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Du Y, Guo Z, Xu B, Yang Y, Hu M, Hu Y, Yang Y, Zhang M, Wang Z, Guo X, Huang Y, Zhu J, Zhang W, Yang C. A real-world disproportionality analysis of the FDA adverse event reporting system events for ibuprofen. Expert Opin Drug Saf 2024:1-11. [PMID: 38686498 DOI: 10.1080/14740338.2024.2348556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Ibuprofen is commonly used as an over-the-counter (OTC) antipyretic and analgesic. As the frequency of its use has increased, there has been a corresponding increase in reports of associated adverse events (AEs). However, these events have not been systematically reported in the literature. Meanwhile, the importance of effective pharmacovigilance in evaluating the benefits and risks of drugs is being recognized. METHODS The data was obtained indirectly from FAERS using the OpenVigil 2 database, lexically mapped using software such as MySQL, Microsoft Excel, and the R language, and then subjected to four more rigorous algorithms to detect risk signals associated with ibuprofen AEs. RESULTS By analyzing data from the past 18 years, 878 ibuprofen-related AEs were identified as primary AEs. Notably, unexpected reproductive system and breast diseases, etc., which were unexpected, were observed as important system organ classes (SOCs) associated with ibuprofen. Among the 651 preferred terms (PTs) that simultaneously satisfy the four arithmetic methods, renal tubular acidosis and lip oedema are proposed as new signals for ibuprofen AEs. CONCLUSION This study explores the important and valuable potential AEs and ADRs of ibuprofen at the SOC and PT levels, respectively. To provide a reference on decision-making for ibuprofen to promote rational clinical dosing.
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Affiliation(s)
- Yikuan Du
- Central Laboratory, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, China
| | - Zhuoming Guo
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Bijun Xu
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Yujia Yang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Mianda Hu
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Yanghui Hu
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Yurong Yang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Mengting Zhang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Zhenjie Wang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Xiaochun Guo
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Yixing Huang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Jinfeng Zhu
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Weichui Zhang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Chun Yang
- Dongguan Key Laboratory of Chronic lnflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, China
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Ghimire A, Li D, Amin L. Ibuprofen-Induced Renal Tubular Acidosis: Case Report on a Not-So-Basic Clinical Conundrum. Can J Kidney Health Dis 2023; 10:20543581231183813. [PMID: 37426490 PMCID: PMC10327409 DOI: 10.1177/20543581231183813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Rationale Renal tubular acidosis (RTA) is a cause of non-anion gap metabolic acidosis (NAGMA) that is infrequently diagnosed and is due to various underlying etiologies that impair the kidney's ability to retain bicarbonate or excrete acid. Ibuprofen is an over-the-counter non-steroidal anti-inflammatory medication that is used by patients widely for a variety of reasons. Although it is well known that ibuprofen and other non-steroidal anti-inflammatory drugs may have nephrotoxic effects, the role of ibuprofen as a cause of RTA and hypokalemia is not well recognized. Presenting Concerns A 66-year-old man with chemotherapy-treated lymphoma in remission and ongoing heavy ibuprofen use for chronic pain presented to hospital with a 1-week history of increasing lethargy and otherwise unremarkable review of systems. Investigations showed acute kidney injury, hypokalemia, hyperchloremia, and NAGMA with elevated urinary pH and positive urine anion gap. Diagnoses The final diagnosis of distal RTA secondary to ibuprofen was made after ruling out gastrointestinal bicarbonate loss and additional secondary causes of RTA, including other medications, autoimmune conditions, and obstructive uropathy. Interventions The patient was admitted and treated with intravenous sodium bicarbonate for 24 hours with correction of hypokalemia via oral supplementation. His ibuprofen-containing medication was discontinued. Outcomes His acute kidney injury and electrolyte abnormalities resolved within 48 hours of initiating treatment with concurrent resolution of his lethargy. He was discharged home and advised to stop taking ibuprofen. Lessons Learned We report a case of patient with hypokalemia and NAGMA secondary to ibuprofen and highlight the importance of monitoring for this side effect in patients taking ibuprofen.
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Affiliation(s)
- Anukul Ghimire
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - David Li
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Leena Amin
- Department of Medicine, University of Alberta, Edmonton, Canada
- Grey Nuns Community Hospital, Edmonton, AB, Canada
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Man AM, Piffer A, Simonetti GD, Scoglio M, Faré PB, Lava SAG, Bianchetti MG, Milani GP. Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review. Ann Pharmacother 2022; 56:10600280221075362. [PMID: 35135381 DOI: 10.1177/10600280221075362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ibuprofen is a widely used nonsteroidal anti-inflammatory drug, which has been occasionally associated with hypokalemia and metabolic acidosis. The objective of this report is to analyze the literature on this issue and to address the underlying pathophysiology. DATA SOURCES Excerpta Medica, the National Library of Medicine, and Web of Science were searched from inception to July 16, 2021. STUDY SELECTION AND DATA EXTRACTION Papers reporting individually documented humans on ibuprofen with hypokalemia, acidosis, or both were retained. Data were extracted using a checklist. DATA SYNTHESIS For the final analysis, we evaluated 41 reports describing 50 cases (26 males and 24 females; 36 adults and 14 children) with often profound hypokalemia, acidosis, or both after ingestion of ibuprofen. Twenty-six cases were acute and 24 long term. Hypokalemia and acidosis occurred not only after ingestion of very high doses but also after ingestion of moderately high or even normal doses of ibuprofen. Laboratory values consistent with an excessive urinary potassium excretion or an altered urinary acidification were often disclosed in most cases. Discontinuation of ibuprofen resulted in a resolution of hypokalemia and acidosis within days in 47 cases. The course was lethal in 3 cases. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review highlights potentially fatal side effects of ibuprofen and can help doctors who are confronted with such a situation. CONCLUSIONS These data highlight the potential of ibuprofen to occasionally induce hypokalemia and acidosis of renal origin. Discontinuation of ibuprofen results in a resolution within days.
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Affiliation(s)
- Anca M Man
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Arianna Piffer
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Martin Scoglio
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro B Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Mario G Bianchetti
- Università della Svizzera Italiana, Lugano, Switzerland
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Physician Perspectives on Codeine Accessibility, Patterns of Use, Misuse, and Dependence in Saudi Arabia. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractIn Saudi Arabia, there are concerning rates of non-compliance with pharmaceutical regulations prohibiting the pharmacy dispensing of prescription-only medications without a physician prescription. This is the first study in the Middle East which examines physicians’ perceptions regarding misuse of codeine, listed as a narcotic, controlled, and prescription-only drug. The CODEMISUSED survey was adapted to the Saudi Arabian context and pilot tested, prior to cross-sectional administration to physicians in Riyadh, Jeddah, Abha, and Jazan (n = 105). Descriptive statistics (frequencies and percentage) present physician level of agreement, neutrality, and disagreement with statements regarding codeine prescribing, patient awareness and use, online and community pharmacy availability, and dependence. The study indicates concern by physicians regarding patient intentional use of codeine to enhance mood, misuse patterns, lack of awareness around habit-forming use and iatrogenic dependence, and sourcing via illegal dispensing. It underscores the imperatives to address pharmacy compliance with pharmaceutical regulatory controls, implement enhanced pharmacovigilance, and improve awareness around safe use.
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5
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Mandal AKJ, Howarth H, Jordaan JAJ, Missouris CG. Ibuprofen-Induced Distal Renal Tubular Acidosis and Hyporeninemic Hypoaldosteronism: Enough NSAID. Mayo Clin Proc 2020; 95:2296-2299. [PMID: 33012367 DOI: 10.1016/j.mayocp.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Amit K J Mandal
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Harrison Howarth
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | | | - Constantinos G Missouris
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK; University of Cyprus Medical School, Nicosia, Cyprus
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Chhabria M, Portales-Castillo I, Chowdhury M, Sohail A, Sanchez-Tejera D, Bress J, Sterns RH. A Case of Severe Hypokalemia. Am J Kidney Dis 2020; 76:A9-A12. [DOI: 10.1053/j.ajkd.2019.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022]
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Mishriky J, Stupans I, Chan V. The views of Australian adults experiencing pain on the upscheduling of codeine-containing analgesics to 'prescription only'. Int J Clin Pharm 2020; 43:386-393. [PMID: 32301065 DOI: 10.1007/s11096-020-01026-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/03/2020] [Indexed: 11/29/2022]
Abstract
Background Codeine is one of the most commonly used opioids worldwide and is available in different formulations, often combined with other simple analgesics. There is a growing concern of the potential harms associated with codeine misuse in the Australian community, and for this reason codeine containing analgesics have been upscheduled in Australia to 'prescription only medicines' from February 2018. There is currently limited knowledge on the views of Australian adults experiencing pain symptoms on this codeine restriction, and whether this change has impacted their ability to adequately manage their pain. Objective To investigate the views of adults experiencing pain on the 2018 codeine upscheduling in Australia. Setting Adults experiencing pain symptoms, predominantly recruited from Victoria, Australia. Method A descriptive cross-sectional study was conducted using a pre-tested customised anonymous self-administered questionnaire between January and March 2019. To capture a broad range of demographics, participants were recruited from ten Victorian community pharmacies across metropolitan Melbourne, Australia. Main outcome measure Opinions of Australian adults experiencing pain to targeted questions regarding the 2018 codeine upscheduling, including perceived advantages and disadvantages. Results A total of 120 participants completed the questionnaire. Sixty-two (52%) participants agreed/strongly agreed that codeine was helpful in alleviating pain symptoms before a prescription was required; while 43% of participants felt the codeine restriction has made it more difficult to manage their pain, with 33% unsure. Participants who were in favour of the codeine upscheduling believed that they are now more encouraged to consult healthcare professionals and make better use of the pain management services made available to them in the Australian community; however some now question the value of pharmacists in this context, given that there is now a reduced array of analgesic medicines available at pharmacies without a prescription. Conclusion This study showed there are mixed views, with some participants being unsure or not in favour of the codeine upscheduling, particularly based on qualitative responses. There is also opportunity in this space for healthcare providers to extend beyond standard practice and offer alternative pain management advice and support now that codeine is no longer available in Australian pharmacies without a prescription.
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Affiliation(s)
- John Mishriky
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia.
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Thammineni N, Kathi PR, Sharma A, Jawed A. Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients. Cureus 2019; 11:e6404. [PMID: 31970034 PMCID: PMC6964961 DOI: 10.7759/cureus.6404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ibuprofen is a commonly used medication in the United States and is used both by prescription and over the counter, while hypokalemia is a life-threatening condition caused by various etiologies, one of which is the side effect of medications. Ibuprofen is well-known for its various nephrotoxic side effects, including hyperkalemia as a common electrolyte abnormality, however, renal tubular acidosis leading to hypokalemia with the use of ibuprofen has been reported rarely. We present here two cases of life-threatening hypokalemia due to over-the-counter use of large doses of ibuprofen and describe its management.
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Affiliation(s)
| | - Pradeep R Kathi
- Internal Medicine / Gastroenterology, University of Arizona, Tucson, USA
| | - Aditi Sharma
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Areeba Jawed
- Internal Medicine / Nephrology, Wayne State University, Detroit, USA
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9
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Li R, Hasan N, Armstrong L, Cockings J. Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse. BMJ Case Rep 2019; 12:12/11/e231403. [DOI: 10.1136/bcr-2019-231403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Ibuprofen-induced renal tubular acidosis is a rare but important diagnosis which should be considered in patients presenting with hypokalaemia and metabolic acidosis. This case report details the case of a 33-year-old woman presenting with reduced conscious state, metabolic acidosis and profound hypokalaemia without an obvious cause. With correction of the patient’s electrolyte and acid-base disturbance, her conscious state improved allowing disclosure of her use of Nurofen Plus for its euphoric opiate effects. The diagnosis of renal tubular acidosis had been considered and subsequent disclosure of excessive chronic ingestion of ibuprofen suggested this to be the underlying cause. The striking feature of our patient was the insidious development of the problem and delayed accurate drug history. An important safety message arising from our case is the composite risk of dependence on the opiate component of over the counter analgesics, such as Nurofen Plus, and adverse events related to the ibuprofen component.
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Ahn JO, Kim SM, Song WJ, Ryu MO, Li Q, Chung JY, Youn HY. Transient Fanconi Syndrome After Treatment with Firocoxib, Cefadroxil, Tramadol, and Famotidine in a Maltese. J Am Anim Hosp Assoc 2019; 55:323-327. [PMID: 31525093 DOI: 10.5326/jaaha-ms-6786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fanconi syndrome is a renal proximal tubulopathy characterized by excessive urinary loss of glucose, amino acids, several electrolytes, and bicarbonate. Here, we report the case of transient Fanconi syndrome in a dog following administration of firocoxib, cefadroxil, tramadol, and famotidine. A 10 mo old Maltese was presented with lethargy, anorexia, vomiting, and weight loss. Transient Fanconi syndrome without azotemia was associated with firocoxib, cefadroxil, tramadol, and famotidine treatment. The dog received supportive care including IV fluids, gastroprotectants, and oral nutritional supplements. Two months after initial diagnosis and treatment, the dog showed complete resolution of glucosuria and aminoaciduria. The unique features of Fanconi syndrome in this case emphasize the potential renal tubular toxicity of this widely used multiple-drug combination.
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Affiliation(s)
- Jin-Ok Ahn
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Sang-Min Kim
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Woo-Jin Song
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Min-Ok Ryu
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Qiang Li
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Jin-Young Chung
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
| | - Hwa-Young Youn
- From the Department of Veterinary Internal Medicine, College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon-do, South Korea (J-O.A., J-Y.C.); and the Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, South Korea (S-M.K., W-J.S., M-O.R, Q.L., H-Y.Y.)
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Cabassi A, Tedeschi S, Perlini S, Verzicco I, Volpi R, Gonzi G, Canale SD. Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice. Eur J Prev Cardiol 2019; 27:850-867. [PMID: 31088130 DOI: 10.1177/2047487319848105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Excessive or inappropriate use of non-steroidal anti-inflammatory drugs can affect cardiovascular and renal function. Non-steroidal anti-inflammatory drugs, both non-selective and selective cyclooxygenase 2 inhibitors, are among the most widely used drugs, especially in the elderly, with multiple comorbidities. Exposition to a polypharmacy burden represents a favourable substrate for the onset of non-steroidal anti-inflammatory drug-induced deleterious effects. Cardiovascular and renal issues concerning the occurrence of myocardial infarction, atrial fibrillation, heart failure and arterial hypertension, as well as acute or chronic kidney damage, become critical for clinicians in their daily practice. We discuss current available knowledge regarding prostanoid physiology in vascular, cardiac and renal systems, pointing out potential negative non-steroidal anti-inflammatory drug-related issues in clinical practice.
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Affiliation(s)
| | - Stefano Tedeschi
- Cardiorenal Research Unit, University of Parma, Parma, Italy.,Cardiology Unit, Ospedale Vaio, Vaio-Fidenza, Parma, Italy
| | - Stefano Perlini
- Unità di Medicina Interna, Università di Pavia, Vaio-Fidenza, Parma, Italy
| | | | - Riccardo Volpi
- Cardiorenal Research Unit, University of Parma, Parma, Italy
| | - Gianluca Gonzi
- Cardiology Unit, Azienda Ospedaliera-Universitaria di Parma, Italy
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12
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Advertising of Over-the-Counter Codeine-Containing Medicines in the EU: Differences in the Regulation of Advertising Between Member States. Pharmaceut Med 2018. [DOI: 10.1007/s40290-018-0245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Bichard L, Toh D. Ibuprofen-induced distal (type 1) renal tubular acidosis and hypokalaemia: the dangers of ibuprofen-codeine combination over-the-counter preparations. Intern Med J 2018; 47:707-709. [PMID: 28580738 DOI: 10.1111/imj.13436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Bichard
- Division of General Internal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dylan Toh
- Division of General Internal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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14
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Patil S, Subramany S, Patil S, Gurram P, Singh M, Krause M. Ibuprofen Abuse-A Case of Rhabdomyolysis, Hypokalemia, and Hypophosphatemia With Drug-Induced Mixed Renal Tubular Acidosis. Kidney Int Rep 2018; 3:1237-1238. [PMID: 30197993 PMCID: PMC6127439 DOI: 10.1016/j.ekir.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Shakuntala Patil
- Department of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Swathi Subramany
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sachin Patil
- Department of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pooja Gurram
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Manisha Singh
- Department of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michelle Krause
- Department of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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15
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Nielsen S, MacDonald T, Johnson JL. Identifying and treating codeine dependence: a systematic review. Med J Aust 2018; 208:451-461. [DOI: 10.5694/mja17.00749] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/19/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Tim MacDonald
- Currumbin Clinic, Gold Coast, QLD
- Griffith University, Gold Coast, QLD
| | - Jacinta L Johnson
- University of South Australia, Adelaide, SA
- Southern Adelaide Local Health Network, Adelaide, SA
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16
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Mill D, Dawson J, Johnson JL. Managing acute pain in patients who report lactose intolerance: the safety of an old excipient re-examined. Ther Adv Drug Saf 2018; 9:227-235. [PMID: 29796247 DOI: 10.1177/2042098617751498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/08/2017] [Indexed: 11/16/2022] Open
Abstract
Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population. A case study is presented detailing a patient reporting lactose intolerance who insists on treatment with the lactose-free product codeine/ibuprofen (Nurofen Plus) rather than other codeine-free analgesics. It is important to assess the likelihood of lactose as an excipient inducing symptoms in this scenario, as reluctance to cease codeine could suggest codeine dependence, an issue that is becoming increasingly common in countries such as Australia and Canada. Given codeine dependence is associated with serious sequelae including hospitalization and death, the patient must either be reassured the lactose component in their prescribed analgesics will not induce symptoms or an alternative treatment strategy must be confirmed. General recommendations applying theory from the literature to the management of acute pain in lactose-intolerant patients are discussed and specific treatment options are outlined. Although large inter-individual variability is reported, most lactose-intolerant patients can tolerate the small quantities of lactose found in pharmaceutical preparations. Cumulative lactose exposure can be assessed in patients taking multiple medications while also consuming lactose in the diet. In those sensitive to small quantities of lactose, lactase supplements can be trailed. Additionally, for the analgesic drug classes employed for the management of acute pain, lactose-free formulations, including most oral liquids and dispersible tablets and some oral tablets and capsules, are available.
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Affiliation(s)
- Deanna Mill
- University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Dawson
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Jacinta Lee Johnson
- University of South Australia Division of Health Sciences, City East Campus, Corner Frome Rd and North Tce, Adelaide, South Australia, 5001, Australia
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17
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Hartlieb KJ, Ferris DP, Holcroft JM, Kandela I, Stern CL, Nassar MS, Botros YY, Stoddart JF. Encapsulation of Ibuprofen in CD-MOF and Related Bioavailability Studies. Mol Pharm 2017; 14:1831-1839. [PMID: 28355489 DOI: 10.1021/acs.molpharmaceut.7b00168] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although ibuprofen is one of the most widely used nonsteroidal anti-inflammatory drugs (NSAIDs), it exhibits poor solubility in aqueous and physiological environments as a free acid. In order to improve its oral bioavailability and rate of uptake, extensive research into the development of new formulations of ibuprofen has been undertaken, including the use of excipients as well as ibuprofen salts, such as ibuprofen lysinate and ibuprofen, sodium salt. The ultimate goals of these studies are to reduce the time required for maximum uptake of ibuprofen, as this period of time is directly proportional to the rate of onset of analgesic/anti-inflammatory effects, and to increase the half-life of the drug within the body; that is, the duration of action of the effects of the drug. Herein, we present a pharmaceutical cocrystal of ibuprofen and the biocompatible metal-organic framework called CD-MOF. This metal-organic framework (MOF) is based upon γ-cyclodextrin (γ-CD) tori that are coordinated to alkali metal cations (e.g., K+ ions) on both their primary and secondary faces in an alternating manner to form a porous framework built up from (γ-CD)6 cubes. We show that ibuprofen can be incorporated within CD-MOF-1 either by (i) a crystallization process using the potassium salt of ibuprofen as the alkali cation source for production of the MOF or by (ii) absorption and deprotonation of the free-acid, leading to an uptake of 23-26 wt % of ibuprofen within the CD-MOF. In vitro viability studies revealed that the CD-MOF is inherently not affecting the viability of the cells with no IC50 value determined up to a concentration of 100 μM. Bioavailability investigations were conducted on mice, and the ibuprofen/CD-MOF pharmaceutical cocrystal was compared to control samples of the potassium salt of ibuprofen in the presence and absence of γ-CD. From these animal studies, we observed that the ibuprofen/CD-MOF-1 cocrystal exhibits the same rapid uptake of ibuprofen as the ibuprofen potassium salt control sample with a peak plasma concentration observed within 20 min, and the cocrystal has the added benefit of a 100% longer half-life in blood plasma samples and is intrinsically less hygroscopic than the pure salt form.
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Affiliation(s)
- Karel J Hartlieb
- Department of Chemistry, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Daniel P Ferris
- Department of Chemistry, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - James M Holcroft
- Department of Chemistry, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Irawati Kandela
- Chemistry of Life Processes Institute, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Charlotte L Stern
- Department of Chemistry, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
| | - Majed S Nassar
- Joint Center of Excellence in Integrated Nano-Systems (JCIN), King Abdul-Aziz City for Science and Technology (KACST) , P.O. Box 6068, Riyadh 11442, Kingdom of Saudia Arabia
| | - Youssry Y Botros
- PanaceaNano, Inc. , 2265 East Foothill Boulevard, Pasadena, California 91107, United States
| | - J Fraser Stoddart
- Department of Chemistry, Northwestern University , 2145 Sheridan Road, Evanston, Illinois 60208, United States
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18
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Buprenorphine-Naloxone in the Treatment of Codeine Dependence: a Scoping Review of Clinical Case Presentations. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-016-9655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Medicines containing codeine: perspectives of medical professionals in the Republic of Ireland. Ir J Med Sci 2017; 186:555-563. [DOI: 10.1007/s11845-016-1546-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/25/2016] [Indexed: 01/31/2023]
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20
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Nielsen S, Van Hout MC. Over-the-Counter Codeine-from Therapeutic Use to Dependence, and the Grey Areas in Between. Curr Top Behav Neurosci 2017; 34:59-75. [PMID: 26768736 DOI: 10.1007/7854_2015_422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Codeine is a widely used analgesic, that is available for sale in pharmacies over the counter (OTC) in a number of countries including the UK, South Africa, Ireland, France and Australia. In these countries with OTC codeine sales there has been emerging concerns about misuse of and dependence on codeine containing combination analgesics, with increasing numbers of people presenting for help with codeine dependence at primary care and addiction treatment services. This has led to many countries reviewing availability of codeine in OTC available preparations, and considering possible measures to reduce harms from misuse of OTC codeine containing combination analgesics.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW, 2031, Australia.
- South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, 591-623 S Dowling Street, Surry Hills, NSW, 2010, Australia.
| | - Marie Claire Van Hout
- Department of Health, Sport and Exercise Science, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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21
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Dang MH, Wu S, Sia C. Ibuprofen-induced renal tubular acidosis-a rare cause of rhabdomyolysis: a case report. Oxf Med Case Reports 2016; 2016:omw057. [PMID: 29497554 PMCID: PMC5782483 DOI: 10.1093/omcr/omw057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/15/2016] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
Ibuprofen is widely used in the community to manage pain, inflammation and fever. In
cases of prolonged and supratherapeutic ingestion of ibuprofen, renal tubular acidosis
(RTA) with profound hypokalemia may occur. Although hypokalemia is known to cause
rhabdomyolysis, rhabdomyolysis occurring in the setting of ibuprofen-induced RTA is rare.
We present an unusual case of a 34-year-old male who presented with rhabdomyolysis in the
setting of profound hypokalemia as a result of ibuprofen-induced RTA. The patient was
successfully treated with fluid resuscitation, electrolyte replacement and supportive
therapy. This case demonstrates a serious complication of ibuprofen and the importance of
monitoring in nonprescription medications.
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Affiliation(s)
- Minh Huan Dang
- Department of Nephrology, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Samuel Wu
- Department of Nephrology, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Christopher Sia
- Department of Nephrology, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
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22
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Dependence on Over the Counter (OTC) Codeine Containing Analgesics: Treatment and Recovery with Buprenorphine Naloxone. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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23
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Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015. [PMID: 26223631 DOI: 10.1111/dar.12315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND AIMS Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence. DESIGN AND METHODS Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. RESULTS A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg day-1 (mean: 564 mg; 95% confidence interval 431-696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4-32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4-32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables. DISCUSSION AND CONCLUSIONS With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - Bridin Murnion
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Adrian Dunlop
- District Drug and Alcohol Clinical Services, Hunter New England Local Health Services, Newcastle West, Australia.,School of Medicine and Public Health (Medicine), University of Newcastle, Newcastle, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, USA
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Peter Muhleisen
- District Drug and Alcohol Clinical Services, Hunter New England Local Health Services, Newcastle West, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
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24
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Abuelo JG. Low dialysate potassium concentration: an overrated risk factor for cardiac arrhythmia? Semin Dial 2014; 28:266-75. [PMID: 25488729 DOI: 10.1111/sdi.12337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Serum potassium concentrations rise with dietary potassium intake between dialysis sessions and are often at hyperkalemic levels by the next session. Conversely, potassium concentrations fall during each hemodialysis, and sometimes reach hypokalemic levels by the end. Low potassium dialysate, which rapidly decreases serum potassium and often brings it to hypokalemic levels, is almost universally considered a risk factor for life-threatening arrhythmias. While there is little doubt about the threat of lethal arrhythmias due to hyperkalemia, convincing evidence for the danger of low potassium dialysate and rapid or excess potassium removal has not been forthcoming. The original report of more frequent ventricular ectopy in early dialysis that was improved by reducing potassium removal has received very little confirmation from subsequent studies. Furthermore, the occurrence of ventricular ectopy during dialysis does not appear to predict mortality. Studies relating sudden deaths to low potassium dialysate are countered by studies with more thorough adjustment for markers of poor health. Dialysate potassium concentrations affect the excursions of serum potassium levels above or below the normal range, and have the potential to influence dialysis safety. Controlled studies of different dialysate potassium concentration and their effect on mortality and cardiac arrests have not been done. Until these results become available, I propose interim guidelines for the setting of dialysate potassium levels that may better balance risks and benefits.
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Affiliation(s)
- J Gary Abuelo
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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25
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Claire Van Hout M. “Doctor shopping and pharmacy hopping”: practice innovations relating to codeine. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-03-2014-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues.
Design/methodology/approach
– A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine.
Findings
– The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity.
Practical implications
– Further development of real-time monitoring processes with process evaluation is advised.
Originality/value
– This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.
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26
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Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) are one of the most commonly used classes of medications in the world, which function by inhibiting the cyclooxygenase (COX) enzymes and downregulating the inflammatory pathway. COX enzymes are constitutively expressed in the kidneys and function to maintain a homeostatic environment in terms of maintaining the glomerular filtration rate, blood pressure, sodium, water, and osmotic regulation. When the COX enzymes are inhibited by NSAIDs, a multitude of renal and vascular complications occur. This article aims to enlighten primary care physicians of the complications that arise with NSAIDs from a renal perspective and to present some management strategies.
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Affiliation(s)
- Saadur Rahman
- Garden City Hospital, Michigan State University, 5001 Sheridan St, B44, Davenport, IA 52806, USA
| | - Anthony Malcoun
- Nephrology Fellowship Program, St John Health System, Macomb-Oakland Campus, St. John Macomb Hospital, 12000 E. 12 Mile Road, Warren, MI 48093, USA; Hypertension Nephrology Associate, PC, Livonia, MI, USA.
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27
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Lim AKH, Choi MJ. Distal renal tubular acidosis associated with Sjogren syndrome. Intern Med J 2014; 43:1330-4. [PMID: 24330363 DOI: 10.1111/imj.12300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 07/07/2013] [Indexed: 12/01/2022]
Abstract
Renal tubular acidosis is a common cause of normal anion gap metabolic acidosis but these disorders can be easily missed or misdiagnosed. We highlight the approach to assessing renal tubular acidosis by discussing a case study with a temporal data set collected over more than 5 weeks. We highlight the principles and the necessary information required for a diagnosis of classic distal renal tubular acidosis. We also briefly review several aspects of type 1 renal tubular acidosis related to autoimmune disease, drugs and thyroid disorders.
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Affiliation(s)
- A K H Lim
- Department of Nephrology and Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, Australia; Department of General Medicine, Dandenong Hospital, Melbourne, Victoria, Australia
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28
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Tobin CL, Dobbin M, McAvoy B. Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Aust N Z J Public Health 2013; 37:483-8. [DOI: 10.1111/1753-6405.12099] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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29
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Pilgrim JL, Dobbin M, Drummer OH. Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia. Med J Aust 2013; 199:329-31. [DOI: 10.5694/mja12.11843] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/11/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Melbourne, VIC
- Forensic Scientific Services, Victorian Institute of Forensic Medicine, Melbourne, VIC
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30
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Ibuprofen-Induced Hypokalemia and Distal Renal Tubular Acidosis: A Patient's Perceptions of Over-the-Counter Medications and Their Adverse Effects. Case Rep Crit Care 2013; 2013:875857. [PMID: 24829833 PMCID: PMC4010021 DOI: 10.1155/2013/875857] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/12/2013] [Indexed: 01/25/2023] Open
Abstract
We highlight a case of distal renal tubular acidosis secondary to ibuprofen and codeine use. Of particular interest in this case are the patient's perception of over-the-counter (OTC) medication use, her own OTC use prior to admission, and her knowledge of adverse reactions or side effects of these medications prior to taking them.
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31
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McWhirter KA, Jones RB. Accidental overdose of proprietary branded, combination analgesics available over the counter. Br J Hosp Med (Lond) 2012; 73:650-1. [DOI: 10.12968/hmed.2012.73.11.650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- KA McWhirter
- Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT and
| | - RB Jones
- Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT
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32
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Hypokalaemia and Renal Tubular Acidosis due to Abuse of Nurofen Plus. Case Rep Crit Care 2012; 2012:141505. [PMID: 24826329 PMCID: PMC4010031 DOI: 10.1155/2012/141505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/22/2012] [Indexed: 02/05/2023] Open
Abstract
Nurofen Plus is a common analgesic containing ibuprofen and codeine. We present a case of a 38-year-old lady who developed renal tubular acidosis with severe hypokalaemia, after chronic abuse of Nurofen Plus tablets. She presented with confusion and profound biochemical abnormalities requiring critical care admission for electrolyte replacement. Ibuprofen causes renal tubular acidosis due to its effects on carbonic anhydrase activity.
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Lugaresi A, Florio C, Brescia-Morra V, Cottone S, Bellantonio P, Clerico M, Centonze D, Uccelli A, di Ioia M, De Luca G, Marcellusi A, Paolillo A. Patient adherence to and tolerability of self-administered interferon β-1a using an electronic autoinjection device: a multicentre, open-label, phase IV study. BMC Neurol 2012; 12:7. [PMID: 22390218 PMCID: PMC3368780 DOI: 10.1186/1471-2377-12-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 03/05/2012] [Indexed: 11/11/2022] Open
Abstract
Background Achieving good adherence to self-injected treatments for multiple sclerosis can be difficult. Injection devices may help to overcome some of the injection-related barriers to adherence that can be experienced by patients. We sought to assess short-term adherence to, and tolerability of, interferon (IFN) β-1a administered via electronic autoinjection device in patients with relapsing-remitting multiple sclerosis (RRMS). Methods BRIDGE (RebiSmart to self-inject Rebif serum-free formulation in a multidose cartridge) was a 12-week, multicentre, open-label, single-arm, observational, Phase IV study in which patients self-administered IFN β-1a (titrated to 44 μg), subcutaneously (sc), three times weekly, via electronic autoinjection device. Patients were assessed at baseline and 4-weekly intervals to Week 12 or early termination (ET) for: physical examinations; diary card completion (baseline, Weeks 4, 8 only); neurological examinations (baseline, Week 12/ET only); MS Treatment Concern Questionnaire (MSTCQ; Weeks 4, 8, 12 only); Convenience Questionnaire (Week 12 only); Hospital Anxiety and Depression Scale (HADS); and Paced Auditory Serial Addition Task (PASAT; baseline only). Adherence was defined as administration of ≥ 80% of scheduled injections, recorded by the autoinjection device. Results Overall, 88.2% (105/119; intent-to-treat population) of patients were adherent; 67.2% (80/119) administered all scheduled injections. Medical reasons accounted for 35.6% (31/87) of missed injections, forgetfulness for 20.6% (18/87). Adherence did not correlate with baseline Expanded Disability Status Scale (P = 0.821) or PASAT (P = 0.952) scores, or pre-study therapy (P = 0.303). No significant changes (baseline-Week 12) in mean HADS depression (P = 0.482) or anxiety (P = 0.156) scores were observed. 'Overall convenience' was the most important reported benefit of the autoinjection device. Device features associated with handling and ease of use were highly rated. Mean MSTCQ scores for 'flu-like' symptoms (P = 0.022) and global side effects (P = 0.002) significantly improved from Week 4-12. Mean MSTCQ scores for pain at injection site and injection pain increased from Week 4-12 (P < 0.001). Adverse events were mild/moderate. No new safety signals were identified. Conclusion Convenience and ease of use of the autoinjection device may improve adherence and, therefore, outcomes, in patients with RRMS receiving sc IFN β-1a. Trial registration EU Clinical Trials Register (EU-CTR; http://www.clinicaltrialsregister.eu): 2009-013333-24
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Affiliation(s)
- Alessandra Lugaresi
- Department of Neuroscience and Imaging, University "G, d'Annunzio", Via dei Vestini 31, 66100 Chieti, Italy.
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34
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Mallett A, Lynch M, John GT, Healy H, Lust K. Ibuprofen-related renal tubular acidosis in pregnancy. Obstet Med 2011; 4:122-4. [PMID: 27579107 DOI: 10.1258/om.2011.110041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2011] [Indexed: 11/18/2022] Open
Abstract
Ibuprofen-related renal tubular acidosis (RTA) has not been previously described in pregnancy but its occurrence outside of pregnancy is being increasingly described. In this case, a 34-year-old woman presented in the third trimester of pregnancy with Type 1 or distal RTA related to ibuprofen and codeine abuse. It was complicated by acute on chronic renal dysfunction and hypokalemia. Delivery at 37 weeks gestation due to concerns of evolving preeclampsia resulted in the birth of a healthy neonate. RTA and hypokalemia were remediated and ibuprofen and codeine abuse ceased. Some renal dysfunction however continued. Thorough and repeated history taking as well as vigilance for this condition is suggested.
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Affiliation(s)
- Andrew Mallett
- Department of Renal Medicine; Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia
| | | | | | | | - Karin Lust
- Department of Obstetric Medicine , Royal Brisbane and Women's Hospital , Butterfield Street, Herston, Brisbane, Queensland, 4029 , Australia
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35
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Page CB, Wilson PA, Foy A, Downes MA, Whyte IM, Isbister GK. Life‐threatening hypokalaemia associated with ibuprofen‐induced renal tubular acidosis. Med J Aust 2011; 194:614. [DOI: 10.5694/j.1326-5377.2011.tb03123.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 04/14/2011] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Aidan Foy
- Calvary Mater Newcastle, Newcastle, NSW
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