Pub Date : 2024-02-28DOI: 10.1136/dtb.2023.245406rep
Krishna Raghu, Mary Judith Berry
{"title":"Acute liver failure secondary to therapeutic paracetamol dosing in an extremely preterm neonate.","authors":"Krishna Raghu, Mary Judith Berry","doi":"10.1136/dtb.2023.245406rep","DOIUrl":"10.1136/dtb.2023.245406rep","url":null,"abstract":"","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":" ","pages":"43-47"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Overview of: Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389:2221-32.
概述：Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. 塞马鲁肽与无糖尿病肥胖症患者的心血管后果。N Engl J Med 2023;389:2221-32.
{"title":"Effect of semaglutide on major cardiovascular events.","authors":"","doi":"10.1136/dtb.2024.000007","DOIUrl":"10.1136/dtb.2024.000007","url":null,"abstract":"<p><p><b>Overview of:</b> Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389:2221-32.</p>","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":" ","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Overview of: Li RHW, Lo SST, Gemzell-Danielsson K, et al. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial [correction appears in Lancet 2023;402:850]. Lancet 2023;402:851-8.
概述：Li RHW, Lo SST, Gemzell-Danielsson K, et al. 左炔诺孕酮加吡罗昔康口服紧急避孕药：随机双盲安慰剂对照试验[更正见《柳叶刀》2023;402:850]。柳叶刀 2023;402:851-8。
{"title":"Do COX-inhibitors improve emergency contraception efficacy?","authors":"","doi":"10.1136/dtb.2024.000011","DOIUrl":"10.1136/dtb.2024.000011","url":null,"abstract":"<p><p><b>Overview of:</b> Li RHW, Lo SST, Gemzell-Danielsson K, et al. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial [correction appears in <i>Lancet</i> 2023;402:850]. <i>Lancet</i> 2023;402:851-8.</p>","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":" ","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of type 2 diabetes has now been simplified by the understanding that the condition is caused by excess fat in the liver together with suppression of beta cell function by the associated excess liver export of fat. These factors can be reversed by substantial weight loss leading to remission in the early years after diagnosis, or at least major decrease in cardiovascular risks and improvement in glucose control for all. Weight loss by any means is successful, but it is most easily achieved by rapid action using a low or very low calorie diet of around 800 kcal/day followed by sustained modest restraint of dietary habits. Oral hypoglycaemic agents and one antihypertensive drug can be withdrawn on day 1 of the weight loss diet, raising the importance of appropriate deprescribing.
{"title":"Very low calorie diets and total diet replacement in type 2 diabetes: where are we now?","authors":"Roy Taylor","doi":"10.1136/dtb.2022.000055","DOIUrl":"10.1136/dtb.2022.000055","url":null,"abstract":"<p><p>Management of type 2 diabetes has now been simplified by the understanding that the condition is caused by excess fat in the liver together with suppression of beta cell function by the associated excess liver export of fat. These factors can be reversed by substantial weight loss leading to remission in the early years after diagnosis, or at least major decrease in cardiovascular risks and improvement in glucose control for all. Weight loss by any means is successful, but it is most easily achieved by rapid action using a low or very low calorie diet of around 800 kcal/day followed by sustained modest restraint of dietary habits. Oral hypoglycaemic agents and one antihypertensive drug can be withdrawn on day 1 of the weight loss diet, raising the importance of appropriate deprescribing.</p>","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":" ","pages":"39-42"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139711697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1136/dtb.2024.251119rep
Chaitanya Bhatt, Zainab Doleeb, Priya Bapat, Christian Pagnoux
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin. Nitrofurantoin is recommended by both the Canadian and American Urological Association as a first-line antibiotic for uncomplicated urinary tract infections (UTIs),1 even though it only exerts bactericidal effects in the urine when reacting with susceptible bacteria at therapeutic doses.2 As a commonly prescribed antibiotic, clinicians should be aware of its broad side effect profile. Nitrofurantoin is frequently associated with nausea, vomiting, diarrhoea and loss of appetite.2 It has also been associated with severe adverse events such as pulmonary toxicity, hepatotoxicity and peripheral neuropathy. Haemolytic anaemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency is another possible side effect, which may be easily overlooked, …
{"title":"Drug-induced haemolysis: another reason to be cautious with nitrofurantoin","authors":"Chaitanya Bhatt, Zainab Doleeb, Priya Bapat, Christian Pagnoux","doi":"10.1136/dtb.2024.251119rep","DOIUrl":"https://doi.org/10.1136/dtb.2024.251119rep","url":null,"abstract":"In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin. Nitrofurantoin is recommended by both the Canadian and American Urological Association as a first-line antibiotic for uncomplicated urinary tract infections (UTIs),1 even though it only exerts bactericidal effects in the urine when reacting with susceptible bacteria at therapeutic doses.2 As a commonly prescribed antibiotic, clinicians should be aware of its broad side effect profile. Nitrofurantoin is frequently associated with nausea, vomiting, diarrhoea and loss of appetite.2 It has also been associated with severe adverse events such as pulmonary toxicity, hepatotoxicity and peripheral neuropathy. Haemolytic anaemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency is another possible side effect, which may be easily overlooked, …","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Key learning points A UK coroner who concluded that the death of a patient was caused by a generally unknown interaction between warfarin and tramadol has asked NHS England to take action to prevent future deaths from such an interaction.1 A patient who had been prescribed warfarin for several years had her international normalised ratio (INR) monitored by …
{"title":"Tramadol-warfarin interaction","authors":"BMJ Publishing Group Ltd","doi":"10.1136/dtb.2024.000008","DOIUrl":"https://doi.org/10.1136/dtb.2024.000008","url":null,"abstract":"Key learning points A UK coroner who concluded that the death of a patient was caused by a generally unknown interaction between warfarin and tramadol has asked NHS England to take action to prevent future deaths from such an interaction.1 A patient who had been prescribed warfarin for several years had her international normalised ratio (INR) monitored by …","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":"170 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1136/dtb.2024.253505rep
Giovanni Cataletti, Fabrizio Santagata, Luca Pastorelli, Pier Maria Battezzati
Drug-induced liver injury (DILI) is the leading cause of acute liver failure in high-income countries. Acute cholestasis is one of the most common forms of hepatotoxicity induced by azathioprine. It usually begins during the first year of treatment, with most cases reported during the first month. We describe an uncommon case of DILI that occurred after 22 months of drug administration. A woman in her 50s was hospitalised because of jaundice and asthenia. She had been treated with azathioprine for myasthenia gravis during the last 2 years. Acute cholestatic injury was diagnosed. After ruling out most common causes of cholestasis, azathioprine was withdrawn and subsequent histological findings in liver biopsy were consistent with drug-induced cholestatic liver damage. After discontinuation of azathioprine, biochemical parameters progressively normalised and remarkable clinical improvement was achieved. With this report, we suggest that azathioprine should be considered among the causes of liver injury, despite long treatment duration. Drug-induced liver injury (DILI) is the most common cause of acute liver failure in high-income countries.1 Most cases are idiosyncratic and involve immune-mediated mechanisms which are independent of the dose used. In population-based studies, the incidence of DILI ranges between 13.9 and 19.1 cases per 100.000 people per year,1 a figure likely flawed by systematic under-reporting. Identification of the liable drug and its prompt discontinuation are critical to achieve patient recovery. Azathioprine is an immunosuppressive drug that works by inhibiting lymphocyte proliferation, thus limiting inflammatory and autoimmune responses. Azathioprine is a well-known cause of DILI, with an incidence of 1 case per 1103 users.2 Most cases of azathioprine-induced liver injury have been reported between the first month3 4 and the first year5–12 of treatment, while only a few cases of DILI have been described in long-term users of azathioprine.13 14 In the present …
{"title":"Severe azathioprine-induced liver injury 22 months after initiation of treatment","authors":"Giovanni Cataletti, Fabrizio Santagata, Luca Pastorelli, Pier Maria Battezzati","doi":"10.1136/dtb.2024.253505rep","DOIUrl":"https://doi.org/10.1136/dtb.2024.253505rep","url":null,"abstract":"Drug-induced liver injury (DILI) is the leading cause of acute liver failure in high-income countries. Acute cholestasis is one of the most common forms of hepatotoxicity induced by azathioprine. It usually begins during the first year of treatment, with most cases reported during the first month. We describe an uncommon case of DILI that occurred after 22 months of drug administration. A woman in her 50s was hospitalised because of jaundice and asthenia. She had been treated with azathioprine for myasthenia gravis during the last 2 years. Acute cholestatic injury was diagnosed. After ruling out most common causes of cholestasis, azathioprine was withdrawn and subsequent histological findings in liver biopsy were consistent with drug-induced cholestatic liver damage. After discontinuation of azathioprine, biochemical parameters progressively normalised and remarkable clinical improvement was achieved. With this report, we suggest that azathioprine should be considered among the causes of liver injury, despite long treatment duration. Drug-induced liver injury (DILI) is the most common cause of acute liver failure in high-income countries.1 Most cases are idiosyncratic and involve immune-mediated mechanisms which are independent of the dose used. In population-based studies, the incidence of DILI ranges between 13.9 and 19.1 cases per 100.000 people per year,1 a figure likely flawed by systematic under-reporting. Identification of the liable drug and its prompt discontinuation are critical to achieve patient recovery. Azathioprine is an immunosuppressive drug that works by inhibiting lymphocyte proliferation, thus limiting inflammatory and autoimmune responses. Azathioprine is a well-known cause of DILI, with an incidence of 1 case per 1103 users.2 Most cases of azathioprine-induced liver injury have been reported between the first month3 4 and the first year5–12 of treatment, while only a few cases of DILI have been described in long-term users of azathioprine.13 14 In the present …","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":"24 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.1136/dtb.2024.253547rep
Annalise Bellizzi, Elyse Mercieca, Catherine Dimech
In conjunction with BMJ Case Reports , DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We present a case of a young man who developed sudden deterioration in his physical and mental state whilst being treated as an inpatient for substance-induced psychosis. This deterioration was manifested by sudden disorientation, change in behaviour and visual hallucinations. It was only after excluding other potential causes that this presentation was attributed to the regular administration of procyclidine that was being used to counteract the extrapyramidal side effects from antipsychotics. The patient showed a dramatic improvement on stopping procyclidine. This case highlights the importance of awareness of rare adverse drug reactions and the resultant distressing effect for the patient himself. Antipsychotics are the mainstay of treatment of psychosis. They are well known for their extrapyramidal side effects (EPSEs) that greatly impact a patient’s well-being, including stiffness, tremor, difficulty eating and writing. Procyclidine is commonly prescribed to alleviate EPSEs. It does so by inhibiting the action of acetylcholine at the muscarinic receptor, hence minimising its excitatory effects.1 Reported side effects of procyclidine include most commonly drowsiness, dizziness, constipation, flushing, nausea, nervousness, blurred vision and dry mouth. Rarely, it is reported to cause abdominal pain, difficulty swallowing, urinary retention, weakness, chest pain, fainting, fever, tachycardia, arrhythmias, change in mental state (such as confusion, hallucinations, memory problems), mydriasis and visual changes.1 2 Being an anticholinergic, anticholinergic delirium is a possible, although rare, adverse effect of procyclidine. Following the use of Adverse Drug Reaction Probability Scale,3 this case report illustrates a probable procyclidine-induced delirium in …
{"title":"Delirium secondary to anticholinergics","authors":"Annalise Bellizzi, Elyse Mercieca, Catherine Dimech","doi":"10.1136/dtb.2024.253547rep","DOIUrl":"https://doi.org/10.1136/dtb.2024.253547rep","url":null,"abstract":"In conjunction with BMJ Case Reports , DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We present a case of a young man who developed sudden deterioration in his physical and mental state whilst being treated as an inpatient for substance-induced psychosis. This deterioration was manifested by sudden disorientation, change in behaviour and visual hallucinations. It was only after excluding other potential causes that this presentation was attributed to the regular administration of procyclidine that was being used to counteract the extrapyramidal side effects from antipsychotics. The patient showed a dramatic improvement on stopping procyclidine. This case highlights the importance of awareness of rare adverse drug reactions and the resultant distressing effect for the patient himself. Antipsychotics are the mainstay of treatment of psychosis. They are well known for their extrapyramidal side effects (EPSEs) that greatly impact a patient’s well-being, including stiffness, tremor, difficulty eating and writing. Procyclidine is commonly prescribed to alleviate EPSEs. It does so by inhibiting the action of acetylcholine at the muscarinic receptor, hence minimising its excitatory effects.1 Reported side effects of procyclidine include most commonly drowsiness, dizziness, constipation, flushing, nausea, nervousness, blurred vision and dry mouth. Rarely, it is reported to cause abdominal pain, difficulty swallowing, urinary retention, weakness, chest pain, fainting, fever, tachycardia, arrhythmias, change in mental state (such as confusion, hallucinations, memory problems), mydriasis and visual changes.1 2 Being an anticholinergic, anticholinergic delirium is a possible, although rare, adverse effect of procyclidine. Following the use of Adverse Drug Reaction Probability Scale,3 this case report illustrates a probable procyclidine-induced delirium in …","PeriodicalId":11277,"journal":{"name":"Drug and Therapeutics Bulletin","volume":"16 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139656133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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