Nortriptyline Cardiac Toxicity Resulting from a Probable Interaction with Telithromycin

2009 ◽  
Vol 44 (5) ◽  
pp. 397-400
Author(s):  
Angela R. Thomason ◽  
Bruce A. Waldrop ◽  
Sherry O. Price
Keyword(s):  
Adverse Effects ◽  
Cardiac Toxicity ◽  
Close Monitoring ◽  
Probability Scale ◽  
Case Summary ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
Interaction Probability ◽  
Probable Interaction ◽  
Reentry Tachycardia ◽  
New Onset

Objective To report a case of probable nortriptyline toxicity associated with a combination of telithromycin and nortriptyline. Case Summary A 50-year-old white woman was admitted to the hospital with new-onset palpitations after taking 5 days of telithromycin in combination with nortriptyline. On admission her electrocardiograph showed atrioventricular nodal reentry tachycardia. The patient was also hypotensive, with a blood pressure of 90/45 mm Hg. She had been taking nortriptyline 150 mg daily at bedtime for 10 years without complications. The final day of telithromycin therapy was completed, and nortriptyline was discontinued on admission. The tachycardia subsided with a dose of diltiazem. Discussion It is suspected that the cardiovascular symptoms observed in the patient are the result of nortriptyline toxicity caused by inhibition of CYP2D6 by telithromycin. Limited evidence shows that telithromycin may be an inhibitor of CYP2D6. An assessment of causation of the adverse effects using the Drug Interaction Probability Scale suggests a probable interaction between telithromycin and nortriptyline. Conclusion It is recommended that clinicians remain aware of possible interactions between telithromycin and known CYP2D6 substrates such as nortriptyline. Should telithromycin therapy be required, close monitoring of the potential adverse effects and/or plasma drug levels of patients taking interacting drugs is warranted.

Transient Elevation of International Normalized Ratio During Cisplatin-Based Chemotherapy in Patients Who are Taking Warfarin

2011 ◽  
Vol 45 (10) ◽  
pp. 1308-1308 ◽  
Author(s):  
Ryoichi Yano ◽  
Tetsuji Kurokawa ◽  
Hideaki Tsuyoshi ◽  
Akiko Shinagawa ◽  
Yoko Sawamura ◽  
...  
Keyword(s):  
International Normalized Ratio ◽  
Target Range ◽  
Probability Scale ◽  
Common Drug ◽  
Case Summary ◽  
The Common ◽  
Transient Elevation ◽  
Interaction Probability ◽  
Antineoplastic Chemotherapy ◽  
Probable Interaction

Objective: To report 2 cases of a probable interaction between cisplatin and warfarin. Case Summary: Two cases of transient elevation of international normalized ratio (INR) during Irinotecan (60 mg/m2 on days 1, 8, and 15) plus cisplatin (60 mg/m2 on day 1) chemotherapy with concomitant warfarin are presented. In both cases, warfarin dosages were stable at the therapeutic target range prior to initiation of chemotherapy. Granisetron hydrochloride (3 mg on days 1, 6, and 15) and dexamethasone (13.2 mg on day 1 and 6.6 mg on days 2, 3, 8, and 15) were used prior to irinotecan administration in both patients. In addition, aprepitant was administered to both patients for 3–5 days with cisplatin. One of these patients also received aprepitant with irinotecan on days 8 and 15. During chemotherapy, INR was transiently elevated almost 1.5-fold over baseline level on day 3. This variation did not occur in subsequent irinotecan cycles on days 8 and 15. The timing of these increases was similar in each of the cycles. Discussion: Cisplatin was the common drug in the cases presented and therefore could be related to the INR elevations. To our knowledge, these are the first reports of an Interaction between warfarin and irinotecan-cisplatin chemotherapy, but reports of a similar interaction with chemotherapy including platinum derivatives exist. Use of the Horn Drug Interaction Probability Scale indicated a probable interaction between warfarin and cisplatin. Conclusions: Cisplatin might affect the anticoagulation function of warfarin. Careful INR monitoring is necessary during antineoplastic chemotherapy with cisplatin in patients taking warfarin.

Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

2019 ◽  
Vol 33 (6) ◽  
pp. 915-918 ◽  
Author(s):  
Amy Hsu ◽  
Nathan A. Painter
Keyword(s):  
Case Reports ◽  
Middle Eastern ◽  
Signs And Symptoms ◽  
International Normalized Ratio ◽  
Cannabis Use ◽  
Bleeding Complications ◽  
Close Monitoring ◽  
Interaction Probability ◽  
Probable Interaction

Objective: To report a probable interaction between warfarin and edible cannabis that resulted in an elevated international normalized ratio (INR) without bleeding complications. Case Summary: A 35-year-old Middle Eastern male on warfarin long term with an INR goal of 2.5 (accepted range: 2.0-3.0). The patient has generally been stable on warfarin 10 mg daily from 2010 to 2018, until INR suddenly increased to 7.2 following 1 month of edible cannabis ingestion and cannabis smoking. Patient denied any signs and symptoms of bleeding. No other reasonable causes of the elevation in INR were apparent. The patient was advised to hold 2 doses of warfarin and discontinue cannabis use. The INR dropped below 4 upon discontinuation of cannabis with dose adjustments to warfarin. Discussion: The elevation in INR can be explained by the inhibition of CYP2C9 by cannabis use causing decreased metabolism of warfarin. The interaction between warfarin and cannabis was determined to be probable using the Horn Drug Interaction Probability Scale. Conclusions: There are no previous reports of interactions between edible cannabis and warfarin, with very few case reports describing the interaction with other forms of cannabis. Close monitoring of INR in patients with concomitant cannabis is recommended for proper warfarin management.

Pseudodementia Associated with Use of Ibuprofen

2003 ◽  
Vol 37 (1) ◽  
pp. 80-82 ◽  
Author(s):  
Allan L Bernstein ◽  
Ann Werlin
Keyword(s):  
Short Term Memory ◽  
Causality Assessment ◽  
Memory Loss ◽  
Probability Scale ◽  
Short Term ◽  
Naranjo Probability Scale ◽  
Case Summary ◽  
Dementing Illness ◽  
Pharmaceutical Agents ◽  
New Onset

OBJECTIVE To report a case of dementing syndrome resulting from ibuprofen use. CASE SUMMARY A 76-year-old white man with normal mental status became confused, was lost in familiar places, and showed short-term memory loss after beginning a therapeutic regimen of ibuprofen 600 mg 3 times daily for osteoarthritis in anticipation of embarking on a foreign trip. Symptoms of dementia began within 1 week after taking ibuprofen and resolved completely within 1 week after the ibuprofen regimen was stopped. This pattern was repeated 6 months later, when the patient again traveled abroad. Consistently before, during, and after these events, the patient took atenolol, clonidine, lisinopril, aspirin, vitamin C, lecithin, vitamin E, and multivitamins. DISCUSSION Using the Naranjo probability scale, we reasoned that the patient's dementia-like syndrome could be attributed to the use of ibuprofen because pseudodementia appeared after the suspected drug was administered, improved when the drug was discontinued, reappeared when the drug was readministered, had no apparent alternative cause, manifested similarly after each exposure to ibuprofen, and was confirmed by the family's observation after both episodes. Objective causality assessment revealed that the adverse drug reaction was probable. CONCLUSIONS Use of ibuprofen must be considered during clinical evaluation of any patient with new onset of dementing illness. The Naranjo probability scale may be clinically useful for evaluating other pharmaceutical agents that may be contributing to development of dementia-like conditions.

P6560Delayed ablation of atrioventricular nodal reentry tachycardia as a risk factor for future atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ferreira Fonseca ◽  
L Parreira ◽  
J Farinha ◽  
R Marinheiro ◽  
A Esteves ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Functional Changes ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
Reentry Tachycardia ◽  
New Onset

Abstract Introduction Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Most of the patients experience recurrent symptoms for years before electrocardiographic documentation and AVNRT ablation. The effects of these ongoing episodes of AVNRT on atrial structure and function, and their influence on new-onset atrial fibrillation (AF) in patients with delayed AVNRT ablation are unknown. Purpose To assess if delayed ablation of AVNRT was associated with the development of AF. Methods We retrospectively evaluated patients subjected to AVNRT ablation between 2009 and 2016. Patients with history of AF previous to ablation were excluded. We evaluated age at the time of AVNRT ablation, the presence of cardiovascular risk factors, left atrial (LA) dilatation and the presence of frequent premature atrial contractions (PACs) (by 24-hour holter monitoring, defined as >30/h). During follow-up we assessed the occurrence of sustained AF episodes and age at the time of the first AF episode. Results We studied 130 patients that underwent AVNRT ablation. Mean follow-up time was 75±27 months and seventeen patients (13%) had new-onset AF during follow-up. Patients who developed AF were more often males (35% vs. 22%, p=0,015), older at the time of AVNRT ablation (60±16 vs. 50±15, p=0,01), had a higher prevalence of hypertension (64% vs. 35%, p=0,03), diabetes mellitus (35% vs. 6%, p=0,02), LA dilation (41% vs. 7%, p=0,01) and frequent PACs (24% vs. 2%, p=0,03). In Univariable Cox regression analysis all these available variables were associated with AF occurrence during follow-up. However, in Multivariable Cox regression analysis, only age at the time of the ablation procedure was independently associated with AF occurrence (Table 1). Multivariable Analysis HR 95% CI P value Age at ablation 8.762 3.308–23.20 <0.001 Age at the time of the first AF episode 0.113 0.043–0.302 <0.001 LA dilation 0.408 0.113–1.472 0.171 Frequent PACs 1.016 0.156–6.611 0.987 Conclusion In this group of patients the occurrence of new-onset AF during follow-up was independently associated with delayed AVNRT ablation. These findings suggest that longer atrial exposure to AVNRT episodes before ablation may be associated with LA structural and functional changes leading to higher occurrence of AF.

Constipation, Polyuria, Polydipsia, and Edema Associated with Orlistat

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1168-1170 ◽  
Author(s):  
Kathleen A Packard ◽  
Richard L Wurdeman ◽  
Antonio P Reyes
Keyword(s):  
Adverse Effects ◽  
Adverse Reactions ◽  
Careful Consideration ◽  
Temporal Association ◽  
Probability Scale ◽  
Case Summary ◽  
Pedal Edema ◽  
Leg Edema ◽  
Event Based ◽  
Fecal Urgency

OBJECTIVE: To report the occurrence of a novel group of adverse effects associated with initiation and rechallenge of orlistat. CASE SUMMARY: A 42-year-old white woman developed symptoms of constipation, polyuria, polydipsia, and increased lower-leg edema after 2 weeks of treatment with orlistat 120 mg 3 × daily. The drug was discontinued for 4 days and the symptoms resolved. On reinstitution of the orlistat treatment, the symptoms reappeared within 2 days. Thereafter, the medication was permanently discontinued. DISCUSSION: Common gastrointestinal adverse reactions associated with orlistat use include fecal urgency and abdominal pain and discomfort. Pedal edema has also been reported to occur, although less frequently. No reports were discovered documenting the occurrence of constipation, polydipsia, and polyuria associated with the use of orlistat. Despite careful consideration of other possible causes of these symptoms, the temporal association between initiation, discontinuation, and rechallenge of orlistat and the patient's symptoms suggest a medication-related adverse event. Based on the Naranjo probability scale, the likelihood that orlistat was the cause of this cluster of adverse effects is possible. CONCLUSIONS: It is important for the healthcare provider to be aware of these adverse effects to promptly evaluate and differentiate between possible causes of similar reactions.

Topical Timolol for Infantile Haemangioma of the Orbit

2021 ◽  
Vol 238 (10) ◽  
pp. 1069-1076
Author(s):  
Göran Darius Hildebrand ◽  
Zuzana Sipkova
Keyword(s):  
Adverse Effects ◽  
Beta Blockers ◽  
Close Monitoring ◽  
Line Treatment ◽  
Timolol Maleate ◽  
First Line ◽  
Benign Tumours ◽  
Meta Analyses ◽  
Oral Propranolol ◽  
First Line Treatment

AbstractInfantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

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