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Morton A, Mackle C, Pavey J. Akathisia and oculogyric crisis in hyperemesis gravidarum. Obstet Med 2024; 17:129-131. [PMID: 38784181 PMCID: PMC11110745 DOI: 10.1177/1753495x221137942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 05/25/2024] Open
Abstract
Hyperemesis gravidarum complicates 0.5-2% of pregnancies. HG is associated with insomnia, significantly increased risks of anxiety and depression, and may be associated with feelings of guilt, social isolation and thoughts of suicidal ideation or termination of pregnancy. Anti-emetic therapy may be complicated by akathisia and dystonic reactions, which may affect the ongoing management of nausea and vomiting. A case of akathisia and oculogyric crisis following the addition of parenteral prochlorperazine to ondansetron and metoclopramide is presented. The treatment options for extrapyramidal side effects with anti-emetics in pregnancy and for ongoing treatment of nausea and vomiting are discussed.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Herston, Queensland, Australia
| | | | - Julian Pavey
- Obstetric Medicine, Mater Health, Brisbane, Australia
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2
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Gibler RC, Knestrick KE, Reidy BL, Lax DN, Powers SW. Management of Chronic Migraine in Children and Adolescents: Where are We in 2022? Pediatric Health Med Ther 2022; 13:309-323. [PMID: 36110896 PMCID: PMC9470380 DOI: 10.2147/phmt.s334744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Migraine is a neurological disorder that affects millions of children and adolescents worldwide. Chronic migraine is a subtype of migraine in which patients experience headaches for more days than not each month, with accompanying symptoms of phonophobia, photophobia, nausea or vomiting for most of these headaches. The burden and impact of chronic migraine in the daily lives of children and adolescents is substantial, requiring a holistic, multidisciplinary, and biopsychosocial approach to conceptualization and treatment. The purpose of this review is to provide a comprehensive “2022” overview of acute and preventive treatments for the management of chronic migraine in youth. We first describe diagnostic criteria for chronic migraine and highlight the state of evidence for acute and preventive treatment in children and adolescents. We then discuss emerging treatments currently receiving rigorous clinical research effort, special considerations for the treatment of chronic migraine in children and adolescents, and avenues for improving existing treatments and expanding access to evidence-based care.
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Affiliation(s)
- Robert C Gibler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Correspondence: Robert C Gibler, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Email
| | - Kaelynn E Knestrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel N Lax
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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3
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Sakamoto S, Deguchi Y, Uchida S, Itoh Y, Inoue K. Prolonged extrapyramidal symptoms induced by long‐term, intermittent administration of low‐dose olanzapine along with metoclopramide for emesis: A case report. Neuropsychopharmacol Rep 2022; 42:380-383. [PMID: 35716124 PMCID: PMC9515702 DOI: 10.1002/npr2.12277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Case Presentation Conclusions
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Affiliation(s)
- Shoko Sakamoto
- Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine Osaka Japan
| | - Yasuhiko Deguchi
- Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine Osaka Japan
| | - Sawako Uchida
- Department of Hepatology Osaka Metropolitan University Graduate School of Medicine Osaka Japan
| | - Yoshiaki Itoh
- Department of Neurology Osaka Metropolitan University Graduate School of Medicine Osaka Japan
| | - Koki Inoue
- Department of Neuropsychiatry Osaka Metropolitan University Graduate School of Medicine Osaka Japan
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Orlova YY, Mehla S, Chua AL. Drug Safety in Episodic Migraine Management in Adults Part 1: Acute Treatments. Curr Pain Headache Rep 2022; 26:481-492. [PMID: 35536501 DOI: 10.1007/s11916-022-01057-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to aid in choosing safe options when assessing potential risks of acute migraine treatments based on known mechanisms of action and anticipated safety concerns. RECENT FINDINGS Part 1 highlights safety issues associated with commonly used medications to treat acute migraine attacks. Strategies to mitigate cardiovascular and gastrointestinal risks of nonsteroidal anti-inflammatory drugs, evaluation of cardiovascular risks of triptan and ergot alkaloids, and precautions with use of antiemetics and the novel drugs gepants and ditans are discussed to help practitioners in clinical decision-making. When available, we included recommendations from professional societies and data from pharmacovigilance systems. While guidelines on efficacy are available, one must also consider the possible risks and adverse effects of a drug when creating treatment plans.
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Affiliation(s)
- Yulia Y Orlova
- University of Florida, 1149 Newell Dr., L3-100, Gainesville, 32611, USA.
| | - Sandhya Mehla
- Ayer Neurosciences Institute, Hartford Health Care Medical Group, University of Connecticut School of Medicine, Norwich, CT, USA
| | - Abigail L Chua
- Geisinger Health Systems, 1000 E. Mountain Boulevard, Wilkes-Barre, PA, 18702, USA
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Sheikh Hassan M, Ahmed Nor M. Metoclopramide induced acute dystonic reaction: A case report. Ann Med Surg (Lond) 2022; 74:103248. [PMID: 35070292 PMCID: PMC8761935 DOI: 10.1016/j.amsu.2022.103248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and Importance: Metoclopramide is a frequently used anti-emetic medication for the treatment of vomiting secondary to medical conditions or chemotherapy. Metoclopramide is known to cause extrapyramidal symptoms (drug-induced movement disorder). While the dystonic reaction is an acute condition that may emerge after a single dose of metoclopramide, Tardive dyskinesia and Parkinsonism are generally seen after prolonged use. These reactions are more frequent in patients receiving high doses of metoclopramide especially in female patients, children, and older patients. Case presentation A 61-year-old male hypertensive patient was admitted into the internal medicine ward following persistent epigastric pain and vomiting. Initial laboratory and imaging assessments were insignificant, Upper GI endoscopy revealed features of gastritis. PPI and metoclopramide 10 mg 3 times daily were started. After 2 days, the patient developed an acute dystonic reaction. The drug was discontinued and anticholinergic biperiden was given. The dystonic reaction was controlled after the third dose. The patient was discharged following recovery. Conclusion Metoclopramide can cause unpredictable acute dystonic reactions. This can be life-threatening and should be detected early. Extrapyramidal side effects should be monitored in patients on metoclopramide since a single dose can cause these symptoms. This case highlights an acute dystonic reaction following the administration of a metoclopromide injection. Highlights A 61-year old man became sensitive to Metoclopromide administration. He developed an acute dystonic reaction following the administration of a metoclopromide injection. He was treated with biperiden 5 mg IV after the condition was diagnosed, and he responded well. Metoclopramide is a frequently used anti-emetic medication for the treatment of vomiting secondary to medical conditions or chemotherapy. Metoclopramide is known to cause extrapyramidal symptoms (including acute dystonic reaction). In this paper, we presented a case report of 61 year old man who developed acute dystonic reaction after administering Metoclopramide.
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6
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Tolmacheva VA. Tardive dyskinesia. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tardive dyskinesia is a group of hyperkinetic and hypokinetic movement disorders, following the administration of dopamine receptor-blocking drugs. The severity of these syndromes varies from soft forms to the development of life-degrading situations. Phenomenologically tardive dyskinesia can be represented both in isolation and in various combinations. Recognition of these syndromes early in the development of tardive dyskinesia can optimize therapeutic treatment and reduce the risk of severe complications. As a means of treatment, deutetrabenazine or valbenazine are used as first-line drugs, with resistance to therapy and in severe cases, drugs of other groups are used (amantadine, baclofen, botulinum toxin type A, clonazepam, donepezil, gabapentin, ginkgo biloba, levetiracetam, melatonin, pregabalin, thiamine, verapamil, vitamin B6, vitamin E). Our own experience of 12 patients with tardive dystonia showed the effeciency of local injections of botulinum toxin.
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Cheng C, Brownstone N, Koo J. Treatment of tardive dyskinesia: a review and update for dermatologists managing delusions of parasitosis. J DERMATOL TREAT 2021; 33:1319-1323. [PMID: 33781159 DOI: 10.1080/09546634.2021.1892025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This article introduces to the dermatology provider two medications for the treatment of tardive dyskinesia (TD), which were the first medications approved by the US FDA specifically for the treatment of TD. In addition to describing these two new medications, this article will also provide a focused review of the pathogenesis of TD, as well as non-FDA-approved treatments, which have been tried prior to the advent of these medications. METHODS A PubMed search was conducted and articles were reviewed by the senior authors and included if they were relevant for dermatologists regarding etiology, symptoms, risk, and treatment of TD. RESULTS One of the most widely accepted explanations of TD involves the concept of 'dopamine receptor hypersensitivity state.' There are several other less well substantiated proposed pathogenic pathways of TD. The clinical manifestation is characterized by involuntary movements. Prevention includes switching to a 2nd generation agent or using the lowest dose possible for the shortest amount of time. Two new FDA-approved medications for TD are also discussed and reviewed. CONCLUSION TD now has FDA-approved medications for treatment. Now, there is even more reason for the dermatologist to have increased confidence when treating delusions of parasitosis (DOP) with antipsychotic agents.
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Affiliation(s)
- Christian Cheng
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Kannikeswaran N, Desai L, Farooqi A, Sivaswamy L. Effectiveness of Standard Combination Therapy in Pediatric Migraine. Pediatr Neurol 2021; 116:68-73. [PMID: 33493999 DOI: 10.1016/j.pediatrneurol.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A combination of parenteral medications (often referred to as standard combination therapy) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the two-hour, 24-hour, and seven-day impact of one such regimen on pain in children who present to the PED. Standard combination therapy for purposes of our study is defined as a bolus of intravenous saline, and a combination of intravenous ketorolac, prochlorperazine, and diphenhydramine. METHODS This prospective observational study included 120 children between the ages seven and 18 years who presented to the PED with migraine, whose parents could read and understand the consent form in English, and who were treated with standard combination therapy. The primary outcome measure for this study was the change in severity of pain as noted by the child using the Faces Pain Scale-Revised. We analyzed normally distributed continuous variables by mean and standard deviation, whereas non-normally distributed continuous variables are reported by median and interquartile range. RESULTS Nonparametric Friedman testing on the entire cohort (n = 120) noted that there was a statistically significant change in the Faces pain scale from before administration of standard combination therapy to the two-hour, 24-hour, and one-week time point with a reduction in pain score of 87.5%, 100%, and 50%, respectively, at the three time points. CONCLUSIONS This study noted moderate relief of pain after administration of standard combination therapy, which persisted at one-week after administration.
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Affiliation(s)
- Nirupama Kannikeswaran
- Professor of Pediatrics and Emergency Medicine, Children's Hospital of Michigan/Central Michigan University, Detroit, Michigan
| | - Lavina Desai
- Resident in Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Biostatistician, Children's Hospital of Michigan, Detroit, Michigan
| | - Lalitha Sivaswamy
- Professor of Pediatrics and Neurology, Children's Hospital of Michigan/Central Michigan University, Detroit, Michigan.
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Zhou B, Zhao X, Lu J, Sun Z, Liu M, Zhou Y, Liu R, Wang Y. Relating Substructures and Side Effects of Drugs with Chemical-chemical Interactions. Comb Chem High Throughput Screen 2020; 23:285-294. [DOI: 10.2174/1386207322666190702102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/11/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
Abstract
Background:Drugs are very important for human life because they can provide treatment, cure, prevention, or diagnosis of different diseases. However, they also cause side effects, which can increase the risks for humans and pharmaceuticals companies. It is essential to identify drug side effects in drug discovery. To date, lots of computational methods have been proposed to predict the side effects of drugs and most of them used the fact that similar drugs always have similar side effects. However, previous studies did not analyze which substructures are highly related to which kind of side effect.Method:In this study, we conducted a computational investigation. In this regard, we extracted a drug set for each side effect, which consisted of drugs having the side effect. Also, for each substructure, a set was constructed by picking up drugs owing such substructure. The relationship between one side effect and one substructure was evaluated based on linkages between drugs in their corresponding drug sets, resulting in an Es value. Then, the statistical significance of Es value was measured by a permutation test.Results and Conclusion:A number of highly related pairs of side effects and substructures were obtained and some were extensively analyzed to confirm the reliability of the results reported in this study.
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Affiliation(s)
- Bo Zhou
- Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Xian Zhao
- College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China
| | - Jing Lu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai 264005, China
| | - Zuntao Sun
- Informatization Office, Shanghai Maritime University, Shanghai 201306, China
| | - Min Liu
- College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China
| | - Yilu Zhou
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Rongzhi Liu
- Center for Medical Device Evaluation, China Drug Administration, State Administration for Market Regulation, Beijing 100081, China
| | - Yihua Wang
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
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Acute Dystonic Reactions in Children Treated for Headache With Prochlorperazine or Metoclopramide. Pediatr Neurol 2020; 106:63-64. [PMID: 32098684 DOI: 10.1016/j.pediatrneurol.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The incidences of dystonic reactions to metoclopramide and prochlorperazine have not been well characterized in children. METHODS Medical record data were reviewed for patients at a tertiary care pediatric hospital who received metoclopramide or prochlorperazine for treatment of headache. RESULTS A total of 4588 clinical encounters were identified, 2542 with prochlorperazine and 2046 with metoclopramide. One patient had a dystonic reaction with metoclopramide (0.049%). Eleven patients had a dystonic reaction with prochlorperazine (0.43%). The relative risk of a dystonic reaction with prochlorperazine over metoclopramide is 8.85 (95% confidence interval 1.15 to 68.5). There were differences between groups of patients who received metoclopramide versus prochlorperazine in terms of age, number of doses, and coadministration of diphenhydramine. In a logistic regression, administration of prochlorperazine over metoclopramide (P = 0.019) and greater number of doses (P < 0.001) remained associated with acute dystonic reactions. CONCLUSIONS Dystonic reactions are rare events among pediatric patients treated for acute headache, but are more common with prochlorperazine than metoclopramide.
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Abstract
RATIONALE Promethazine is an antihistamine agent used commonly for nausea and allergy. Along with its anticholinergic and antidopaminergic functions, promethazine is also used for psychiatric symptoms, such as troubling sleep, anxiety, and agitation. Previous studies have reported that promethazine may occasionally elicit acute dystonia in some individuals, especially for young children and pregnant women. PATIENT CONCERNS The 68-year-old female patient was admitted to our hospital because of feeling anxious and intermittent palpitation for over 1 year. She developed acute orofacial dystonia following promethazine treatment. DIAGNOSES Her diagnoses was generalized anxiety disorder. INTERVENTIONS Discontinuation of the offending agent, promethazine, and injection of Botulinum toxin. OUTCOMES The acute orofacial dystonia was finally alleviated by local injection of Botulinum toxin. LESSONS Careful assessment of the risk of developing acute dystonia is also needed in old patients when initiating the promethazine treatment.
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Affiliation(s)
- Ruili Zhang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
- Brain Research Institute of Zhejiang University, Hangzhou, China
| | - Jinwen Huang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
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Arya D, Khan T, Margolius AJ, Fernandez HH. Tardive Dyskinesia: Treatment Update. Curr Neurol Neurosci Rep 2019; 19:69. [DOI: 10.1007/s11910-019-0976-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Treatment of Tardive Dyskinesia: A General Overview with Focus on the Vesicular Monoamine Transporter 2 Inhibitors. Drugs 2019; 78:525-541. [PMID: 29484607 DOI: 10.1007/s40265-018-0874-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tardive dyskinesia (TD) encompasses the spectrum of iatrogenic hyperkinetic movement disorders following exposure to dopamine receptor-blocking agents (DRBAs). Despite the advent of atypical or second- and third-generation antipsychotics with a presumably lower risk of complications, TD remains a persistent and challenging problem. Prevention is the first step in mitigating the risk of TD, but early recognition, gradual withdrawal of offending medications, and appropriate treatment are also critical. As TD is often a persistent and troublesome disorder, specific antidyskinetic therapies are often needed for symptomatic relief. The vesicular monoamine transporter 2 (VMAT2) inhibitors, which include tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice for most patients with TD. Deutetrabenazine-a deuterated version of tetrabenazine-and valbenazine, the purified parent product of one of the main tetrabenazine metabolites, are novel VMAT2 inhibitors and the only drugs to receive approval from the US FDA for the treatment of TD. VMAT2 inhibitors deplete presynaptic dopamine and reduce involuntary movements in many hyperkinetic movement disorders, particularly TD, Huntington disease, and Tourette syndrome. The active metabolites of the VMAT2 inhibitors have high affinity for VMAT2 and minimal off-target binding. Compared with tetrabenazine, deutetrabenazine and valbenazine have pharmacokinetic advantages that translate into less frequent dosing and better tolerability. However, no head-to-head studies have compared the various VMAT2 inhibitors. One of the major advantages of VMAT2 inhibitors over DRBAs, which are still being used by some clinicians in the treatment of some hyperkinetic disorders, including TD, is that they are not associated with the development of TD. We also briefly discuss other treatment options for TD, including amantadine, clonazepam, Gingko biloba, zolpidem, botulinum toxin, and deep brain stimulation. Treatment of TD and other drug-induced movement disorders must be individualized and based on the severity, phenomenology, potential side effects, and other factors discussed in this review.
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Nagesh D, Goeden M, Coffman KA. Pediatric Iatrogenic Movement Disorders. Semin Pediatr Neurol 2018; 25:113-122. [PMID: 29735109 DOI: 10.1016/j.spen.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The acute development of a movement disorder is often a dramatic and frightening experience for patients and families, often requiring urgent or emergent evaluation by a neurologist. In the assessment of these patients, one relies on the history, physical and neurologic examination to determine the etiology of the condition. We aim to demonstrate that a thorough medication history is an incredibly critical part of this evaluation as iatrogenic movement disorders can arise from exposure not only to psychoactive medications, but from drugs prescribed for a variety of nonneurologic disorders. This comprehensive review is organized by movement disorder semiology so that the reader can more readily develop a differential diagnosis when evaluating a patient with a movement disorder.
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Affiliation(s)
- Deepti Nagesh
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Marcie Goeden
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Keith A Coffman
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
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Svendsen K, Wood M, Olsson E, Nordeng H. Reported time to onset of neurological adverse drug reactions among different age and gender groups using metoclopramide: an analysis of the global database Vigibase®. Eur J Clin Pharmacol 2017; 74:627-636. [PMID: 29290074 DOI: 10.1007/s00228-017-2407-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite FDA and EMA warnings of long-term use, little is known regarding the time to onset (TTO) of neurological adverse drug reactions (ADR) for metoclopramide. The aims of this study were, first, to evaluate whether neurological ADRs are more commonly reported for metoclopramide than for other medications, and second, to describe how time to onset of neurological ADRs differs by age and gender. METHODS All ADR reports with metoclopramide as the suspected/interacting drug were extracted from the WHOs Global ADR database Vigibase® between 1967 and May 2016. Cox proportional hazards models were fit using TTO of neurological ADRs as the outcome and age, gender, and type of ADR as predictors. Proportional Reporting Ratios (PRRs) for neurological ADRs were compared across age and gender. Lawyer reports were excluded in the analysis. RESULTS Over 47,000 ADR reports with metoclopramide were identified. Over one third (35.6%) of the reports came from lawyers. The majority of ADRs in general and neurological ADRs in specific occurred within the first 5 days of metoclopramide use (median 1 day). TTO increased with age. Neurological ADRs were reported two to four times as frequently for metoclopramide than for other drugs, with the highest PRRs observed in children (PRR = 4.24 for girls and 4.60 for boys). CONCLUSIONS Most adverse drug reactions occur within the first 5 days of treatment with metoclopramide. Patients requiring use of metoclopramide should be carefully monitored for neurological ADRs during the first days of treatment.
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Affiliation(s)
- Kristian Svendsen
- Hospital Pharmacy of Tromsø, Sykehusapotek Nord HF, Norway, Postboks 6147 Langnes, 9291, Tromsø, Norway.
| | - Mollie Wood
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy & PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Erika Olsson
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy & PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy & PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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17
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Xu D, Ham AG, Tivis RD, Caylor ML, Tao A, Flynn ST, Economen PJ, Dang HK, Johnson RW, Culbertson VL. MSBIS: A Multi-Step Biomedical Informatics Screening Approach for Identifying Medications that Mitigate the Risks of Metoclopramide-Induced Tardive Dyskinesia. EBioMedicine 2017; 26:132-137. [PMID: 29191560 PMCID: PMC5832625 DOI: 10.1016/j.ebiom.2017.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 02/02/2023] Open
Abstract
In 2009 the U.S. Food and Drug Administration (FDA) placed a black box warning on metoclopramide (MCP) due to the increased risks and prevalence of tardive dyskinesia (TD). In this study, we developed a multi-step biomedical informatics screening (MSBIS) approach leveraging publicly available bioactivity and drug safety data to identify concomitant drugs that mitigate the risks of MCP-induced TD. MSBIS includes (1) TargetSearch (http://dxulab.org/software) bioinformatics scoring for drug anticholinergic activity using CHEMBL bioactivity data; (2) unadjusted odds ratio (UOR) scoring for indications of TD-mitigating effects using the FDA Adverse Event Reporting System (FAERS); (3) adjusted odds ratio (AOR) re-scoring by removing the effect of cofounding factors (age, gender, reporting year); (4) logistic regression (LR) coefficient scoring for confirming the best TD-mitigating drug candidates. Drugs with increasing TD protective potential and statistical significance were obtained at each screening step. Fentanyl is identified as the most promising drug against MCP-induced TD (coefficient: −2.68; p-value < 0.01). The discovery is supported by clinical reports that patients fully recovered from MCP-induced TD after fentanyl-induced general anesthesia. Loperamide is identified as a potent mitigating drug against a broader range of drug-induced movement disorders through pharmacokinetic modifications. Using drug-induced TD as an example, we demonstrated that MSBIS is an efficient in silico tool for unknown drug-drug interaction detection, drug repurposing, and combination therapy design. An in silico MSBIS approach was developed to identify concomitant drugs that mitigate the side effects of a primary drug. Fentanyl and loperamide were identified to protect patients against drug-induced tardive dyskinesia (TD). MSBIS can be generalized to provide rational starting points for drug repurposing and combination therapy design.
Many dopamine antagonists cause TD and other severe, irreversible movement disorders. 120 drugs were screened using the MSBIS approach, leading to the discovery of fentanyl and loperamide. When co-administered with dopamine antagonists such as metoclopramide, they may protect patients against drug-induced movement disorders including TD. Their mechanisms of toxicity-mitigating action are remarkably different. The statistical significance of the findings was established using the FDA Adverse Event Reporting System and supported by published clinical reports and pharmacologic data. This study demonstrated the feasibility of the MSBIS approach and its applicability in identifying unknown drug-drug interactions that either mitigate undesirable toxicities or synergize therapeutic effects.
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Affiliation(s)
- Dong Xu
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA.
| | - Alexandrea G Ham
- College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Rickey D Tivis
- Idaho Center for Health Research, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Matthew L Caylor
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Aoxiang Tao
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Steve T Flynn
- College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Peter J Economen
- College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Hung K Dang
- College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Royal W Johnson
- College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
| | - Vaughn L Culbertson
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Kasiska Division of Health Sciences, Idaho State University, Meridian, ID 83642, USA
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18
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Affiliation(s)
- Benjamin W Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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19
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Case Studies of Uncommon and Rare Headache Disorders. Neurol Clin 2016; 34:631-50. [PMID: 27445245 DOI: 10.1016/j.ncl.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The following 6 case studies are presented: a 12-day migraine with recurring aura?; a migraineur with a new constant headache for 1 month; an orthostatic headache; a unilateral headache; migraine with aura and limb pain without headache; and nocturnal headaches. These cases illustrate the fascinating diversity and challenges of primary and secondary headaches that neurologists commonly encounter.
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