bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venlafaxine and Bupropion Combination Therapy in a Case of Treatment-Resistant Depression
Authors: Fatemi S Hossein , Emamian Effat-S , Kist David A 
Published: March 2004

OBJECTIVE: To report the therapeutic efficacy of venlafaxine and bupropion in a patient with treatment-refractory major depression. CASE SUMMARY: A 21-year-old white woman with chronic and recurrent major depression presented with lack of response to several antidepressants. On examination, the patient exhibited neurovegetative signs of depression, guilt feelings, and suicidal ideation. The patient was administered venlafaxine 75 mg three times daily. The dose was titrated to 150 mg three times daily over the next month. Later bupropion was instituted up to 100 mg three times daily over a four-month period. The patient responded favorably to combination therapy and has remained free of depression for approximately 23 months. DISCUSSION: Venlafaxine and bupropion are antidepressant agents with unique pharmacologic profiles, each effective in the treatment of depression. Recent data indicate that combinations of selective serotonin-reuptake inhibitors and bupropion can convert partial response to full response in patients with treatment-resistant depression. We considered whether a combination of venlafaxine and bupropion would reduce the depressive symptoms of a patient who was unresponsive to various classes of psychotropic agents. Gradual administration of venlafaxine and bupropion acted synergistically to significantly reduce depressive symptoms (p < 0.002) and significantly increase social function (p < 0.002) over a period of eight months. CONCLUSIONS: To our knowledge this is the first report of successful combination therapy with venlafaxine and bupropion in treatment of chronic recurrent and refractory major depression.
Discontinuation Rates for Protease Inhibitor Regimens Containing Ritonavir 600 mg versus Ritonavir 400 mg Plus Saquinavir 400 mg
Authors: Rublein John C , Eron Joseph J , Butts John D , Raasch Ralph H 
Published: March 2004

OBJECTIVE: A retrospective study was performed to determine whether twice-daily ritonavir 400 mg plus twice-daily saquinavir 400 mg (ritonavir 400/saquinavir 400) was better tolerated than ritonavir 600 mg twice daily (ritonavir 600). A secondary objective was to determine whether the rate of discontinuation due to therapeutic failure differed between the two ritonavir regimens. DESIGN: The study was a retrospective chart review. Data collected included ritonavir dose; length of ritonavir therapy; reason for discontinuation; HIV-1 RNA prior to and at discontinuation of ritonavir therapy; CD4+ count; and antiretroviral therapy prior to, concomitant with, and initiated after ritonavir therapy. SETTING: Patient charts were reviewed in a university teaching hospital clinic. PATIENTS: Patients were identified through a search of the pharmacy database from December 18, 1995, to December 18, 1997. Patients were >18 years old, but not restricted by gender or race. MAIN OUTCOME MEASURES: The main outcome measures were frequency of discontinuation of ritonavir due to intolerance or due to lack of therapeutic efficacy. RESULTS: The search identified 116 patients, including 57 patients taking ritonavir 400/saquinavir 400 and 54 patients taking ritonavir 600. Five patients on other ritonavir regimens were excluded. Significantly fewer patients receiving ritonavir 400/saquinavir 400 (14%) discontinued ritonavir due to intolerance compared with ritonavir 600 (37%; p = 0.002). Discontinuations due to therapeutic failure were not significantly different: 8.8% for ritonavir 400/saquinavir 400 and 7.4% for ritonavir 600, despite the fact that ritonavir/saquinavir therapy followed another protease inhibitor in 41 patients (73.2%) compared with 12 patients (24.5%) for ritonavir 600 (p = 0.001). CONCLUSIONS: Ritonavir 400/saquinavir 400 is better tolerated than ritonavir 600.
Potential Fluconazole-Induced Carbamazepine Toxicity
Authors: Nair Dileep R , Morris Harold H 
Published: March 2004

OBJECTIVE: To report a case of carbamazepine toxicity resulting from a drug interaction with fluconazole, and to review the possible mechanisms of this interaction. DATA SOURCES: Medical record review. DATA SYNTHESIS: A 33-year-old white man with a history of mental retardation and seizures experienced stupor due to carbamazepine toxicity after fluconazole was initiated. The patient had been taking carbamazepine for several years and maintained stable therapeutic concentrations. He started fluconazole therapy after developing a rash presumably due to candidiasis. After admission to the hospital for carbamazepine toxicity, both fluconazole and carbamazepine were withheld and the patient returned to his normal baseline mental status once the carbamazepine concentration declined to a therapeutic range. Carbamazepine was restarted and the patient experienced no further adverse events. Carbamazepine is metabolized by the cytochrome P450 3A4 isoenzyme. Fluconazole is renally excreted but has been noted to inhibit CYP3A4. Fluconazole has also been noted to increase phenytoin concentrations. CONCLUSIONS: Fluconazole may cause carbamazepine toxicity presumably by inhibiting the cytochrome P450 3A4 isoenzyme.
Allergic-Type Reactions to Corticosteroids
Authors: Kamm Gayle L , Hagmeyer Kathleen O 
Published: March 2004

OBJECTIVE:To review reported cases of suspected allergic reactions to various corticosteroids.DATA SOURCES:A MEDLINE search (January 1966–December 1997) was performed to obtain case reports and review articles on allergic-type reactions to corticosteroids. Further references were obtained from these publications.STUDY SELECTION:Reports involving allergic or allergic-type reactions to systemic administration of corticosteroids were chosen for this review. An allergic-type reaction was defined as any reaction after administration of the drug that involved the appearance of adverse symptoms that are characteristic of unwanted immune responses. These symptoms include rash, sneezing, dyspnea, edema, bronchospasm, or death. Articles were excluded from the evaluation if they described reactions to topical, intraarticular, or ophthalmic corticosteroid administration.DATA SYNTHESIS:Corticosteroids are medications that are often used to treat allergic reactions. However, it appears that patients can also have allergic-type reactions to these agents. The severity of the reaction can vary from a rash to anaphylaxis or death. Both immediate and delayed reactions can occur. Allergic-type reactions are reported to occur more frequently in asthmatic and renal transplant patients than other patient populations. However, it is questionable whether all of these are true allergic responses, as there is conflicting evidence regarding the mechanism of the reaction. The most commonly implicated corticosteroids are methylprednisolone and hydrocortisone, but reactions have also occurred with others. Intradermal skin testing can help determine cross-sensitivity, although its value has not been conclusively demonstrated.CONCLUSIONS:Clinicians should be aware that allergic reactions to corticosteroids are possible. Worsening of symptoms may not always mean treatment failure, but may indicate an allergic reaction. High doses of corticosteroids (≥500 mg) should be given over 30–60 minutes, and patients should be observed after administration for at least the same time period. Asthmatics, renal transplant patients, and hemodynamically unstable patients may be at higher risk for adverse events. If a patient is found to be allergic to one corticosteroid, intradermal skin testing may help identify another corticosteroid that can be tolerated.
Marked Elevation of Serum Creatine Kinase Associated with Olanzapine Therapy
Authors: Marcus Esther-Lee , Vass Agnes , Zislin Joseph 
Published: March 2004

OBJECTIVE: To report a case of marked elevation of serum creatine kinase (CK) associated with olanzapine therapy. CASE SUMMARY: A 39-year-old white Jewish schizophrenic man treated with olanzapine developed an elevated serum CK concentration with a peak concentration of 4000 IU/L (normal <230). No other diagnostic criteria for neuroleptic malignant syndrome (NMS) were present. On discontinuation of the drug, serum CK concentrations returned to normal within eight days. DISCUSSION: Olanzapine, like other atypical antipsychotic drugs, may cause muscle injury with concomitant elevations of serum CK of muscle origin. We suggest that in patients treated with olanzapine, CK concentrations should be checked on initiation of therapy, within the first 48 hours, and weekly thereafter for at least one month. In addition, patients with clinical signs suggestive of NMS should be monitored more carefully. For those patients with a history of NMS, or even of isolated serum CK elevation during antipsychotic therapy, follow-up should be stricter. CONCLUSIONS: Marked elevation of serum CK may be a possible complication of olanzapine therapy.
Use of Nonprescription Medications by Patients with Congestive Heart Failure
Authors: Ackman Margaret L , Campbell Jeffrey B , Buzak Kimberly A , Tsuyuki Ross T , Montague Terrence J , Teo Koon K 
Published: March 2004

OBJECTIVE: To define the utilization pattern of nonprescription therapies in patients with congestive heart failure (CHF) and to compare this pattern with that of an age- and gender-matched control group without any self-reported heart conditions. DESIGN: Survey questionnaire completed by participants at home. SETTING: Ambulatory CHF clinic in a tertiary care hospital. SUBJECTS: Patients attending the clinic between July 1995 and May 1996 who agreed to participate. Control subjects were age- and gender-matched participants identified and approached by participating patients. OUTCOME MEASURES: Nonprescription therapies used at least once weekly. RESULTS: Completed questionnaires were received from 180 (75%) of the 239 patients who agreed to participate and from 133 controls. Mean age of responding patients was 69 years (63% men). Controls were younger, with a mean age of 64 years (63% men). The most commonly used nonprescription medication categories for both patients and controls, with no significant intergroup differences, were vitamins and minerals (59% patients, 50% controls), pain relievers (48% and 43%, respectively), herbal or health food products (38% and 38%), antacids (26% and 28%), and laxatives (24% and 21%). Significantly fewer patients than controls used cough and cold products (9% vs. 17%; p < 0.05), specifically oral decongestants (0.6% vs. 5%; p < 0.01), and more patients than controls used nutritional supplements (17% vs. 4%; p < 0.01). CONCLUSIONS: Overall, use of nonprescription therapies by our CHF clinic patients is similar to that of an age- and gender-matched population without a self-reported heart condition. The differences in medication use observed between patients and controls included cough and cold products that might be harmful. This likely reflects appropriate caution with which CHF patients approach nonprescription therapies.
Clozapine-Associated Neuroleptic Malignant Syndrome: Two New Cases and a Review of the Literature
Authors: Karagianis James L , Phillips Leslie C , Hogan Kevin P , LeDrew Kellie K 
Published: March 2004

BACKGROUND: Clozapine has recently been found to be associated with neuroleptic malignant syndrome (NMS). Our objective is to determine if clozapine causes NMS, if the presentation of clozapine-induced NMS differs from that of traditional agents, and which set of diagnostic criteria will most readily allow diagnosis of NMS associated with clozapine. METHODS: Two new cases of clozapine-associated NMS are presented, along with previously reported cases from the literature, identified by using a MEDLINE search (1966-August 1998). From all cases, concomitant medications and washout periods were examined (if available) to assess clozapine as the likely cause of NMS. Characteristics of clozapine and traditional antipsychotic-induced NMS were compared. Different diagnostic criteria for NMS were applied to the cases to determine which were more likely to diagnose the syndrome. RESULTS: Clozapine was deemed a highly probable cause of NMS in 14 cases, a medium probability cause in five cases, and a low probability cause in eight cases. The most commonly reported clinical features were tachycardia, mental status changes, and diaphoresis. Fever, rigidity, and elevated creatine kinase were less prominent than in NMS associated with classical neuroleptics. CONCLUSIONS: Clozapine appears to cause NMS, although the presentation may be different than that of traditional antipsychotics. Levenson's original and Add-Onizio's modified criteria were more likely to diagnose NMS than were other criteria. Clozapine-associated NMS may present with fewer clinical features. Limitations are the lack of detailed information provided by many of the case reports and the use of “modified” diagnostic criteria for retrospective diagnosis.
Dextromethorphan and Diabetic Neuropathy
Authors: Criner Tonya M , Perdun Carla S 
Published: March 2004

OBJECTIVE: To review the use of dextromethorphan for the treatment of painful diabetic neuropathy. DATA SOURCES: MEDLINE and EMBASE searches for studies using dextromethorphan to manage diabetic neuropathy were conducted from 1966 to 1999 and 1980 to 1999, respectively. DATA SYNTHESIS: Peripheral neuropathy is a common manifestation of diabetic patients. Many classes of medications have been investigated to treat this condition, including N-methyl- D-aspartate inhibitors. A review of studies using dextromethorphan to manage diabetic neuropathy was performed. CONCLUSIONS: There are insufficient safety and efficacy data to justify the use of dextromethorphan for treating painful diabetic neuropathy. Further clinical trials are needed.
Levofloxacin-Induced Bilateral Achilles Tendonitis
Authors: Lewis James R , Gums John G , Dickensheets David L 
Published: March 2004

OBJECTIVE: To report a case of possible levofloxacin-induced bilateral Achilles tendonitis. CASE SUMMARY: An 83-year-old white woman presented to her physician with five days of hemoptysis. She was diagnosed with right lower-lobe pneumonia based on chest X-ray, and levofloxacin 500 mg/d po for 10 days was prescribed. Three days into treatment she began having a variety of adverse effects, including severe nausea, constipation, stomach cramps, and dizziness. Signs of tendonitis began three days after treatment and peaked four days after completion of therapy. Two weeks later, she was treated by her podiatrist with an ankle immobilizer and rest. At her three-week follow-up, she had marked improvement in her pain and bruising; however, her symptoms had not completely resolved. DISCUSSION: Tendonitis and tendon rupture are rare adverse effects of fluoroquinolone antibiotics; there are no reports in the literature of levofloxacin-induced tendonitis. As newer fluoroquinolones become available, the postmarketing studies will become increasingly important to capture the data on rare but serious adverse effects not discovered in the premarketing trials. CONCLUSIONS: To our knowledge, this is the first reported case of tendonitis caused by levofloxacin reported in the literature. Reports have been made, however, to the manufacturer via postmarketing surveillance. As more people are treated with newer fluoroquinolones, the clinical incidence of tendon rupture with these agents may become clearer.
Naratriptan: An Alternative for Migraine
Authors: Dulli Douglas A 
Published: March 2004

OBJECTIVE: To critically evaluate the literature regarding naratriptan's clinical pharmacology, efficacy, safety, and indications. DATA SOURCE: A MEDLINE search was conducted for the period from January 1990 to June 1998. Key words used included naratriptan, triptan, serotonin agonists, migraine, and migraine therapy. In addition, pertinent references cited in articles obtained from MEDLINE and product information for triptans were reviewed. STUDY SELECTION AND DATA EXTRACTION: All original and review articles and abstracts pertaining to naratriptan were reviewed, as were product information extracts. Clinical trials of naratriptan were critically reviewed and compared with pertinent clinical trials of other oral triptans. DATA SYNTHESIS: The treatment of migraine has been dramatically improved with the use of sumatriptan, other triptans, and serotonin-receptor subtype 1B and 1D agonists. Drawbacks to these medications, however, have included poorly tolerated adverse effects and the recurrence of the migraine. Naratriptan has been recently approved for acute oral migraine therapy. In two Phase III trials of naratriptan compared with placebo, relief at four hours was obtained in 60% and 68% of patients using the 2.5-mg dose, with recurrence of headache in 24 hours in 27% and 28% of patients. The data on migraine recurrence were similar to those of other oral triptans; the efficacy of naratriptan at two hours was not specifically analyzed. Adverse effects of naratriptan were similar to placebo, and its tolerability seemed superior compared with studies of other oral triptans. CONCLUSIONS: Naratriptan is a promising new oral therapy for acute migraine; it may successfully treat patients who poorly tolerate other triptan therapies or have longer duration migraine headaches.
Acute Renal Failure after Large Doses of Intravenous Immune Globulin
Authors: Haskin Janet A , Warner David J , Blank Douglas U 
Published: March 2004

OBJECTIVE:To describe a case of acute renal failure after high-dose intravenous immune globulin (IVIG) therapy and the measures undertaken to prevent this complication during subsequent administration.CASE SUMMARY:A 54-year-old white man with valvular cardiomyopathy was receiving large doses (2 g/kg/mo) of IVIG in order to attenuate his immune system in preparation for a heart transplant. After his first infusion, he had to be rehospitalized for nausea, vomiting, fever, chills, and acute renal failure (serum creatinine [Scr] peak 8.4 mg/dL, baseline 1.0 mg/dL). His second infusion produced similar complications. Sandoglobulin 100 mL/h (172 g; 10% solution prepared with sterile water) was used on both occasions, and the large sucrose load (1.67 g sucrose/g protein) was suspected to be the causative agent. Upon switching to Polygam (170 g; 10% solution prepared with sterile water), a glucose-containing product which only has 0.4 g glucose/g protein, and infusing it at half of the Sandoglobulin rate (50 mL/h), the patient was able to tolerate the infusion without complications (Scr and blood urea nitrogen unchanged).DISCUSSION:Stabilizing agents such as sucrose, maltose, and glucose are added to IVIG preparations to help reduce immunoglobulin aggregation. These aggregates are associated with some of the more serious adverse effects of IVIG administration. When large doses of IVIG are used, the stabilizing agents can induce an osmotic nephrosis due to the large solute load. A review of the previous literature on IVIG-induced renal failure is provided, as well as the differences in the various IVIG formulations. Also, general guidelines are offered to prevent this complication.CONCLUSIONS:Large doses of Sandoglobulin (400–2000 mg/kg) have been associated with acute renal failure due to the large sucrose load. By taking certain precautions, especially in high-risk patients, this uncommon, but serious, adverse effect can be avoided.
Onycholysis Associated with Weekly Administration of Paclitaxel
Authors: Flory Stefanie M , Solimando Dominic A , Webster Guy F , Dunton Charles J , Neufeld Julia M , Haffey Mary B 
Published: March 2004

OBJECTIVE: To report an unusual reaction associated with weekly administration of paclitaxel. CASE SUMMARIES: Onycholysis was seen in four women with recurrent ovarian cancer being treated with low-dose, weekly paclitaxel. Two of the patients had previously received higher doses of paclitaxel on an every-three-week schedule without similar reactions. Onycholysis developed between weeks 10–13 of treatment in three of the patients. In the fourth patient, it developed shortly after initiation of weekly paclitaxel. None of the reactions required dose adjustments or discontinuation of therapy. Direct toxicity to the nail bed or inhibition of angiogenesis are possible mechanisms for this reaction. DISCUSSION: Onycholysis, separation of the nail from the nail bed, is an infrequent adverse effect of drug therapy. Antineoplastic drugs have previously been reported to cause onycholysis, pigmentation, bands, thickening or thinning of the nail bed, and nail shedding. Nail changes with the taxanes, primarily docetaxel, are reported in up to 30–40% of patients. Paclitaxel is not commonly associated with dermatologic reactions, although localized skin reactions and tissue necrosis have been reported. Nail changes, pigmentation or discoloration of the nail bed, occur in 2% of patients receiving paclitaxel. CONCLUSIONS: Onycholysis is an uncommon reaction that may occur in some patients receiving weekly, low-dose paclitaxel therapy. The reaction is not life-threatening and does not warrant discontinuation of therapy. However, clinicians should be aware of the possibility of this effect and be prepared to advise patients who develop signs of nail changes.
Effect of Over-the-Counter Cimetidine on Phenytoin Concentrations in Patients with Seizures
Authors: Rafi John A , Frazier Lisa M , Driscoll-Bannister Susan M , O'Hara Kathryn A , Garnett William R , Pugh Carol B 
Published: March 2004

OBJECTIVE: To determine the effects of the maximum recommended over-the-counter (OTC) cimetidine dosage on phenytoin concentrations in ambulatory seizure patients on long-term phenytoin therapy. METHODS: Adults with seizure disorders requiring phenytoin therapy were recruited. Trough total phenytoin concentrations were measured initially and once weekly for six weeks. All assays were performed using Biotrack patient-side cartridges. After a two-week baseline period, patients took cimetidine 200 mg twice daily for two weeks. Toxicity was monitored via weekly neurologic examinations and midweek telephone surveys. Patients were asked to return to clinic weekly during a two-week cimetidine washout period. RESULTS: Nine patients entered and completed the study. All but two patients took other anticonvulsants known to interact with phenytoin (carbamazepine, n = 5; phenobarbital, n = 2). No adverse effects or changes in seizure frequency were reported. Paired Student's t-tests revealed no significant difference between serum phenytoin concentrations before (12.3 ± 3.2 mg/L [mean ± SD]) and after (12.8 ± 4.0 mg/L) two weeks on the OTC cimetidine regimen. No differences were noted in estimated pharmacokinetic parameters (maximum metabolic rate, Michaelis–Menten constant) for the same time periods (paired Student's t-test, p > 0.05). The Biotrack assay had an r2 = 0.7311 (p < 0.001, two-sided) when compared with TDx. CONCLUSIONS: It is possible that the lack of change in phenytoin concentrations was a result of the low daily dosage of cimetidine used or other factors related to the “real world” setting of the study. However, the potential for a serious drug interaction occurring in patients taking long-term oral phenytoin and OTC cimetidine appears to be small.