Relative efficacy of the proposed Space Shuttle antimotion sickness medications

Space motion sickness has been estimated as affecting between 1/3 and 1/2 of all space flight participants. NASA has at the moment proposed a combination of promethazine and ephedrine (P/E) and one of scopolamine and dextroamphetamine (S/D), both given orally, as well as a transdermally applied scopolamine (TAS), as preventive and ameliorative measures. The reported double-blind study, tests the early phase actions and efficacy of the transdermal scopolamine (Transderm (TM)-V of ALZA Corporation) and compares these in detail to the oral medications. Motion sickness resistance was tested by standardized head movements while accelerating at 0.2 degree/sec2 to a maximum rotation of 240 degrees/sec, with an intermediate plateau of 10 min at 180 degrees/sec. To permit weighting motion sickness protection against other system influences, cardiovascular, psychological (subjective and objective), and visual parameter changes were documented for the three therapeutic modes. The relative impact of the various modalities on operational and experimental components of space missions is discussed. A comparison to intramuscularly administered promethazine (a backup therapeutic mode suggested for Space Shuttle use) is also included.

[Physiologic jaundice in preterm newborns (author's transl)]

Jaundice appearing in the first 24 hours of life, usually called early jaundice, is regarded as pathologic. On the opposite, one of the defining criteria of physiologic jaundice is its' occurrence after the first day of postnatal life. Authors, starting from repeated clinical observations of early jaundice of unknown etiology in preterm newborns, bring about a retrospective study of 1,527 clinical records in order to identify the cases of early jaundice of unknown origin. After known early jaundice-producing causes were excluded, 11 "unknown origin" cases were left. On comparing them with 11 other cases of similar characteristics (gestational age, weight at birth, year and season) who had presented physiologic jaundice, it turned out that the evolution of jaundice was comparable in both groups, except for age of appearance. Early jaundice group bilirubinemia was X = 7.4 (SD +/- 1.59 mg./dl. at 14 (+/- 6.6) hours of age, and physiologic jaundice group bilirubinemia was X = 9.8 (SD +/- 2.25) mg./dl. at 53 (+/- 21.3) hours at age. Since according to selection criteria both groups were made up by healthy preterm newborns, without any perinatal pathology, a study of the drugs administered to the mothers within 24 hours prior to birth was performed: not any reason for early appearance of jaundice was found. Authors' hypothesis support that the chronological criteria used to define physiologic jaundice in full-term newborns cannot always be applied to preterm newborns.

[Physostigmine reversal of central anticholinergic syndrome induced by midazolam/fentanyl, benzoctamine/buprenorphine and etomidate/carticaine or by atropine/promethazine/pethidine for premedication? (author's transl)]

Five cases of post narcotic delirium, somnolence or coma are interpreted as central anticholinergic syndromes as they were reversed by physostigmine. There is to date no information whether the drug combinations midazolam/fentanyl, benzoctamine/buprenorphine and etomidate/carticaine may act as central anticholinergic agents.

Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers

Fifteen out of 18 "pink and puffing" patients completed a double-blind, placebo-controlled cross-over trial of diazepam and promethazine for breathlessness and reduced exercise tolerance. Dosages were 25 mg and 125 mg daily, respectively, and each course lasted two weeks. Patients with psychiatric or other major medical histories were excluded. Of the three patients who did not complete the trial, one died during an exacerbation of breathlessness while taking diazepam, one was withdrawn because of mild hypercapnia while taking placebo, and one suffered intolerable drowsiness while taking diazepam. Of the remaining 15 patients, six needed a reduction in dosage because of drowsiness: one of these was taking promethazine and five diazepam. Diazepam had no effect on breathlessness and noticeably reduced exercise tolerance. Promethazine reduced breathlessness and improved exercise tolerance without altering lung function. From these results diazepam is contraindicated for breathlessness and reduced exercise tolerance in fixed airways obstruction, but promethazine may be beneficial.

Heat stroke during a 'run for fun': A case report

An athlete taking part in a mini-marathon race on a cold mid-winter morning collapsed with heat stroke after completing 19,5 km. To stop himself coughing during the run, he had taken a proprietary cough mixture containing 18 mg of the phenothiazine antihistaminic, promethazine, before the start. A possible explanation for the development of heat stroke is that the promethazine interfered with the body's ability to dissipate the enormous endogenous heat load which is generated during the course of a marathon race.

[Fatal hyperthermic crisis after premedication. Human stress syndrome or trigger effect of promethacine (author's transl)]

A case report of a fatal hyperthermic crisis after premedication and before introduction of anaesthesia is given. Based on the typical clinical course, CK isoenzyme patterns and preliminary results of familial investigation the diagnosis of malignant hyperthermia could be established. According to literature reports, psychic stress and/or phenothiazine medication may be assumed as triggering factors. Until a potential causality between malignant hyperthermia and phenothiazine medication can definitely be ruled out, their use in suspicious cases of susceptibility to malignant hyperthermia should be avoided.

[Direct skin tests in the prevention of allergic reactions in surgical patients (500 cases)]

The methodology used to diagnose drug allergy in 500 surgical patients is described. After an introduction in which the choice of this method is justified, the used methods are shown in detail with the tested active pharmacological principles (it is a group of drugs for pre, intra and post-surgery use). The tested patients have been clinically watched during all their stay in hospital. The results achieved are shown, as well as the good mutual relation between anamnesis and clinical progress with the answers obtained from the tests. The detailed analysis of skin-reactions showed that positive answers against penicillin (in more than 37% of the tested cases) clearly prevailed over other drugs (petidinum about 12%; propanididum about 10%) etc. Skin-test positivity against prometazinum (6%) is stressed as being quite considerable, considering its prevalent anthistaminic pharmacological effect. The work ends showing how this method, if correctly used, can give good results which can be compared with the results achieved by other more sophisticated methodologies. The kind of test is recommended to be adopted by other hospitals to reduce the incidence of immunological pathogenesis diseases which is more and more frequent.

Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure

Adverse reactions to phenothiazines have not been commonly recognized in patients with chronic renal failure. We wish to report a characteristic acute psychosis as a complication of phenothiazine use in such individuals. Four patients with chronic renal failure requiring hemodialysis were given doses of chlorpromazine ranging from 100--1000 mg over time intervals varying from 2--7 days. All developed extreme restlessness, auditory and visual hallucinations, and episodes of belligerent behavior. A fifth patient treated with promethazine developed a similar psychosis. Each became ill shortly after the initiation of phenothiazine therapy. All improved slowly after cessation of the drug. Hemodialysis in four patients did not appear to affect the course of the illness. The use of phenothiazines in patients with chronic renal failure is cautioned.

Comparative study of two long-acting tranquillizers for oral premedication

Lorazepam 2.5 mg was compared with promethazine 50 mg as oral premedication in a double-blind study in women. The premedication was given at the same time to all patients on each operating list, and both drugs continued to be effective 6 h after ingestion. A similar number of patients considered each drug to have relieved anxiety and the amnesic effect of lorazepam was confirmed. However, the use of lorazepam alone was accompanied by significantly more salivation during and after anaesthesia than the use of promethazine, especially in patients in whom the trachea was intubated. There was also a higher frequency of vomiting during and after operation with lorazepam (seven of 67 patients) than after promethazine (one of 71 patients). Promethazine produced dyskinetic side-effects in six of 71 patients.

[Allergic agranulocytosis due to promethazine]

An allergic agranulocytosis developed after promethazine administration to a 34-year-old man with a compulsion neurosis. Promethazine-specific leucocyte antibodies were demonstrated in the antiglobulin consumption test. Four similar cases, reported in the literature, are discussed in relation to this personal case. The findings are contrasted to the majority of cases of toxic "phenothiazine agranulocytosis".

Possible effect of maternal promethazine therapy on neonatal immunologic functions

The effect of the administration of promethazine in the treatment of erythroblastosis fetalis was studied in four maternal-fetal pairs. The three infants exposed for a prolonged period of time had decreased neonatal number and function of T cells, and abnormal specific humoral immune responses. The possible role of promethazine in the induction of fetal immunoincompetence is discussed.

Elastotic and citrine skin following an allergic photo-contact dermatitis in a child

A case of Phenergan-induced allergic photo-contact dermatitis in a boy aged 11 years is described. The condition produced a dermatological picture of senile-looking elastosis and citrine skin in exposed areas.

Metoclopramide and pimozide in Parkinson's disease and levodopa-induced dyskinesias

Metoclopramide is an antiemetic drug which occasionally produced acute dystonic reactions. Although known to interfere with central dopamine mechanisms, it is frequently used in Parkinson's disease to prevent levodopa-induced nausea and vomiting. In this study metoclopramide did not increase Parkinsonism or reduce levodopa-induced involuntary movements in patients with Parkinson's disease. Pimozide, by contrast, increased Parkinsonism and reduced involuntary movements. The capacity of metoclopramide to produce acute dyskinesias while being apparently free of Parkinsonism effects is pharmacologically unique and differentiates this drug from the phenothiazines and butyrophenones.

Tardive dyskinesia treated with pimozide

We have investigated the action of pimozide in tardive dyskinesia induced by prolonged administration of phenothiazines. Improvement was recorded in a double blind study of 18 patients treated with maximum tolerated dosage (mean 18.8 mg/day) for 6 weeks. There was no deterioration in the therapeutic action of pimozide over this time. Parkinsonism and sedation were the main adverse effects. They were corrected by reduction of the dose of pimozide, but often recurred so that further adjustments of dosage were necessary. Our findings support the view that tardive dyskinesia is produced by a disturbance in the balance of central transmitters such that dopaminergic transmission is increased.

Local-regional anesthesia during childbirth: effect on newborn behaviors

Administration of local-regional anesthesia during norgnal deliveries was correlated significantly with newborn behaviors as evaluated by the Brazelton neonatal assessment scale. Three days after birth, infants whose mothers received local-regional anesthesia were more irritable and motorically less mature than those infants whose mothers were not medicated.