Pharmacological Treatment of ADHD

2021 ◽  
pp. 132-145
Author(s):  
Prateek Yadav
Keyword(s):  
Side Effects ◽  
Pharmacological Treatment ◽  
Psychosocial Treatments ◽  
First Choice

The pharmacological treatment for ADHD has been researched well and we have efficacious drugs. Drugs are the mainstay of treatment particularly for over 6 years of age. There are two broad classes of drugs that are used in the treatment, psychostimulants and non-stimulants. Transcranial current stimulation and neurofeedback are other mechanisms that have been tried. There are various formulations and doses available for each and only certain drugs are available in India. The various guidelines broadly put stimulant Methylphenidate as the first choice and recommend early shift to a longer acting formulation. Treatment, various comorbidities, and side-effects of these drugs have to be kept in mind and dealt accordingly. Further psychosocial treatments should be used concurrently to improve the outcome.

scholarly journals The association between cannabis use and outcome in pharmacological treatment for opioid use disorder

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tea Rosic ◽  
Raveena Kapoor ◽  
Balpreet Panesar ◽  
Leen Naji ◽  
Darren B. Chai ◽  
...  
Keyword(s):  
Side Effects ◽  
Pharmacological Treatment ◽  
Addiction Treatment ◽  
Age Of Onset ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Self Report ◽  
Opioid Use ◽  
Differential Outcomes ◽  
Urine Drug

Abstract Background With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users. Methods Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: “What effect does marijuana have on your treatment?”. Results Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87–1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared  with occasional use (OR = 0.61, 95% CI 0.47–0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment. Conclusion Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

scholarly journals Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

2002 ◽  
pp. 1-11 ◽  
Author(s):  
SJ Bonnema ◽  
L Bartalena ◽  
AD Toft ◽  
L Hegedus
Keyword(s):  
Side Effects ◽  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Stimulating Hormone ◽  
Radioprotective Effect ◽  
Antithyroid Drugs ◽  
Favourable Effect ◽  
Glucocorticoid Treatment ◽  
Graves Ophthalmopathy ◽  
First Choice

In routine use for more than 50 years, radioiodine ((131)I) is generally considered safe and devoid of major side effects. Therefore, it is surprising that relatively many aspects of radioiodine therapy are controversial, as illustrated by recent international questionnaire studies. Our review aims at highlighting three of these areas - namely, the influence of (131)I on the course of Graves' ophthalmopathy, the possible radioprotective effects of antithyroid drugs, and the use of (131)I in large goitres. (131)I therapy carries a small (but definite) risk of causing progression of Graves' ophthalmopathy. Identification of risk factors (thyroid dysfunction, high level of thyroid-stimulating hormone (TSH) receptor antibodies, cigarette smoking) allows the identification of patients at risk and the institution of concomitant glucocorticoid treatment, thereby hindering progression of eye disease. On the basis, largely, of retrospective data, it appears that carbimazole (or methimazole), if stopped 3-5 days before treatment, does not influence the outcome of (131)I therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of (131)I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole. Surgery is the treatment of first choice in patients with a large goitre. However, in the case of patient ineligibility or preference, (131)I therapy may be an option. The treatment has a favourable effect on tracheal compression and inspiratory capacity, but the reduction in thyroid volume is only 30-40%. Inpatient treatment, necessitated by the large doses, makes the treatment cumbersome. Controversy related to radioiodine therapy is mainly based on the lack of adequate prospective randomised studies comparing efficacy, side effects, cost and patient satisfaction.

scholarly journals Photoepilation and skin photorejuvenation: an update

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Alessandro Martella ◽  
Mauro Raichi
Keyword(s):  
Side Effects ◽  
Vascular Malformations ◽  
Purchase Price ◽  
Aesthetic Dermatology ◽  
First Choice ◽  
Wide Range ◽  
Skin Conditions ◽  
Laser Devices ◽  
Skin Coverage ◽  
Comparative Trials

The effectiveness of intense pulsed light (IPL) and laser devices is widely accepted in aesthetic dermatology for unwanted hair removal and treatment of a variety of cutaneous conditions. Overall, most comparative trials have demonstrated similar effectiveness for IPL and laser devices. Literature studies alternatively favor the IPL and laser concepts, but the incidence of severe local pain and side effects were generally lower with IPL. IPL phototherapy, already established as a sound option in photoepilation and treatment of photoaging, hyperpigmentation and other skin conditions, is also considered first choice in the phototherapy of skin vascular malformations. When treating large areas, as often required in photoepilation and many aesthetic dermatology indications, IPL technologies show advantages over laser-based devices because of their high skin coverage rate. Compared to lasers, the wide range of selectable treatment settings, though a strong advantage of IPL, may also imply some more risk of local thermal side effects, but almost only in the hands of poorly trained operators. Overall, the strongest advantages of the IPL technologies are robust technology, versatility, lower purchase price, and the negligible risk of serious adverse effects in the hands of skilled and experienced operators.

A cross-sectional study on global disparities in information experiences of patients with lymphoma/CLL.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18517-e18517
Author(s):  
Olufunmilayo Bamigbola ◽  
Natalie Dren ◽  
Lorna Warwick
Keyword(s):  
Side Effects ◽  
Medical Information ◽  
Information Source ◽  
Treatment Options ◽  
Information Provision ◽  
Patient Advocacy ◽  
Patient Survey ◽  
Cross Sectional ◽  
Treatment Side Effects ◽  
First Choice

e18517 Background: Patient-centricity remains a cornerstone in the care of patients with lymphoma and CLL, as informed patients are consistently associated with better outcomes and experiences. This study uses the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL to describe the global differences in the top choices for medical information among patients with lymphoma, as well as differences in their understanding of this information relating to various aspects of their care. Methods: Globally, 9,179 patients from 89 countries took part in the LC 2020 GPS. The countries were grouped into regions, and the regions with greater than 200 patients were included in the analysis (Table). The demographics of the regions were examined, and descriptive analyses of questions relating to information source preferences, information provision at diagnosis (addressing treatment options; process and stages of care; managing treatment side effects), and corresponding levels of patient understanding were performed in IBM SPSS v27. Results: Doctors were the first choice for medical information for patients in each region (SA-82%, AS- 75%, EU-69%, OC-63%, NA-61%). In EU, NA and SA, websites were the most prevalent second and third choice for information (27% and 28%; 30% and 32%; 35% and 27%, respectively). In AS, patient advocacy organisations were the most prevalent second and third choices for information (32% and 40%, respectively), while in OC, the most prevalent second and third choices were nurses (27%) and patient advocacy groups (32%) respectively. Over a fifth of NA patients were not given information on the process and stages of care and how to manage side effects of treatment (21% and 29%, respectively). About a third of patients from SA (32%) reported not getting information on treatment options. Over half of OC patients reported being given information on and completely understanding the different treatment options (51%), processes and stages of care (53%) and how to manage treatment side-effects (58%). Patients from AS were the most prevalent in reporting across the three categories, that they were given information but did not understand it (10%, 7%, 5%, respectively). Conclusions: Globally, patients with lymphoma use various avenues to source the medical information they need, and they differ in their information experiences. Access to appropriate and adequate medical information remains an essential aspect of a successful patient experience and LC advocates that this information be contextual and accessible to all patients with lymphoma. [Table: see text]

Effcacy of quadruple therapy for the treatment of H. pylori infection at Gia Dinh people’s hospital

2021 ◽  
Vol 30 (4) ◽  
pp. 12-19
Author(s):  
Nguyen Thi Minh Thuan ◽  
Luong Thi Ha Vi
Keyword(s):  
Side Effects ◽  
Bacterial Infections ◽  
Cross Sectional Study ◽  
Consensus Conference ◽  
Total Rate ◽  
Cross Sectional ◽  
Quadruple Therapy ◽  
First Choice ◽  
H Pylori ◽  
Gastroenterology Unit

Helicobacter pylori (H. pylori) infection is one of the most common chronic bacterial infections in the world. For the purpose of eradicating H. pylori, quadruple therapies are widely prescribed in patients infected with H. pylori. According to the Maastricht V Consensus Conference, in regions where the rate of resistance of H. pylori to CLR and MTZ is high such as Viet Nam, bismuth quadruple therapy is the first choice. However, bismuth also causes many side efects. The aim of this study was to assess the effectiveness of quadruple therapies on H. pylori infection at Gia Dinh people’s hospital. Seventy-one patients aged 18 years old and older diagnosed with H. pylori infection at the Gastroenterology Unit of Gia Dinh People’s hospital were enrolled in this descriptive cross–sectional study. The efficacy and frequency of side effects of bismuth and non-bismuth quadruple therapies for H. pylori eradication were evaluated and the total rate of H. pylori eradication with both therapies was reported to be 70.4%. The success rate of bismuth quadruple therapy was 80.0%, significantly higher than that of non bismuth quadruple therapy (47.6%). Additionally, the frequency of side effects encountered by bismuth quadruple therapy was insignificantly higher than non-bismuth quadruple therapy (p > 0.05). In conclusion, the effectiveness of treatment with bismuth quadruple therapy was higher than that with non-bismuth quadruple therapy.

CYP450 Enzymes Genetic Polymorphism Influence on Treatment of Affective Disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S167-S168 ◽  
Author(s):  
A. Lengvenytė ◽  
R. Strumila ◽  
E. Dlugauskas ◽  
A. Utkus
Keyword(s):  
Genetic Polymorphism ◽  
Side Effects ◽  
University Hospital ◽  
Substantial Part ◽  
Pharmacogenetic Testing ◽  
Unsuccessful Treatment ◽  
First Choice ◽  
Vilnius University ◽  
Competing Interest ◽  
Intermediate Metabolizer

IntroductionIndividualized treatment decisions in psychiatry may be important, since substantial part of first choice drugs are ineffective or cause side effects. Polymorphic variants of genes that code CYP450 enzymes cause differences in their activity and therefore in efficacy and safety of drugs that are metabolized by them.Aim of the studyDetermine whether pharmacogenetic testing of CYP2D6, CYP2C19 and CYP2C9 polymorphism would have had influence on selected patients’ treatment courses.MethodsFive patients that were diagnosed for treament-resistant mood disorders in Vilnius university hospital Santariskiu clinics centre of neurology, department of psychiatry were invited to give blood samples for genetic testing retrospectively. Patients’ CYP2C19, CYP2D6 and CYP2C9 enzymes genetic polymorphism results were compared with previous empirical pharmacological treatment courses of these patients.ResultsIn four out of five cases significant polymorphism of CYP2C19 enzyme allele was detected. In all of these cases 1*/2* variant, that conditions intermediate metabolizer phenotype, was identified. Alterations in CYP2D6 and CYP2C19 regions were not found. In three cases the presence of varied genetic variant could have been clinically relevant. In two of these cases Sertraline and valproates, that are both metabolized by CYP2C19 enzyme, were taken by patients and side effects were observed. Unsuccessful treatment was repeated without effect, both in clinical and outpatient environment. Continuous rehospitalization took place until appropriate empirical treatments were established.ConclusionsPharmacogenetic testing could have had influence on treatment choices for three out of five selected patients leading to less side effects and rehospitalizations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effects of Intravenous Erythromycin Lactobionate in Respiratory Infections

1987 ◽  
Vol 15 (4) ◽  
pp. 245-250
Author(s):  
A. Di Sciacca ◽  
F. Durante ◽  
G. Cucchiara ◽  
A. Ingrassia ◽  
G. Mira ◽  
...  
Keyword(s):  
Side Effects ◽  
Respiratory Disease ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
High Plasma ◽  
Resistant Bacteria ◽  
Gram Positive Bacteria ◽  
Pharmacological Interactions ◽  
First Choice ◽  
Erythromycin Lactobionate

The antibiotic erythromycin lactobionate given intravenously acts almost exclusively on Gram-positive bacteria. Even at high plasma and tissue concentrations there is an almost total absence of side-effects. It could be considered, therefore, as first choice in the treatment of patients with infectious respiratory diseases. Most of the 40 patients admitted to the present study were elderly and all had either acute or chronic and becoming acute respiratory disease. Their clinical symptoms and levels of phlogosis improved on treatment with erythromycin lactobionate without any interruption of therapy due to side-effects and toxicity. The absence of unfavourable pharmacological interactions further enhances the usefulness of the drug. In view of the excellent response to monotherapy with erythromycin lactobionate and the few groups of resistant bacteria found in those cases when it was possible to check, it was not considered necessary to investigate any synergistic association with other antibiotics. It can be concluded, therefore, that therapy with erythromycin lactobionate in patients with infective respiratory disease is favourable and patients show excellent tolerability.

Rare MEFV variants are not associated with risk to develop multiple sclerosis and severity of disease

2013 ◽  
Vol 19 (9) ◽  
pp. 1132-1136 ◽  
Author(s):  
Ine Pauwels ◽  
Leentje Cosemans ◽  
Steven Boonen ◽  
Bénédicte Dubois ◽  
An Goris
Keyword(s):  
Multiple Sclerosis ◽  
Side Effects ◽  
Disease Severity ◽  
Rare Variants ◽  
Mefv Gene ◽  
P Value ◽  
Inflammatory Disorder ◽  
First Choice ◽  
Mediterranean Fever ◽  
Systemic Side Effects

Background: Recent studies suggest an association between rare variants in Mediterranean fever (MEFV), the gene underlying the auto-inflammatory disorder Familial Mediterranean Fever (FMF), the risk to develop multiple sclerosis (MS) and severity of MS. Objective: The objective of this study is to investigate these findings in a Belgian MS population and to test for association with additional clinical parameters such as treatment response. Methods: MEFV was sequenced in a cohort of MS patients ( N=94) suffering from auto-inflammatory symptoms, systemic side-effects upon interferon-beta (IFN-β) treatment, or patients in whom glatiramer acetate was started as first choice due to severe fatigue. Five rare non-synonymous variants were detected in this cohort and subsequently genotyped in 915 MS patients and 763 healthy controls. Results: We observed no association between these alleles and susceptibility to MS ( p-value=0.99) or disease severity ( p-value=0.78). However, we did observe a correlation between carrying an MEFV variant and the development of systemic side-effects upon IFN-β treatment ( p-value=0.022). Conclusion: In contrast to recent smaller studies, we did not find an association between carrying a rare variant in the MEFV gene and the risk to develop MS or disease severity. However, carrying rare variants in MEFV was associated with the development of severe systemic side-effects upon IFN-β treatment.

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