scholarly journals Antimicrobial-induced cognitive side effects

2016 ◽  
Vol 6 (4) ◽  
pp. 207-214 ◽  
Author(s):  
Amanda Warstler ◽  
Jennifer Bean
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Time Frame ◽  
Drug Induced ◽  
Pubmed Search ◽  
Neuropsychiatric Side Effects ◽  
Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

Prevalence and Risk Factors Associated with First-Line Anti-Tuberculosis Induced Hepatotoxicity in Suratthani Hospital, Thailand

2021 ◽  
Vol 104 (2) ◽  
pp. 233-239
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Clinical Symptoms ◽  
Significant Risk ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
First Line ◽  
Drug Induced ◽  
Factors Associated ◽  
Drug Risk

ackground: Tuberculosis (TB) is a major public health problem, including Thailand. Anti-TB drugs are very effective treatment, but they can cause hepatotoxicity. Data on the prevalence of anti-TB drug-induced hepatotoxicity (DIH), as well as the contributing risk factors, are scarce in Thailand. Objective: To measure the prevalence and identify risk factors associated with first-line drugs (FLD) induced hepatoxicity in TB patients. Materials and Methods: The present study was a retrospective study design in TB clinic of Suratthani Hospital, in Southern Thailand. All patients diagnosed with TB and received FLD between January and December 2017, were eligible for the study. Hepatoxicity defined as the following criteria: serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels >5x upper limit of normal (ULN) without symptoms, or AST or ALT >3x ULN with clinical symptoms. Results: Of all the 198 TB cases, 18 were identified as DIH. Prevalence of DIH was 9.1%. Hepatitis after FLD was independently associated with age>60 years (adjusted OR [aOR] 28.49, 95% CI 2.68 to 302.95, p=0.005) and serum albumin <3.5 g/dL (aOR 20.97, 95% CI 2.11 to 208.51, p=0.009). Conclusion: Age of more than 60 years and low serum albumin of less than 3.5 g/dL were significant risk factors associated with first-line anti-TB drugs induced hepatoxicity. Keywords: Hepatoxicity, Anti-tuberculosis drug, Risk factor, Thailand

Clinical case: Gynecological side effects caused by methylphenidate

2017 ◽  
Vol 41 (S1) ◽  
pp. S430-S430
Author(s):  
A. Ballesteros ◽  
Á.S. Rosero ◽  
F. Inchausti ◽  
E. Manrique ◽  
H. Sáiz ◽  
...  
Keyword(s):  
Side Effects ◽  
Attention Deficit Disorder ◽  
Clinical Case ◽  
Case Reports ◽  
Treatment Plan ◽  
Complete Recovery ◽  
Current Evidence ◽  
Drug Discontinuation ◽  
Pubmed Search ◽  
Competing Interest

IntroductionMethylphenidate drugs is prescribed in attention deficit disorder and hyperactivity. Among its rare side effects, include alterations in the gynecological. We report a clinical case and review current evidence regarding the tolerability this drug in this area.MethodsWe performed a PubMed search of articles published in English of different types (case reports or case/controls studies). We collected the clinical practice guidelines conclusions regarding adverse drug reactions.Case presentationOur patient is a 14-year-old male diagnosed of ADHD treated with methylphenidate (0.8–1 mg\kg). He developed bilateral and asymmetric gynecomastia under this treatment plan so a referral was made to rule out other causes of this event. After performing several work up tests, it was concluded that this clinical presentation was caused by methylphenidate. Hence, we initiated crossed titration swapping this drug to atomoxetine. Four months later, he was mentally stable and he experimented a volumetric decrease as concerns his gynecomastia.As regards methylphenidate, in 2009 a couple of cases in which alterations in the sexual sphere presented with the oros presentation were reported. There are series of reported pharmacological side effects (gynecomastia) and also denoted an improvement of the same months after drug discontinuation.ConclusionsGynecological clinic secondary to the use of psychotropic drugs in ADHD is uncommon. In line with our case, the current evidence suggests a drug suspension as adverse effects are usually reversible (although it may take several months to complete recovery). Further studies are needed to understand the mechanisms underlying these tolerability issues.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical considerations of sleep related amnestic behaviours associated with zolpidem

2020 ◽  
Vol 36 (1) ◽  
pp. 23-31
Author(s):  
Agata M. Grzegorzewska ◽  
Jerzy J. Landowski ◽  
Wiesław J. Cubała
Keyword(s):  
Side Effects ◽  
Adverse Reactions ◽  
Case Reports ◽  
Anterograde Amnesia ◽  
Gaba A ◽  
Concurrent Use ◽  
Comprehensive Search ◽  
Insomnia Treatment ◽  
Dose Dependent ◽  
Neuropsychiatric Side Effects

Objective. Zolpidem is a non-benzodiazepine agonist of GABA-A receptor indicated for the short-term insomnia treatment. Over the years, there have been reports in literature on zolpidem abuse complications and neuropsychiatric side effects involving headache, dizziness, nightmares, confusion, depression, sleepiness, memory deficits as well as hallucinations, sensory distortions, delirium and sleep-related complex behaviours with anterograde amnesia. The aim of this work is to review and highlight the most serious adverse reactions to zolpidem with emphasis on sleep-related amnestic behaviours. We also focus our attention on common traits, patterns and predisposing factors. This paper refers to zolpidem side effects or complex amnestic behaviours, or sleep related amnestic behaviours presented in literature. Literature review. A comprehensive search of PubMed and Google Scholar was conducted to find relevant studies, case reports and literature reviews addressing the zolpidem use in insomniac patients. Conclusions. Zolpidem may pose a risk for serious adverse reactions most common dose-dependent and associated with age, gender, concurrent use of medications and concomitant comorbidities. If severe adverse reactions occur, the drug should be immediately discontinued or switched to another hypnotic. This review indicates an association between psychotic reactions and complex sleep related behavioural abnormalities in patients using zolpidem alone or in combination with other psychotropic medications. Clinicians should adopt a cautious approach prescribing zolpidem and be alert to possible unusual adverse effects of the drug.

Effect of integrated yoga on anti-psychotic induced side effects and cognitive functions in patients suffering from schizophrenia

2018 ◽  
Vol 16 (1) ◽  
Author(s):  
Meghnath Verma ◽  
Hemant Bhargav ◽  
Shivarama Varambally ◽  
Nagarathna Raghuram ◽  
Gangadhar BN
Keyword(s):  
Side Effects ◽  
Cognitive Functions ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Clinical Symptoms ◽  
Stable State ◽  
Preliminary Evidence ◽  
Relaxation Techniques ◽  
Anti Psychotic ◽  
Drug Induced

Abstract Background Twenty one (12 females) subjects, diagnosed with schizophrenia by a psychiatrist using ICD-10, in the ages 52.87 + 9.5 years and suffering since 24.0 ± 3.05 years were recruited into the study from a schizophrenia rehabilitation center in Bengaluru. Methods All subjects were taking anti-psychotic medications and were in stable state for more than a month. Psychiatric medications were kept constant during the study period. Assessments were done at three points of time: (1) baseline, (2) after one month of usual routine (pre) and (3) after five months of validated Integrated Yoga (IY) intervention (post). Validated 1 h Yoga module (consisting of asanas, pranayama, relaxation techniques and chantings) was practiced for 5 months, five sessions per week. Antipsychotic-induced side effects were assessed using Simpson Angus Scale (SAS) and Udvalg for Kliniske Undersogelser (UKU) side effect rating scale. Cognitive functions (using Trail making Test A and B), clinical symptoms and anthropometry were assessed as secondary variables. Comparisons between “pre” and “post” data was done using paired samples t-tests after subtracting baseline scores from them respectively. Results At the end of five months, significant reduction in drug-induced Parkinsonian symptoms (SAS score; p=0.001) and 38 items of UKU scale was observed along with significant improvement in processing speed, executive functions and negative symptoms of schizophrenia patients. No side effects of Yoga were reported. Conclusions The present study provides preliminary evidence for usefulness of Integrated Yoga intervention in managing anti-psychotic-induced side effects.

scholarly journals Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults’ Cognitive Function

2020 ◽  
Vol 32 (9) ◽  
pp. 1165-1177 ◽  
Author(s):  
Duy Do ◽  
Jason Schnittker
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Side Effects ◽  
Word Learning ◽  
Memory Loss ◽  
Digit Symbol ◽  
Digit Symbol Substitution ◽  
Symbol Substitution ◽  
Cognitive Side Effects

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects (“cognitive side effects” hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999–2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ ( N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall ( p = .02), digit symbol substitution ( p < .01), and the average standardized score of the three assessments ( p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.

scholarly journals Successful clozapine rechallenge in a patient with suspected drug induced lupus

2019 ◽  
Vol 12 (4) ◽  
pp. e228574 ◽  
Author(s):  
Suraj Pathak ◽  
Scott Cherry ◽  
Samreen Samad ◽  
Ambreen Aftab
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Effective Treatment ◽  
Case Reports ◽  
Suspected Drug ◽  
Drug Induced

Clozapine is the most effective treatment for patients with refractory schizophrenia. Clozapine is also associated with serious and potentially lethal side effects including drug induced lupus (DIL). There have been four previous published case reports describing clozapine inducing a lupus-like syndrome including one previous case where a clozapine rechallenge was attempted without success. This case report describes a successful clozapine rechallenge in a patient with suspected DIL.

scholarly journals Drug-Drug-Induced Akathisia: Two Case Reports

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Grace Owusu Aboagye ◽  
Daniel Ankrah
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Beta Blockers ◽  
Case Reports ◽  
First Episode ◽  
Extrapyramidal Side Effects ◽  
Drug Induced ◽  
Fluphenazine Decanoate ◽  
Probable Case ◽  
Psychotropic Medicines

Extrapyramidal side effects of psychotropic medicines are usually experienced by patients in the first few weeks of initiating therapy. Patients stabilized on these medications who present with distressing complaints akin to akathisia may be triggered by other factors. This report presents two cases of drug-drug-induced akathisia. Case A is a patient with schizophrenia who was being managed with risperidone 2 mg tablet daily for the past 3 years. She fell ill and reported to a nearby clinic where she was prescribed ciprofloxacin and artemether/lumefantrine tablets for the treatment of an infection and malaria. She presented 7 days later to her psychiatrist with complaints of restlessness, tremor, palpitations, insomnia, and resurgence of obsessive thoughts. Case B is a patient who was diagnosed with first-episode psychotic depression and admitted for 10 days. Her medications on admission were fluphenazine decanoate 25 mg depot injection once, olanzapine 10 mg tablet daily, and fluoxetine 20 mg capsule daily. On discharge, ciprofloxacin 500 mg tablet every 12 hours for 5 days and fluconazole 150 mg capsule once were added to her medications for the treatment of a urinary tract infection. She reported back to the hospital a day after discharge with complaints of restlessness, “seizures,” tremor, abdominal discomfort, and weight gain. Both patients were diagnosed with akathisia using ICD-10 classification and the Barnes akathisia rating scale and managed with anticholinergics, benzodiazepines, and beta blockers. Other measures employed in managing the akathisia included reducing the dose of the antipsychotic and/or switching antipsychotics. Despite these management measures, the symptoms of akathisia persisted and only resolved after 4weeks. Upon the resolution of symptoms, Case A continued treatment on olanzapine 5 mg tablet daily and fluoxetine 20 mg capsule daily while Case B continued treatment on risperidone 2 mg tablet daily and fluoxetine 20 mg capsule daily. Using Naranjo’s adverse drug reaction causality assessment scale, Medscape drug interaction checker, and literature review, a possible and probable case of drug-drug-induced akathisia was made for Case A and Case B. This report is to create more awareness about psychotropic-antimicrobial-induced akathisia. The information underpins the need for health professionals to consider adverse drug-drug interactions as the probable cause of extrapyramidal side effects experienced by patients on antipsychotics.

scholarly journals Risperidone induced pancytopenia: a case report

2021 ◽  
Vol 10 (8) ◽  
pp. 1016
Author(s):  
Nader M. Alrahili
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Case Reports ◽  
Internal Medicine Ward ◽  
Provisional Diagnosis ◽  
Drug Induced ◽  
First Case ◽  
Lymph Node Enlargement ◽  
Tract Infections ◽  
Irritable Mood

There are several case reports on hematological side effects after using antipsychotics in the literature. This case report could be the first case report of pancytopenia where laboratory work showed thrombocytopenia, lymphocytopenia, and neutropenia after using risperidone. It is about 14-year-old female presented with irritable mood and aggression started on Risperidone 0.75 mg every night. A few weeks later she developed frequent and recurrent urinary tract infections and heavy vaginal bleeding that lasted for 5 days and reoccurred twice in the same month. Patient was admitted to internal medicine ward to investigate the cause of bleeding. No signs of splenomegaly, hepatomegaly, or lymph node enlargement were observed. All immunological workup results were negative. Bone morrow showed normal cellularity with granulocytic hyperplasia, suggesting a peripheral cause that was most likely a drug-induced effect. A provisional diagnosis of drug-induced pancytopenia was established. These hematological side effects may make physician to be more careful while prescribing risperidone and to follow the guideline of regular lab work especially CBC.

Safety and Tolerability of the Anxiolytic and Nootropic Drug Phenibut: A Systematic Review of Clinical Trials and Case Reports

2020 ◽  
Vol 53 (05) ◽  
pp. 201-208 ◽  
Author(s):  
Einars Kupats ◽  
Jelena Vrublevska ◽  
Baiba Zvejniece ◽  
Edijs Vavers ◽  
Gundega Stelfa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Gabab Receptor ◽  
Case Reports ◽  
Safety Data ◽  
Cardiovascular Effects ◽  
Nootropic Drug ◽  
The One

AbstractPhenibut is a nootropic drug that exerts anxiolytic and antinociceptive effects by acting on the GABAB receptor and the α2-δ subunit of voltage-dependent calcium channels. An increased number of reports of dependence to and intoxication by phenibut purchased online on the one hand and the wide prescription of phenibut in Eastern Europe for more than half a century on the other hand have resulted in a number of controversies regarding its use. In this review, we have summarized currently available information from case reports of phenibut dependence and intoxication and safety data from clinical trials. We included 14 dependence and intoxication case reports (16 patients) and reviewed 11 phenibut clinical trials (583 patients). The clinical symptoms in the case reports included cardiovascular effects, insomnia, anxiety and agitation, hallucinations, and depressed level of consciousness. In addition, the doses used (0.5–100 g/day) were much higher than the recommended daily dose (0.25–2 g/day). An analysis of phenibut side effects described in the clinical trials showed adverse events in only 5.66% of patients, and the most reported side effect was somnolence (1.89%). There are discrepancies in the reported side effects of phenibut in clinical trials compared to those reported in cases of online-purchased phenibut dependence and intoxication. The current systematic review provides evidence that, at therapeutic doses, phenibut is safe and well tolerated with minor adverse effects, but questions regarding the quality of phenibut obtained online and the contribution of alcohol and other drug abuse to phenibut dependence and intoxication remain open.

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