-- Back to Table of ContentsStudy Objective. To compare the reported occurrence of liver failure in subjects in prospective trials with that in patients in retrospective reports after repeated use of therapeutic dosages of acetaminophen.
Design. Systematic review of the medical literature.
Data Source. MEDLINE and EMBASE biomedical and pharmacologic databases.
Subjects. Adults who received repeated dosing of acetaminophen 4 g/day or lower for at least 24 hours.
Measurements and Main Results. Articles written in several languages were abstracted by trained personnel using a structured abstraction form. Data were categorized by methodology (prospective vs retrospective), acetaminophen dosage, and type of liver effect. A total of 791 articles were identified, which included 30,865 subjects in prospective studies and 9337 patients in retrospective reports. The prospective studies reported no cases of fulminant hepatic injury, liver transplantation, or death due to acetaminophen. Of the 30,865 subjects in these studies, 129 (0.4%) were identified who had a serum aminotransferase level that exceeded the upper limit of normal, including 61 subjects in randomized trials in which the proportion of serum aminotransferase level increase was the same as or less than that in the placebo group and 68 subjects in trials without a placebo group. In addition, 4263 (13.8%) received the maximum recommended therapeutic dosage (3.9-4 g/day). In the retrospective reports, 96 patients (1.0%) had a serum alanine aminotransferase level that exceeded the upper limit of normal, one (0.01%) underwent liver transplantation, and six (0.06%) died. Causality relationship of acetaminophen for each retrospective case was assessed with the Naranjo adverse drug reaction probability scale. The mean ± SD Naranjo score for all 103 retrospective cases was 3.2 ± 1.9, indicating a possible relationship between the increased aminotransferase levels and acetaminophen use. Some retrospective reports contained information suggesting that the patient had ingested an overdose despite a history of therapeutic use.
Conclusion. Prospective studies indicated that repeated use of a true therapeutic acetaminophen dosage may slightly increase the level of serum aminotransferase activity, but hepatic failure or death was not reported. Retrospective reports indicated a higher rate of increased serum aminotransferase levels, and several reported associated liver injury and death. The differing results and presence of evidence indicating inaccurate acetaminophen dosage information in some case reports suggests that these cases may be inadvertent overdoses, rather than true therapeutic dosages.
Key Words: acetaminophen, acute liver failure, therapeutic dosage.
(Pharmacotherapy 2007;27(9):1219-1230)
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Study Objective. To determine the effect of S-albuterol on the dose response to levalbuterol in patients with moderate bronchoconstriction induced by a methacholine challenge.
Design. Prospective, randomized, double-blind, placebo-controlled, crossover study.
Setting. University-affiliated clinical trial center.
Patients. Twenty-two adults with mild, stable asthma.
Intervention. At the screening visit, patients were switched from their b2-agonist to ipratropium bromide for use as an as-needed rescue therapy. At the baseline visit 2-6 days later, the provocative concentration of metha-choline to induce a 30% decrease in forced expiratory volume in 1 second (FEV1 PC30) was determined, followed by a nebulized racemic albuterol dose-response study with three doses of albuterol, to familiarize patients with the procedures. At visits 2 and 3, patients were randomly assigned to receive nebulized normal saline placebo or S-albuterol 5 mg before the methacholine challenge and were administered three escalating doses of levalbuterol after the challenge.
Measurements and Main Results. Area under the curve for FEV1 over 40 minutes (AUC0-40) after administration of levalbuterol was the primary outcome, with slope of FEV1 as the secondary outcome. In addition, the fraction of exhaled nitric oxide (FeNO) was measured before and after the challenges. In the 17 patients who met criteria for completion, no delete-rious effect for S-albuterol was found for FEV1 PC30, AUC0-40 FEV1, or the FEV1 slope0-40. However, S-albuterol reduced the provocative concentration of methacholine to induce a 20% decrease in FEV1 (PC20 0.52 ± 2.06 vs 0.39 ± 1.58 mg/ml, placebo vs S-albuterol, p=0.044) but did not affect FeNO.
Conclusion. A single high dose of S-albuterol did not alter the bronchodilator response to levalbuterol. The effect on bronchial responsiveness requires further study.
Key Words: asthma, levalbuterol, S-albuterol, R-albuterol, methacholine-induced bronchoconstriction.
(Pharmacotherapy 2007;27(9):1231-1236)
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(Pharmacotherapy 2007;27(9):1237-1247) Purchase a secure PDF of this article | Purchase a printed copy of this articleStudy Objective. To determine the risk of bleeding and supratherapeutic international normalized ratios (INRs) associated with use of complementary and alternative medicine (CAM) in patients receiving warfarin.
Design. Prospective, longitudinal study.
Setting. An acute care, academic and research hospital in Canada.
Patients. A total of 171 adults who were prescribed warfarin anticoagulation therapy for an expected duration of at least 4 months after enrollment.
Intervention. Patients were asked to complete a 16-week diary by recording bleeding events and exposure to factors previously reported to increase the risk of bleeding and supratherapeutic INRs, including CAM consumption.
Measurements and Main Results. Prescription, medical, and laboratory records were reviewed. Risk factors for bleeding events and supratherapeutic INR (at least 0.5 units above the target range) were evaluated longitudinally by using generalized estimating equation (GEE) modeling. Of the 171 patients completing a diary, 87 (51%) reported at least one bleeding event and 36 (21%) had a supratherapeutic INR. Seventy-three patients (43%) indicated they had used at least one CAM product previously reported to interact with warfarin. Warfarin use of less than 3 months’ duration was the only statistically significant risk factor identified for supratherapeutic INR. The CAM therapies associated with an increased risk of self-reported bleeding included cayenne, ginger, willow bark, St. John’s wort, and coenzyme Q10. Use of more than one CAM while receiving warfarin was also a significant risk factor. Two CAMs were independently associated with an increased risk of self-reported bleeding: coenzyme Q10 (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.88-7.24) and ginger (OR 3.20, 95% CI 2.42-4.24). Other risk factors significantly associated with increased bleeding included high target INR (2.5-3.5), diarrhea, acetaminophen use, increased alcohol consumption, and increased age.
Conclusions. The use of CAM by patients receiving warfarin is common, and consumption of coenzyme Q10 or ginger appears to increase the risk of bleeding in this population.
Key Words: complementary and alternative medicine, CAM, warfarin, bleeding events, international normalized ratio, INR, adverse events, drug interactions, dietary interactions, risk factors.
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Study Objective. To determine whether lung transplant recipients would have a less vigorous T-cell response to hepatitis B surface antigen (HBsAg) than that of patients awaiting lung transplantation and healthy subjects, we sought to measure and compare T-cell responses among these three groups.
Design. Prospective study.
Setting. Lung transplant clinic at a university hospital.
Subjects. Twelve lung transplant recipients, 12 patients awaiting lung transplantation, and 15 healthy subjects. All participants had received the hepatitis B vaccine series and had a documented antibody response to it.
Intervention. Blood samples were obtained from each participant.
Measurements and Main Results. Participants’ sex, age, time since lung transplantation (if applicable), and time since hepatitis B immunization were recorded. Peripheral blood mononuclear cells were isolated from the participants’ blood samples for the trans vivo delayed-type hypersensitivity (DTH) assay. These cells were mixed with saline, tetanus toxoid, or HBsAg and injected into the footpads of immunodeficient mice. Resultant swelling of the footpad was used as an index of human T-cell response. The healthy subjects were younger than the patients in both transplant groups. However, we found no significant difference in DTH response elicited by HBsAg among the healthy subjects, patients awaiting lung transplantation, and lung transplant recipients (mean ± standard error [SE] 34.7 ± 4.3, 32.1 ± 3.1, and 33.5 ± 4.0 x 10-4 in., respectively, p>0.8) or when tetanus toxoid was used as a positive control (15.7 ± 2.8, 22.8 ± 6.5, and 21.7 ± 3.9 x 10-4 in., respectively, p>0.3). No correlation between age or time since immunization and DTH response was noted.
Conclusion. Lung transplant recipients maintained a T-cell response to HBsAg that was similar in vigor to that of both patients awaiting trans-plantation and healthy subjects even though their antibody concentrations waned rapidly after transplantation. The role of these T cells as a correlate of protection from infection remains to be investigated.
Key Words: lung transplantation, hepatitis B vaccine, T cell, vaccine response, antibody response, immunizations.
(Pharmacotherapy 2007;27(9):1248-1252)
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Study Objective. To evaluate the single- and multiple-dose pharmacokinetics of an oral extended-release formulation of guanfacine in children and adolescents with a diagnosis of attention-deficit-hyperactivity disorder (ADHD).
Design. Phase I-II, open-label, dose-escalation study.
Setting. Clinical study center.
Patients. Fourteen children (aged 6-12 yrs) and 14 adolescents (aged 13-17 yrs) with ADHD.
Intervention. All patients received guanfacine as a single 2-mg dose on day 1. They received a daily dose of 2 mg on days 9-15, 3 mg on days 16-22, and 4 mg on days 23-29.
Measurements and Main Results. Blood samples, vital signs, and electrocardiograms (ECGs) were obtained before dosing on day 1 and at intervals over 24 hours, with repeat measurements on days 14 and 28. Guanfacine demonstrated linear pharmacokinetics. Mean plasma concentrations, peak exposure (Cmax), and total or 24-hour exposure (area under the concentration-time curve [AUC]0-∞ or AUC0-24, respectively) were as follows in children and adolescents, respectively: after a single 2-mg dose, AUC0-∞ was 65.2 ± 23.9 ng•hour/ml and 47.3 ± 13.7 ng•hour/ml, and Cmax was 2.55 ± 1.03 ng/ml and 1.69 ± 0.43 ng/ml; after multiple 2-mg doses, AUC0-24 was 70.0 ± 28.3 ng•hour/ml and 48.2 ± 16.1 ng•hour/ml, and Cmax was 4.39 ± 1.66 ng/ml and 2.86 ± 0.77 ng/ml; and after multiple 4-mg doses, AUC0-24 was 162 ± 116 ng•hour/ml and 117 ± 28.4 ng•hour/ml, and Cmax was 10.1 ± 7.09 ng/ml and 7.01 ± 1.53 ng/ml. After a single 2-mg dose, half-life was 14.4 ± 2.39 hours in children and 17.9 ± 5.77 hours in adolescents. The most frequent treatment-emergent adverse events were somnolence, insomnia, headache, blurred vision, and altered mood. Most were mild to moderate in severity, with the highest frequency associated with the 4-mg doses. Blood pressure, pulse, and ECG readings were all within normal limits.
Conclusion. Guanfacine extended-release formulation demonstrated linear pharmacokinetics. Plasma concentrations and concentration-related pharmacokinetic parameters were higher in children than in adolescents. These differences are likely due to heavier body weights in adolescents and young male subjects. No serious adverse events were reported.
Key Words: attention-deficit-hyperactivity disorder, ADHD, guanfacine, SPD503, extended release, pharmacokinetics, children, adolescents, nonstimulant, stimulant.
(Pharmacotherapy 2007;27(9):1253-1262)
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Study Objective. To evaluate the effectiveness and safety of enoxaparin therapy in a neonatal intensive care unit (NICU).
Design. Retrospective chart review.
Setting. Level III NICU in a Canadian academic center.
Patients. All neonates treated with enoxaparin while in the NICU between January 1, 1998, and June 1, 2006.
Measurements and Main Results. Data abstracted included patient demographics, diagnosis of thrombosis and its progression, enoxaparin dosages with corresponding antifactor Xa levels, and adverse events. Sixteen neonates (four term, 12 preterm) were treated with enoxaparin at a mean ± SD initial subcutaneous dose of 1.41 ± 0.15 mg/kg every 12 hours. The target therapeutic range (antifactor Xa level 0.5-1.0 U/ml) was achieved by 12 infants at a mean ± SD dose of 1.92 ± 0.43 mg/kg every 12 hours, after a mean of 5.6 days (range 1-15 days). Preterm infants required a higher dose (per kilogram) compared with term infants to maintain therapeutic antifactor Xa levels (mean ± SD 1.94 ± 0.39 vs 1.65 ± 0.14 mg/kg every 12 hrs, p<0.001). Enoxaparin doses were more strongly correlated to antifactor Xa levels in term infants (r2=0.51, p<0.001) compared with preterm infants (r2=0.20, p<0.001). Ten (71%) of 14 thromboembolic events resolved, either partially or completely, at a mean of 39 days (range 8-61 days) of enoxaparin therapy. Nine infants (56%) experienced minor local adverse effects at the site of the indwelling subcutaneous catheter (induration, bruises, hematomas, or leakage). Systemic adverse events that were possibly related to enoxaparin therapy included osteopenia (one infant), scleral hemorrhage (one), and minor gastrointestinal tract bleeding (three) found in gastric feeding tubes. No adverse effects were associated with antifactor Xa levels greater than 1.0 U/ml.
Conclusion. Enoxaparin may be effective in the treatment of neonatal thrombosis. An initial dosage of 1.5 mg/kg every 12 hours is likely inadequate to obtain therapeutic antifactor Xa levels rapidly and differs for term and preterm neonates. Therapeutic levels in preterm infants may be more variable, and the pharmacokinetics of this drug in preterm infants requires further evaluation. Future studies in neonates should prospectively evaluate a higher starting dose of enoxaparin to document effectiveness, acceptance, compliance with treatment guidelines, and adverse effects.
Key Words: neonate, enoxaparin, thrombosis, neonatal intensive care unit, NICU, thromboembolism, anticoagulation, antifactor Xa.
(Pharmacotherapy 2007;27(9):1263-1271)
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Study Objectives. To determine if coadministration of polysaccharide iron complex and slow-release ferrous sulfate alter the absorption of mycophenolic acid (MPA), and to examine the potential influence of dosing relative to mycophenolate mofetil (MMF) administration and the effect of immediate- versus sustained-release iron products on the steady-state pharmacokinetics of MPA.
Design. Prospective, open-label, three-phase, crossover, steady-state pharmacokinetic study.
Setting. National Institutes of Health-sponsored General Clinical Research Center at a university medical center.
Patients. Twelve adult (mean age 50 yrs) renal transplant recipients who were receiving concomitant iron and MMF maintenance therapy.
Intervention. Oral iron therapy was coadministered with MMF on days -6-0, MMF was administered alone on days 1-8 (control phase), then oral iron therapy was administered 2 hours after MMF administration on days 9-16.
Measurements and Main Results. Baseline demographics, concurrent drug regimens, and clinical laboratory values were assessed. Blood samples were obtained at baseline and at 1, 2, 3, 4, 6, 8, and 12 hours after MMF administration on days 0, 8, and 16. The MPA levels were measured by high-performance liquid chromatography. We found no significant differences in the dose-standardized area under the concentration-time curve from 0-12 hours (AUC0-12) for MPA between the control phase (39.66 ± 8.70 mg•hr/L) and the concomitant ferrous sulfate or dose-separated ferrous sulfate (37.56 ± 9.95 or 32.84 ± 8.43 mg•hr/L, respectively, p>0.05) phases. Dose-standardized AUC0-12 values for MPA did not significantly differ after the concomitant administration of polysaccharide iron complex from that of the control phase (48.46 ± 9.68 and 43.80 ± 9.46 mg•hr/L, respectively, p=0.065). However, the AUC0-12 for MPA significantly increased when polysaccharide iron complex was administered 2 hours after MMF (53.41 ± 11.75 mg•hr/L, p=0.012). Maximum concentrations and times to reach maximum concentrations remained consistent across all study phases in each arm of the trial (p>0.05).
Conclusion. Multiple doses of iron therapy -- slow-release ferrous sulfate, or polysaccharide iron complex -- did not significantly reduce systemic exposure to MMF, as measured by using AUC0-12 values.
Key Words: mycophenolate mofetil, pharmacokinetics, renal transplantation, drug interactions, ferrous sulfate, polysaccharide iron complex.
(Pharmacotherapy 2007;27(9):1272-1278)
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The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most commonly prescribed agents for hypercholesterolemia and have revolutionized the management of hyperlipidemia and the area of cardiovascular risk reduction. However, recent data suggest that their effects go well beyond the lipid lowering seen with long-term use and may include acute antiinflammatory activity, anticoagulation, immunomodulation, as well as promotion of changes in smooth-muscle tone. Because of these data, promising research has begun into the use of these agents in various critical care areas such as the early phases of sepsis, bacteremia, and ischemic stroke. Recent data also show a decrease in cerebral vasospasm after subarachnoid hemorrhage, an area deficient in therapeutic options. More research is necessary to ascertain the true role of statins in the treatment of these various disorders. Nevertheless, the concept of a statin’s role as being only a routine preventive therapy with benefits limited to patients undergoing extended treatment is rapidly becoming inaccurate.
Key Words: statins, critical care, 3-hydroxy-3-methylglutaryl reductase inhibitors, HMG-CoA reductase inhibitors, sepsis, bacteremia, subarachnoid hemorrhage, stroke, pleiotropy.
(Pharmacotherapy 2007;27(9):1279-1296)
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Class III antiarrhythmic agents are used for conversion to and maintenance of sinus rhythm from arrhythmias of atrial or ventricular origin. Monotherapy can be limited by adverse events or recurrent arrhythmias. Sotalol, dofetilide, and ibutilide may induce torsade de pointes in 2-8% of patients, whereas amiodarone induces torsade de pointes in less than 1%. We reviewed the literature regarding the possible combination of class III antiarrhythmics and risk for inducing torsade de pointes. Animal studies using amiodarone plus sotalol or d-sotalol suggest that these drug combinations prolong the QTc interval but do not induce torsade de pointes. Similar data extracted from human studies of ibutilide in patients also receiving amiodarone or sotalol showed greater efficacy with combination therapy than with monotherapy, without increased torsade de pointes induction. Reduced transmural dispersion of repolarization with amiodarone and sotalol combination therapy may serve as a mechanism for reducing the risk of torsade de pointes compared with sotalol monotherapy.
Key Words: combination therapy, class III antiarrhythmics, transmural dispersion of repolarization.
(Pharmacotherapy 2007;27(9):1297-1305)
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Hospital antibiograms are commonly used to help guide empiric antimicrobial treatment and are an important component of detecting and monitoring trends in antimicrobial resistance. To serve these purposes, antibiograms must be constructed using standardized methods that allow inter- and intrahospital comparisons. Antibiograms that include surveillance cultures and duplicate bacterial isolates can overestimate rates of resistance. In 2002, the National Committee for Clinical Laboratory Standards (now known as the Clinical and Laboratory Standards Institute [CLSI]) published standards for constructing antibiograms. According to national surveys, many of the recommended elements of the CLSI document have not been fully adopted. In lieu of full compliance with CLSI standards, it is necessary that the methods used to construct antibiograms are clearly delineated. Antibiograms have several limitations, such as their inability to track emergence of resistance during therapy. The antibiogram can serve as a valuable tool in guiding antimicrobial therapy, but other patient factors, such as previous infection history and antibiotic use, also need to be considered. Additional data are needed for specialized applications of resistance analyses.
Key Words: antibiograms, susceptibility reporting, susceptibility testing, M39-A guideline.
(Pharmacotherapy 2007;27(9):1306-1312)
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Maltose, a disaccharide composed of two glucose molecules, is used in a number of biological preparations as a stabilizing agent or osmolality regulator. Icodextrin, which is converted to maltose, is present in a peritoneal dialysis solution. Galactose and xylose are found in some foods, herbs, and dietary supplements; they are also used in diagnostic tests. When some blood glucose monitoring systems are used -- specifically, those that use test strips containing the enzymes glucose dehydrogenase-pyrroloquinolinequinone or glucose dye oxidoreductase -- in patients receiving maltose, icodextrin, galactose, or xylose, interference of blood glucose levels can occur. Maltose, icodextrin, galactose, and xylose are misinterpreted as glucose, which can result in erroneously elevated serum glucose levels. This interference can result in the administration of insulin, which may lead to hypoglycemia. In severe cases of hypoglycemia, deaths have occurred. If patients are receiving maltose, icodextrin, galactose, or xylose, clinicians must review the package inserts of all test strips to determine the type of glucose monitoring system being used and to use only those systems whose tests strips contain glucose oxidase, glucose dehydrogenase-nicotinamide adenine dinucleotide, or glucose dehydrogenase-flavin adenine dinucleotide.
Key Words: maltose, maltose metabolism, galactose, xylose, icodextrin, blood glucose monitoring system, glucose dehydrogenase pyrroloquino-linequinone, glucose dye oxidoreductase, insulin, hypoglycemia.
(Pharmacotherapy 2007;27(9):1313-1321)
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The role of b-blockers in uncomplicated hypertension has been challenged recently. Compared with other antihypertensives, b-blockers are less effective for preventing cardiovascular events in patients with uncomplicated hypertension. Moreover, a recent meta-analysis of placebo-controlled clinical trials concluded that atenolol is not more efficacious than placebo for preventing cardiovascular events in patients with hypertension. Although these agents lower blood pressure measured conventionally over the brachial artery with a blood pressure cuff, they do not exert a commensurate effect on blood pressure in the central aorta. Central aortic blood pressure and aortic augmentation index are strong predictors of left ventricular hypertrophy, an independent risk factor for cardiovascular events. Emerging data are illuminating the antihypertensive paradox whereby antihypertensive agents may elicit discordant effects on central and peripheral blood pressure and hemodynamics. Vasodilatory antihypertensives, such as renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, elicit reductions in central aortic blood pressure equal to or greater than that in the brachial artery. Conversely, b-blockers lower central aortic blood pressure to a lesser degree even when blood pressure measured by sphygmomanometry is reduced substantially. Given the strong relationship between central aortic blood pressure and target organ damage, the effectiveness of b-blockers may be overestimated in practice on the basis of conventional blood pressure measurements alone. Differences in central and peripheral blood pressure may account for the lack of cardiovascular protection afforded by b-blockers in clinical trials and could account for a portion of the apparent “benefit beyond blood pressure” reduction with other classes of antihypertensive agents. Future studies should aim to better clarify the role of central aortic blood pressure in the treatment of hypertension. In the meantime, the effects of antihypertensive drugs on blood pressure “beyond the brachial blood pressure cuff” should be considered when prescribing antihypertensive agents for a patient.
Key Words: hypertension, b-blocker, blood pressure, cardiovascular disease.
(Pharmacotherapy 2007;27(9):1322-1333)
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Strong data are lacking on the cross-reactivity between individual carbapenems. We describe a 48-year-old woman with ventilator-associated Pseudomonas aeruginosa pneumonia who received an 8-day course of imipenem-cilastatin and experienced a delayed (i.e., nonimmediate) hypersensitivity reaction, evidenced by an extensive erythematous macular morbilliform rash and an increased eosinophil count. Eight days after completion of therapy, the pneumonia returned, and it was decided to avoid using imipenem-cilastatin; she was administered a 14-day course of meropenem. To our knowledge, this is the first report of a nonimmediate hypersensitivity reaction to imipenem-cilastatin without cross-reactivity to meropenem. This suggests that if carbapenem therapy is unavoidable, meropenem may be cautiously administered in patients with a known allergy to imipenem-cilastatin.
Key Words: antibacterial agents, adverse effects, drug hypersensitivity, b-lactams, carbapenems, meropenem, imipenem, cilastatin, skin tests, nonimmediate hypersensitivity.
(Pharmacotherapy 2007;27(9):1334-1338)
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Aripiprazole is a novel antipsychotic with a mechanism of action different from those of traditional first- and second-generation antipsychotics. We describe three patients with long histories of treatment for schizophrenia or schizoaffective disorder in whom conversion to aripiprazole was being attempted. After they started aripiprazole, their psychosis, agitation, anxiety, or aggression worsened. Although the cause of the increased agitation was unclear, it may have been related to long-term use of dopamine-blocking antipsychotics and resultant upregulation of postsynaptic dopamine receptors. The mechanism of partial dopamine agonism observed with aripiprazole may increase dopaminergic activity and worsen positive dopamine-associated symptoms, such as paranoia, agitation, and aggression. The treatment of schizophrenia is often a clinical challenge, particularly when patients have a long history of noncompliance and poor response. Clinicians face difficult decisions in finding an effective and well-tolerated regimen. These cases magnify some of the challenges and provide insight into the clinical implications of converting to therapies with different pharmacodynamic effects.
Key Words: aripiprazole, antipsychotics, agitation, aggression, schizophrenia, schizoaffective disorder, irritability, dopamine.
(Pharmacotherapy 2007;27(9):1339-1342)
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Drug-induced acute febrile neutrophilic dermatosis, or Sweet’s syndrome, is rare and, to our knowledge, has not previously been associated with clindamycin therapy. We describe a 47-year-old woman with type 2 diabetes mellitus and end-stage renal disease requiring hemodialysis who developed Sweet’s syndrome after receiving oral and intravenous clindamycin for a tooth infection. After the clindamycin was discontinued, the patient’s clinical symptoms resolved over several days. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient’s development of Sweet’s syndrome and clindamycin therapy. Clinicians should be aware that Sweet’s syndrome can occur with clindamycin treatment. Early recognition of this condition in conjunction with cessation of drug exposure, with or without antiinflammatory therapy, can produce complete recovery.
Key Words: clindamycin, Sweet’s syndrome, acute febrile neutrophilic dermatosis.
(Pharmacotherapy 2007;27(9):1343-1346)
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