Current drug safety最新文献

Objective: Hypercalcemia allied with thiazide diuretics is a widely acknowledged clinical presentation. Hence, the purpose of this investigation was to ascertain the prevalence of hypercalcemia and hypercalcemia linked to thiazides and to evaluate serum phosphorous, 25- hydroxyvitamin D, and parathyroid hormone (PTH).

Methods: This prospective, cross-sectional research study involved all patients, including outpatients, and was conducted over a 12-month period. Between December 2017 and December 2018, an aggregate of 373 patients were enrolled. All patients with hypercalcemia (albumincorrected serum calcium > 10.8 mg/dL) had their medical information put on a proforma, together with the results of any tests (such as parathyroid hormone (PTH), 25-hydroxyvitamin D, and serum phosphorus).

Results: Out of 373 subjects, 7 (2%) were hypercalcemic. The mean corrected calcium levels in the normo-calcemic group were 9.46 ± 0.60 mg/dL (95% CI, 9.4 - 9.5), and that in the hypercalcemic group were 11.68 ± 0.82 mg/dL (95% CI, 10.9 - 12.4). Of the seven cases of hypercalcemia, 2 patients (28.6%) had thiazide-associated hypercalcemia (TAH) along with primary hyperparathyroidism (PHPT). Of the remaining 5 hypercalcemia patients, two more had PHPT, and one (14.3%) had hypervitaminosis D, whereas no cause was mentioned in the remaining 2 patients. Among the 4 PHPT patients, corrected calcium was slightly higher in those with TAH vs those without TAH, though the difference was statistically insignificant (11.32 ± 0.43 vs 11.14 ± 0.39 mg/dL; P > 0.7).

Conclusion: TAH is the second primary cause of asymptomatic hypercalcemia after PHPT. Thus, close coordination between the clinicians, pharmacology, pharmacovigilance, and the biochemistry department may help in identifying these cases.

Opioid Use Disorder (OUD) is defined by the persistent use of opioids despite adverse consequences. It is associated with increased mortality and a variety of mental and general medical comorbidities. Risk factors include younger age, male sex, lower educational attainment, lower income, and psychiatric disorders, such as other substance use disorders and mood disorders. Genetics also play a role in susceptibility to opioid use disorders. Long-term selfefficacy in opioid use for non-medical purposes suggests irreversible opioid use disorders. To evaluate the current understanding of opioid use disorders, the limitations in existing treatment approaches were examined, and strategies to improve outcomes through expanded treatment access and personalized care interventions were identified. An analysis was carried out regarding the role of existing pharmacological treatments, barriers within the care cascade, and potential advancements in healthcare delivery and innovation was carried out to address opioid use disorders. A comprehensive review of the literature was conducted by searching electronic databases (e.g., PubMed, Scopus) for articles published over the past 20-25 years. Relevant studies were selected based on predefined inclusion criteria, focusing on OUD risk factors, pharmacological treatments, barriers in the care cascade, and strategies for improving care. The selection process prioritized systematic reviews, clinical trials, and key guidelines. Although medications for opioid use disorders are effective, their impact is hindered by systemic issues at multiple levels of care. Addressing these challenges requires comprehensive efforts, including professional training, innovative treatments, and healthcare reforms to expand access and personalize care.

Introduction: Acute parotid gland enlargement is an extremely rare post-surgical complication. Several etiological factors have been proposed, including preoperative dehydration, medications that cause an increase in viscosity of glandular secretions or loss of muscle tone and retrograde passage of air into the parotid glands, prolonged surgery, and operative position of the patient leading to pooling of secretions of the gland.

Case representation: We present a series of two cases that developed bilateral enlargement of parotid glands post-operatively. Case 1 was a 30-year-old male who underwent a Trendelenburg operation with flush ligation and ligation of perforators for varicose veins of the right leg under spinal anaesthesia with bupivacaine. Fentanyl, midazolam, bupivacaine, and ondansetron were administered to the patient perioperatively. Case 2 was a 51-year-old female who underwent laparoscopic cholecystectomy for cholelithiasis under general anaesthesia. Fentanyl, midazolam, sevoflurane, and vecuronium were administered to this patient during the surgery. Both of these cases were managed conservatively by adequate hydration, antibiotics, and analgesics, and they recovered completely three days following the surgery.

Conclusion: The causative drug could not be well-established, but such cases stress that the surgeon, anesthetist, and patients should be aware of possibility of this adverse event. Postoperative anaesthesia mumps are usually of minimal clinical significance and resolve spontaneously with appropriate symptomatic care.

Docetaxel exhibits high protein binding and P450-mediated metabolism, which influences its pharmacokinetics. As a taxane-family chemotherapeutic agent, it stabilizes microtubules and disrupts cell division. Combining docetaxel with agents like 5-fluorouracil and oxaliplatin enhances treatment outcomes for colon cancer. Emerging drug delivery systems, including nanoparticles and micelles, aim to improve efficacy while reducing toxicity. However, its safety during pregnancy remains uncertain, and ongoing clinical trials continue to evaluate its therapeutic potential.

Background: In recent years, transdermal drug delivery systems (TDDS) have gained popularity as a non-invasive, patient-friendly medication delivery method.

Objective: This review article examines the latest transdermal medication delivery developments and breakthroughs. The review begins with a brief summary of transdermal medication administration, stressing the skin's barrier role and drug permeation methods. Novel materials and methods improve drug solubility, stability, and skin permeability in formulation technologies.

Methods: A literature review of the most recent innovations in TDDS, such as nano-based delivery systems, microneedles, and smart patches, was conducted. Major challenges of drug solubility, stability, and skin permeability were carefully discussed, along with the transdermal patch designs of new therapeutic applications in pain management, cardiovascular diseases, and hormone therapy.

Results: Transdermal medication delivery difficulties may be overcome via nano-based drug delivery systems, microneedle arrays, and smart patches. Furthermore, the paper discusses current advances in transdermal patch design for therapeutic applications, highlighting effective instances in pain management, cardiovascular illness, and hormone therapy.

Conclusion: The article examines transdermal medication delivery regulations, safety, and patient compliance in addition to technological advances. The complete study in this review seeks to help academics, doctors, and pharmaceutical professionals understand transdermal drug delivery and its future. Understanding recent advances in this field can help stakeholders design more effective and patient-friendly transdermal drug delivery systems, enhancing treatment outcomes and patient well-being.

Background: Rifampicin is a first-line anti-tuberculosis drug, but it may cause severe allergic adverse reactions.

Case presentation: This case report describes an unusual and severe adverse reaction to rifampicin in a 53-year-old male patient with pulmonary tuberculosis. The patient developed intense systemic pain within 4 hours of rifampicin administration, affecting multiple organs and joints, without typical allergic manifestations, such as fever or rash. The pain progressively worsened over three consecutive days of treatment, reaching its peak intensity (NRS score 8/10) on the third day with pain duration extending from 3 to 8 hours. The severe pain was characterized as sharp and burning in nature, significantly impacting the patient's daily activities and mobility. A subsequent rifampicin challenge test (single dose 0.45g) confirmed the causal relationship by reproducing identical severe pain symptoms. The Naranjo adverse drug reaction probability scale yielded a score of 7, indicating a "probable" causal relationship. Notably, the patient exhibited underlying autoimmune abnormalities (positive ANA and elevated ESR), which may have contributed to the severity of the reaction through enhanced inflammatory responses and altered pain mechanisms. The symptoms completely resolved upon rifampicin discontinuation, and alternative treatment with levofloxacin proved successful with no pain recurrence during the fourmonth follow-up period.

Conclusion: This case highlights a previously unreported presentation of rifampicin hypersensitivity and emphasizes the importance of careful risk assessment in patients with autoimmune features before initiating rifampicin therapy.

Pharmacovigilance is an important subject in medicine and healthcare, which aims to prevent side effects and other drug-related problems by identifying, evaluating, understanding, and avoiding them. Its main objectives are ensuring that a drug's benefits balance its hazards and improving patient safety. Within medicine and healthcare, pharmacovigilance is an essential subject that focuses on identifying, evaluating, comprehending, and preventing side effects or any other issues associated with drugs. Its main objective is to improve patient safety and ensure a drug's advantages exceed its drawbacks. Pharmacovigilance has evolved significantly as a result of technological advancements, enabling more efficient medication, safety monitoring, and management. The combination of machine learning (ML) with artificial intelligence (AI) for data analysis, adverse reaction prediction, and signal detection, electronic health records (EHRs), and mobile health (mHealth) applications have enhanced real-time data collecting and expedited the reporting of adverse drug reactions (ADRs). Pharmacovigilance plays an important role which focuses on detecting, assessing, comprehending, and averting adverse medication reactions. Making sure a drug's advantages outweigh its disadvantages is its main objective to improve patient safety. Pharmacovigilance, which balances patient safety, efficacy, and regulatory compliance in clinical trials, is necessary to promote the safe and effective use of drugs.

This review addresses the significant part pharmacological treatment plays in treating gestational diabetes mellitus (GDM), therefore enhancing the results for mother and child. Talking about the frequency and relevance of GDM would help to underline the need for good management. The pathophysiology presents a thorough examination of the fundamental processes, clarifying how hormonal changes seen during pregnancy lead to insulin resistance and raised blood sugar levels. The pharmacological treatment approaches for GDM, including insulin treatment and oral hypoglycemic medications, are investigated in this paper. Taking into consideration the hazards of generating birth deformities and safety data, the paper also evaluates the safety of the drugs in diabetes pregnancy in order to offer best treatment results. Moreover, the function of pharmacists in GDM highlights their significance in patient education, ensuring adherence to medication and overseeing therapy in collaboration with multidisciplinary teams. Furthermore, the impact of pharmaceutical care on maternal and neonatal outcomes demonstrates how pharmaceutical interventions can effectively reduce complications like preeclampsia and neonatal hypoglycemia, highlighting the importance of personalized medication management. Finally, the challenges and future directions of GDM address the difficulties in pharmaceutical care, including patient compliance, healthcare access and emerging treatment methods, calling for more research and policy initiatives to improve pharmaceutical care frameworks and enhance health outcomes for both mothers and infants. This comprehensive review highlights the need for integrated pharmaceutical care in managing GDM and its potential to improve health outcomes for both mothers and infants.

Background: Trimethoprim-Sulfamethoxazole (TMP-SMX) is a commonly used antibiotic for the treatment of several infections, such as urinary tract infections, respiratory infections, and in certain cases, septic arthritis. Rhabdomyolysis (RM) is very rare and less than 20 cases have been reported, so far, in the literature, in particular in immunocompromised patients. Here, we report a case of TMP-SMX-induced RM in an immunocompetent patient, adding to the limited data on this association.

Case presentation: A 53-year-old male patient with no prior medical history presented with septic arthritis and was initiated on TMP-SMX therapy. Within days, he developed muscle pain and weakness with laboratory tests revealing markedly elevated Creatine Kinase (CK) levels, consistent with rhabdomyolysis. Following the discontinuation of TMP-SMX, the patient's CK levels gradually decreased, and his symptoms resolved without further intervention.

Conclusion: To our knowledge, this is the sixth reported case of TMP-SMX-associated rhabdomyolysis in an immunocompetent patient. This case highlights the need for clinicians to consider the potential for rhabdomyolysis in patients receiving TMP-SMX, regardless of their immune status, and to recognize that prompt withdrawal of the drug is critical for patient recovery.

Background: Clomipramine, a Tricyclic Antidepressant (TCA), is known for its efficacy in treating Obsessive-compulsive Disorder (OCD). However, it is associated with several side effects, including urinary retention. This case report discusses the case of a 20-year-old male with OCD who developed urinary retention following clomipramine administration.

Case representation: A 20-year-old male with a one-year history of OCD with psychotic features was admitted to SIR-T Hospital, Bhavnagar, due to worsening symptoms. He was prescribed clomipramine along with other psychotropic medications. On the 16th day of hospitalization, the patient experienced acute urinary retention, necessitating catheterization. Clomipramine dosage was subsequently reduced, resulting in the resolution of urinary retention. The patient was discharged after 29 days with no further urinary complications.

Discussion: The causality assessment suggested a probable link between clomipramine and urinary retention, supported by the Naranjo Scale, WHO-UMC criteria, and literature. The anticholinergic properties of clomipramine likely contributed to the condition. Despite its side effects, clomipramine remains a valuable treatment for OCD, requiring careful dose management to mitigate adverse effects.

Conclusion: Clinicians should be vigilant for urinary retention in patients receiving clomipramine, especially at higher doses. Regular monitoring and dose adjustments are crucial for managing this side effect without compromising the therapeutic benefits for OCD.