Non hemorrhagic pericardial effusion from ibrutinib İn a patient without comorbidities

Introduction The most common kind of leukemia in adults is chronic lymphocytic leukemia (CLL). CLL is treated with ibrutinib. During the course of ibrutinib therapy, bleeding and cardiac arrhythmias may occur. Non-hemorrhagic adverse events are extremely infrequent in individuals using ibrutinib. Case report A 64 year-old man was diagnosed with CLL in June 2016. He was treated with 6 courses of FCR, he stayed in remission for 3 years and then relapsed. He achieved partial remission after two months of therapy with ibrutinib. The patient was admitted to the hospital with fever and shortness of breath. Pericardial tamponade and effusion was diagnosed during his evaluation. Management & outcome Non-hemorrhagic exudative effusion was drained by pericardiocentesis and a pericardial catheter was inserted to drain pericardial effusion. In all pleural and pericardial effusion samples, pathological and flow cytometric examination revealed no atypical malignant cells for malignancy, including CLL. Infections, both bacterial and viral, were also undetectable in the samples, as were rheumatological markers of collagen vascular disease. Ibrutinib therapy was discontinued. The pericardial effusion and tamponade were linked to ibrutinib treatment after evaluating the adverse drug reaction probability scale with a total score of 6. Colchicine was administered to reduce the pericardial effusion. The catheter was removed; pericardial effusion did not reoccur during follow up visits. Discussion Serious adverse events of ibrutinib are seen when treating CLL patients. This group of individuals should be closely monitored for potentially serious complications such as pericardial effusion and cardiac tamponade.

Possible inhibitory effects of terbinafine on aripiprazole metabolism: Two case reports

Aripiprazole, an atypical antipsychotic, is a metabolic substrate for cytochrome P450 (CYP)3A4 and 2D6. Terbinafine, an antifungal agent used for onychomycosis, is a CYP2D6 inhibitor and could theoretically reduce the metabolism of aripiprazole. However, there are no published reports describing this interaction. We present 2 female patients hospitalized in a psychiatric unit who were both taking aripiprazole 15 mg daily and terbinafine 250 mg daily prior to admission. The first patient was a 58-year-old female who was prescribed aripiprazole and terbinafine concomitantly for approximately 5 months prior to admission. A commercial pharmacogenetic testing platform classified this patient as a normal metabolizer for CYP3A4 and 2D6. The first patient's serum trough aripiprazole concentration at steady-state concentration (Css) was 207.5 ng/mL. The second patient was a 43-year-old female who was taking aripiprazole and terbinafine concomitantly for approximately 2 weeks prior to admission who had a Css aripiprazole concentration of 278.9 ng/mL. Aripiprazole has a wide therapeutic range (100 to 350 ng/mL) and a reference dose-related drug concentration of 11.7 (mean) ± 5.6 (SD) ng/mL/mg/d. Our patients had Css aripiprazole concentrations 18% and 59% higher than guideline-supported dose-related drug concentrations. Through the use of therapeutic drug monitoring, pharmacogenetic data, electronic pharmaceutical claims data, and the Drug Interaction Probability Scale, we suggest terbinafine possibly increases aripiprazole concentrations 18% to 59%. Further reports are needed to confirm these findings prior to using this information in clinical practice.

ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry

Background Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients. Materials and methods Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram. Results Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%). Conclusions Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.

Acute lung toxicity by nitrofurantoin

Nitrofurantoin is a synthetic derivative of imidazolinedione, used to treat uncomplicated urinary tract infections. It acts by inhibiting bacterial DNA, RNA and cell wall protein synthesis. It is used prophylactically as a urinary anti-infective agent against most gram-positive organism and for long-term suppression of infections. Nitrofurantoin-associated pulmonary injuries occur in 1% of patients, presenting with dyspnoea and dry cough, and it can mimic interstitial lung disease. We present a case of an 81-year-old woman with shortness of breath and cough 3 days after initiation of nitrofurantoin. CT of the chest revealed bilateral pleural effusion and extensive pulmonary interstitial prominence, suggesting pulmonary fibrosis. According to the Naranjo Adverse Drug Reaction Probability Scale score of 6, it was determined that nitrofurantoin was the probable cause, and immediate cessation of the medication showed a marked clinical improvement and resolution after 10 days.

Self-medicated, satranidazole induced fixed drug eruption: a case report

Fixed drug eruption (FDE) is described as the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with re-exposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in addition to lighting up the older hyperpigmented lesions. Here we present an interesting case of satranidazole induced FDE with a past history of FDE to the same drug 5 months back. Since the eruption occurred in the same site on re-exposure to the same drug, a diagnosis of FDE was made and causality assessment by Naranjo adverse drug reaction probability scale showed a certain relationship between the cutaneous adverse reaction and the offending drug

Epileptic Convulsions Probably Induced by Desloratadine, a Second-Generation H1-Antihistamine

Second-generation H1-antihistamines are generally considered to be safe. Here we describe a healthy boy who developed left-arm convulsions after repeated exposure to a dry suspension of desloratadine combined with Huatengzi granules. The boy had no family or disease history of epilepsy, convulsions, or any other drug therapy. The Naranjo Adverse Drug Reaction Probability Scale was used to determine that the convulsions were probably related to desloratadine. Our findings suggest that desloratadine (a second-generation H1-antihistamine) can cause epileptic convulsions in healthy children, and so clinicians should be vigilant of the possibility of central side effects.

Rosuvastatin induced gynecomastia: a rare presentation of newer statin

Gynecomastia is a common benign disease characterized by the progressive enlargement of the glandular tissue of the male breast. The etiology may vary and may be physiological, pharmacological, pathological, or even idiopathic. Among men, drug induced gynecomastia may account for 10-20% of cases. Several case reports have associated this condition to the use of statins. However, there are few case reports of rosuvastatin induced gynecomastia have been reported in literature. We describe a 45-year-old male who developed bilateral gynecomastia after one month of rosuvastatin therapy, after switching to a different or less potent statin (atorvastatin), his symptoms resolved with-in one month. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient’s development of gynecomastia and rosuvastatin therapy.

Carbonation dysgeusia associated with topiramate

Purpose A case of carbonation dysgeusia associated with the use of topiramate is reported in order to bring awareness to a lesser-known adverse effect of the medication so that providers may be able to more effectively counsel patients and provide potential solutions. Summary A 39-year-old Caucasian woman with longstanding epilepsy was initiated on topiramate therapy after experiencing a generalized seizure (she reported not taking any antiepileptic medication for years). Topiramate was started at a dosage of 25 mg by mouth twice daily and after 3 weeks titrated to a dosage of 100 mg by mouth twice daily for maintenance therapy. After initiation of topiramate therapy, the patient began to experience an immediate change in her carbonation perception when drinking carbonated beverages; all carbonated beverages, including seltzer and beer, tasted “flat.” The patient remained on topiramate for the subsequent 12 months without her carbonation perception returning to normal but noted that drinking carbonated beverages through straws slightly mitigated the adverse effect. Case assessment using the adverse drug reaction probability scale of Naranjo et al indicated that topiramate was the probable cause of the patient’s carbonation taste perversion. Conclusion A 39-year-old Caucasian woman developed chronic carbonation dysgeusia after initiation of topiramate following a generalized seizure.

ANALYSIS OF ADVERSE DRUG EVENTS REPORTED AT PERIPHERAL ADR MONITORING CENTRE IN GUJARAT

Objective: Hospital-based ADR (Adverse drug reaction) monitoring and reporting programmes are useful for identifying and minimizing preventable ADRs and may enhance the ability of prescribers to manage ADRs more effectively. The objective of this study was to evaluate and analyze the spontaneously reported adverse drug events from various departments of Shree Krishna Hospital, Karamsad. Methods: This was a retrospective study and data was analyzed for adverse drug events reported during the period of April 2018 to March 2019 from various departments of Shree Krishna Hospital, Karamsad. Analysis was done on the basis of the demographic profile of patients, health care professionals who have reported and drugs causing ADRs, with their causality assessment using WHO probability scale. Results: Out of 36 patients, 20 (55.55%) were males and 16 (44.44%) were females. Antibiotics were the most common culprit group of drugs for reported ADRs in 21 patients. The number of ADRS related to the skin was 21 (58.33%) followed by GIT 11 (30.55%), cardiovascular 2(5.55%) and neuronal 2(5.55%). According to WHO causality assessment scale 01 (2.77%) of the suspected ADR was certain, 27(75%) were probable and 8 (22.22%) were possible. Conclusion: Our study concluded that the most commonly reported ADRs were dermatological reactions like itching and rashes. Antimicrobials were the most common drug group involved in causing ADRs. Even though there were continuous efforts for adverse drug event reporting awareness, still there is need to sensitize health care professionals to improve reporting.