, oral administration is problematic in patients presenting dysphagia. In this case report, we describe an end-stage cancer patient with aphagia who developed delirium and responded to sublingual antipsychotic asenapine for treating delirium. We also discuss the effectiveness of asenapine in hyperactive delirium as well as its usefulness for treating delirium in palliative care.MethodA cancer patient with delirium was treated with several oral antipsychotics commonly used to treat delirium but did not respond to any of them. The patient subsequently developed aphagia with progression of the disease. Sublingual asenapine was therefore given to treat delirium.ResultAsenapine was effective in treating delirium without causing any obvious side effects.Significance of resultsIn the present case, asenapine was effective in treating hyperactive delirium that did not respond to commonly used antipsychotics. Because asenapine is a sublingual tablet, it can be used in patients with dysphagia and aphagia. In addition, this drug is anticipated to diminish the burden of end-stage patients from taking oral medications. Furthermore, its management is easier compared with injections, and can therefore also be easily used in homecare patients. Based on these perspectives, asenapine may become an important option for treating delirium in palliative care.

scholarly journals A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
pp. 263-267
Author(s):  
Sana Siddiq ◽  
Naila Asad ◽  
Abaid -ur- Rehman ◽  
Maqsood Ali ◽  
Hafiz M Usman Khalid ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Comparative Study ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Onset Time ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Group B

Background & Objective: The augmentation of local anesthetics with various adjuvants to enhance the quality and efficacy of subarachnoid block is clinically in practice since long. Comparative studies on effects of adding intrathecal tramadol and buprenorphine has never been studied before. Both drygs are esily available in our country. So, we conducted this study to evaluate and compare the characteristics of subarachnoid blockade, duration of postoperative analgesia, dose of recue analgesic postoperatively, and adverse effects of intrathecal buprenorphine (50 μg) and intrathecal tramadol (30 mg) as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries Methodology: This prospective randomized, single blind controlled trial was carried out at Services Hospital Lahore, from January to July 2018. 110 American society of Anesthesiologist I - II male patients, 35 to 45 y of age undergoing subarachnoid block for infra-umbilical surgery were randomized into two groups. Group T (n = 55) patients received 10 mg of 0.5% bupivacaine and 30 mg of tramadol intrathecally, while group B (n = 55) received 10 mg 0.5% bupivacaine with 50 μg of buprenorphine. Sensory testing was done by pin prick method using 25G blunt needle and time taken to reach T10 level noted. Motor block was assessed using Modified Bromage Scale. The time taken to reach modified Bromage 3 was recorded. Side effects and postoperative analgesia noted for 24 h by VAS score every 20 min for first 2 h in PACU and then 4 hourly for 24 h in the ward. Patients with inadequate block were converted into general anesthesia and were excluded from the study. Time to first rescue analgesia, and total analgesic required in 24 h were compared in two groups.Results: Mean VAS scores were less in Group T as compared to Group B. Significant difference was seen among groups at 45 min (p = 0.04), 60 min (p = 0.02), 75 min (p = 0.03), 90 min (p = 0.01), 120 min (p = 0.00), 4h (p = 0.007), 8 h (p = 0.01), 12 h (p = 0.01), 16 h (p = 0.00). After 24 h no significant difference was seen in both groups. Mean onset time for sensory block was earlier in Group B (2.4 min) compared to Group T (2.7 min)(p = 0.001). Mean onset time for motor block was earlier in Group B (4.8 min)as compared to Group T (5.5 min)(p = 0.00). No significant difference was seen among groups in side effects (p > 0.05). Mean time for rescue analgesia in Group B was earlier (4.51 ± 2.8 h.) as compared to Group T (4.94 ± 4.1h). Total dose of analgesic given in 24 h was significantly less in group T. (p = 0.004) The mean dose given in Group B (1.24 ± 0.96 mg/kg) was greater than Group T (0.76 ± 0.71 mg/kg)Conclusion: We conclude that both tramadol and buprenorphine, prolong the duration of postop analgesia without adding any adverse effects, but duration with tramadol is longer; it significantly reduces VAS and the dose of analgesic requirement in 24 h postoperatively.IRB letter No. IRB/2018/427/SIMS Citation: Siddiq S, Asad N, Rehman AU, Ali M, Khalid HMU, Butt Z. A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries. Anesth pain & intensiv care 2019;23(3):263-267

scholarly journals Transition from Methylphenidate to Atomoxetine: reasons for switching and clinical outcome

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S69-S70
Author(s):  
Fabrizia Cassar ◽  
Giovanni Grech ◽  
Bertha Grech ◽  
Joseph Cassar
Keyword(s):  
Side Effects ◽  
Clinical Outcome ◽  
Behavior Disorder ◽  
Clinical Excellence ◽  
First Line ◽  
Nice Guidelines ◽  
Hyperactivity Disorder ◽  
Study Results ◽  
Dose Recommendations ◽  
Line Drug

AimsAttention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder originating in childhood comprising of a constellation of features including inattention, impulsivity, and hyperactivity. The National Institute of Clinical Excellence (NICE) Guidelines 2018 recommends methylphenidate as a first line pharmacological agent for treatment of children aged 5 years and over with ADHD. Lisdexamfetamine, dexamfetamine and atomoxetine are recommended in this order if methylphenidate is not tolerated or if symptoms did not respond to separate 6-week trials. Our aim was to, assess the transition of methylphenidate to atomoxetine, the reasons for switching and its clinical outcome in order to make recommendations to current practice regarding treatment of ADHD.MethodThe study examined a total of 53 children between 0-16 years of age who were being treated for ADHD with atomoxetine at CYPS till September 2018. Data was collected from patients’ files retrospectively by using a proforma based on the NICE guidelines 2018 ADHD: diagnosis and management.ResultOut of 53 patients’ on atomoxetine in September 2018, 49 were included in the study. Results recorded side-effects as the main reason for switching from methylphenidate to atomoxetine. Unwanted side-effects were documented in 71.7% of patients of which 57.9% exhibited more than 1 side-effect with the two commonest side-effects documented being weight loss and decreased appetite. The audit highlighted the fact that the correct dose of atomoxetine was only administered in 17.2% of children with 56.9% of patient's being given a higher dose than recommended. Initial weight was not documented in 19% and hence, ideal dose could not be calculated. Overall, atomoxetine was shown to be an effective treatment. Out of the 40 patients documented to have hyperactivity this symptom was decreased in 82.5% whilst 82.9% were shown to have increased concentration. 35 patients had documented impulsivity and this was decreased in 62.9% of cases. 11 patients had documented anxiety with 72.7% being treated effectively with atomoxetine. 31% of patients’ had documented side-effects with 16% of these being tics. 20% of patient's required augmentation.ConclusionThe results indicate that the majority of doctors at CYPS in Malta adhered to the NICE guidelines 2018 and atomoxetine was proven to be efficacious as a second line drug in the treatment of ADHD. However, better adherence to NICE guidelines is required when it comes to the calculation of appropriate dosage. Our prediction is had dose recommendations according to weight been adhered to there may have been less side-effects documented.

scholarly journals Adverse Effects of Pharmacotherapy in Children with Enuresis: A Single Centre Experience

2018 ◽  
Vol 11 (4) ◽  
pp. 1749-1753
Author(s):  
Pietro Ferrara ◽  
Giulia Franceschini ◽  
Lucia Lo Scalzo ◽  
Francesca Ianniello ◽  
Antonio Chiaretti
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Adherence To Treatment ◽  
First Line ◽  
Single Centre ◽  
First Line Therapy ◽  
Line Therapy ◽  
Single Centre Experience ◽  
Pediatric Service ◽  
University Of Rome

To assess side effects of MELT monotherapy and MELT in association with oxybutynin in children suffering from nocturnal enuresis (NE). We enrolled 340 enuretic children admitted to our Pediatric Service, Campus Bio-Medico University of Rome, from April 2014 to April 2018; 23 children were excluded. The research was structured in 2 steps. During step 1, a patient’s medical history was carefully collected and physical assessment was performed. During step 2, after 3-month treatment period with MELT (Minirin/dDAVP®) at the dose of 120 mcg a day or MELT plus oxybutynin (Ditropan®), voiding calendar, adherence to treatment and any side effects were examined. The study was conducted in accordance with the Helsinki Declaration. Among 317 patients enrolled in the study, 18 male and 8 female (n=26; 26/317: 8.2%) children, with a mean age 10.86 ± 2.42 years, referred side effects: 13 cases (n=13, 13/26: 50%) treated with MELT monotherapy, 11 cases (n=11, 11/26: 42.3%) treated with MELT plus oxybutynin, 2 cases (n=2, 2/26: 7.7%) who received only oxybutynin. In our research, higher bioavailability of MELT guaranteed lower frequency of adverse effects with a spontaneous and rapid resolution. Several studies demonstrate that dDAVP is an effective and safe drug for NE and MELT formulation is actually considered for first-line therapy of NE, although further research is needed to endorse the observations of the authors.

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