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Nordström P, Nordström A. Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort. Osteoporos Int 2019; 30:1983-1993. [PMID: 31363793 PMCID: PMC6795622 DOI: 10.1007/s00198-019-05085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
UNLABELLED Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that the increased risk during treatment is influenced by other factors, such as underlying disease. INTRODUCTION The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture. METHODS Four cohorts were formed from all individuals living in Sweden aged ≥ 50 years in 2005 (n = 3,341,706). In the first cohort, individuals prescribed long-acting propiomazine (n = 233,609) were matched 1:1 with controls. In the second cohort, individuals prescribed short-acting z-drugs (zopiclone, zolpidem, and zaleplon, n = 591,136) were matched 1:1 with controls. The third and fourth cohorts consisted of full sibling pairs with discordant propiomazine (n = 83,594) and z-drug (n = 153,314) use, respectively. RESULTS The risk of fracture was greatest among users of hypnotics in the 90 days before the initiation of treatment, both for propiomazine (odds ratio [OR], 2.52; 95% confidence interval [CI], 2.28-2.79) and z-drugs (OR, 4.10; 95% CI, 3.86-4.35) compared with that in matched controls. Furthermore, this risk was significantly reduced after the initiation of treatment with propiomazine (OR, 1.42; 95% CI, 1.27-1.60) and z-drugs (OR, 1.67; 95% CI, 1.56-1.80) and remained the first year following the last prescribed dose both for propiomazine (OR, 1.28, 95% CI, 1.21-1.36) and z-drugs (OR, 1.19, 95% CI, 1.16-1.23). The pattern was similar in the sibling cohorts, with the greatest risk of fracture seen in the 90 days before treatment with hypnotics was initiated. CONCLUSION The use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease.
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Affiliation(s)
- P Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90185, Umeå, Sweden.
| | - A Nordström
- Department of Public Health and Clinical Medicine, Environmental Medicine, Umeå University, 90185, Umeå, Sweden
- School of Sports Science, UiT The Arctic University of Norway, Tromsö, Norway
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Cieślik-Boczula K. Effect of phenothiazine compounds on the secondary structure and fibrillogenesis of poly-l-lysine. Spectrochim Acta A Mol Biomol Spectrosc 2019; 216:15-24. [PMID: 30870786 DOI: 10.1016/j.saa.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
Phenothiazine molecules are effective and commonly used antipsychotic drugs, especially in the treatment of schizophrenia. However, they produce strong extrapyramidal side-effects manifested by drug-induced parkinsonism. Because Parkinson's disease as a neurodegenerative illness is associated with the formation of amyloid fibrils in neuronal cells, it is postulated that the development of phenothiazine-induced parkinsonism may be related to the phenothiazine-induced formation of fibrillar aggregates. The effect of phenothiazine compounds (fluphenazine (FPh), chlorpromazine (ChP) and propionylpromazine (PP)) on the fibrillogenesis of poly-l-lysine (PLL) was studied using Fourier-transform infrared (FTIR) spectroscopy supported by principal component analysis (PCA), vibrational circular dichroism (VCD), transmission electron microscopy (TEM) and Congo red binding assay. The fibrillogenesis of PLL is accompanied by fibril formation with charged or uncharged polypeptides with PPII (polyproline-like extended helix), α-helix or β-sheet conformations. All of the phenothiazine molecules investigated effectively reduced the temperature required to induce the formation of β-sheet-rich fibrils from α-helix-rich fibrils of PLL.
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Abstract
BACKGROUND Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability-adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. OBJECTIVES To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia-like psychoses in comparison with piperacetazine. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short-term data were available.Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low-quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD -0.40, 95% CI -1.41 to 0.61; participants = 182; studies = 1; very low-quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low-quality evidence), with approximately 40% of these participants experiencing some parkinsonism-type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low-quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low-quality evidence). No trial reported data for change in negative symptoms or economic costs. AUTHORS' CONCLUSIONS The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.
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Affiliation(s)
- Mahin Eslami Shahrbabaki
- Kerman University of Medical Sciences, Afzalipour School of MedicineNeuroscience Research Centre, Institute of Neuropharmacology, Department of PsychiatryKermanIran7618834115
| | - Reza Dehnavieh
- Kerman University of Medical SciencesHealth Services Management Research Centre, Institute for Futures Studies in HealthHaft Bagh RoadKermanIran
| | - Leila Vali
- Kerman University of Medical SciencesEnvironmental Health Engineering Research CentreKermanIran
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Drugs to avoid in pregnant women with allergies. Prescrire Int 2016; 25:103. [PMID: 27186625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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5
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Affiliation(s)
- S Lerman
- New York Medical College, Eye Research Laboratory, Valhalla
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Donnier-Maréchal M, Larchanché PE, Le Broc D, Furman C, Carato P, Melnyk P. Carboline- and phenothiazine-derivated heterocycles as potent SIGMA-1 protein ligands. Eur J Med Chem 2015; 89:198-206. [PMID: 25462240 DOI: 10.1016/j.ejmech.2014.10.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
Sigma 1 receptors are associated with neurodegenerative and psychiatric disorders. These receptors, via their chaperoning functions that counteract endoplasmic reticulum stress and block neurodegeneration, may serve as a target for a new generation of antidepressants or neuroprotective agents. The involvement of these receptors has also been observed in neuropathic pain and cancer. Only a few ligands, such as Igmesine and Anavex 2-73, have been involved in clinical trials. Thus the development of sigma 1 ligands is of interest to a new generation of drugs. Previous work in our lab underlined the potency of benzannulated bicyclic compounds as interesting ligands. Herein the work was extended to a series of novel tricyclic compounds. Carboline- and phenothiazine-derivated compounds were designed and synthesized. In vitro competition binding assays for sigma 1 and 2 receptors showed that most of them have high affinity for sigma 1 receptor (Ki = 2.5-18 nM), and selectivity toward sigma 2 receptor, without cytotoxic effects on SY5Y cells.
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Affiliation(s)
- Marion Donnier-Maréchal
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4481, UFR Pharmacie, F-59000 Lille, France.
| | - Paul-Emmanuel Larchanché
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4481, UFR Pharmacie, F-59000 Lille, France.
| | - Delphine Le Broc
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4483, UFR Pharmacie, F-59000 Lille, France.
| | - Christophe Furman
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4483, UFR Pharmacie, F-59000 Lille, France.
| | - Pascal Carato
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4481, UFR Pharmacie, F-59000 Lille, France.
| | - Patricia Melnyk
- Univ Lille Nord de France, F-59000 Lille, France; UDSL, EA 4481, UFR Pharmacie, F-59000 Lille, France.
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At'kov OY, Lazarenko GN, Labartkava EZ, Gorokhova SG, Il'ina ES, Zekir EA. [ETACISIN-INDUCED BRUGADA SYNDROME IN A PATIENT WITH LONG-STANDING SUPRAVENTRICULAR EXTRASYSTOLE]. Klin Med (Mosk) 2015; 93:71-73. [PMID: 26964470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Brugada syndrome is a commonest cause of malignant disorders of cardiac rhythm associated with sudden death. It is diagnosed based on characteristic ECG signs and ventricular arrhythmia. This paper reports a 49 year-old patient with long-standing latent BS manifest as supraventricular and transient blockade of the right branch of the His bundle. The ECG pattern of BS became apparent in association with a 7 day treatment with class IC antiarrhythmic agent etacisin. Diagnostic difficulties account for the fact that the disease was initially described as myocardial infarction. Diagnosis of BS was confirmed by an electrophysiological study in which stable ventricular tachycardia and fibrillation were induced by etacisin. A cardioverter defibrillator was implanted to the patient.
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Nargeot J, Langlet C, Merlot A, Buard M, Mondoloni A, Viala A, Vacheron MN. [Antipsychotics-induced acute necrotizing enterocolitis: a case report]. Therapie 2014; 69:186-8. [PMID: 24926641 DOI: 10.2515/therapie/2013070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/23/2013] [Indexed: 11/20/2022]
Abstract
The acute necrotizing enterocolitis (ANE) is a partial or total necrosis of the small and large intestine. This is a case report of an antipsychotic induced ANE.
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Abstract
BACKGROUND Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating. Dopamine receptor subtype analysis has not been performed for pericyazine, but the drug appears to induce greater noradrenergic than dopaminergic blockade. Compared to chlorpromazine, pericyazine reportedly has more potent antiemetic, antiserotonin, and anticholinergic activity. OBJECTIVES To evaluate the clinical effects and safety of pericyazine in comparison with placebo, typical and atypical antipsychotic agents and standard care for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (February 2013) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. SELECTION CRITERIA All relevant randomised controlled trials focusing on pericyazine for schizophrenia and other types of schizophrenia-like psychoses (schizophreniform and schizoaffective disorders). We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS Data were extracted independently from included papers by at least two review authors. Risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data were calculated. We assessed risk of bias for included studies and used GRADE to judge quality of evidence. MAIN RESULTS We could only include five studies conducted between 1965 and 1980. Most of the included studies did not report details of randomisation, allocation concealment, details of blinding and we could not assess the impact of attrition due to poor reporting.For the primary outcome of Global state - not improved, the confidence interval was compatible with a small benefit and increased risk of not improving with pericyazine compared with typical antipsychotics (2 RCTs, n = 122, RR 1.24 CI 0.93 to 1.66, very low quality of evidence) or atypical antipsychotics (1 RCT, n = 93, RR 0.97 CI 0.67 to 1.42, very low quality of evidence).When compared with typical antipsychotics relapse was only experienced by one person taking pericyazine (1 RCT, n = 80, RR 2.59 CI 0.11 to 61.75, very low quality of evidence).Pericyazine was associated with more extrapyramidal side effects than typical antipsychotics (3 RCTs, n = 163, RR 0.52 CI 0.34 to 0.80, very low quality of evidence) and atypical antipsychotics (1 RCT, n = 93, RR 2.69 CI 1.35 to 5.36, very low quality of evidence).The estimated risk of leaving the study early for specific reasons was imprecise for the comparisons of pericyazine with typical antipsychotics (2 RCTs, n = 71, RR 0.46 CI 0.11 to 1.90, very low quality of evidence), and with atypical antipsychotics (1 RCT, n = 93, RR 0.13 CI 0.01 to 2.42, very low quality of evidence). AUTHORS' CONCLUSIONS On the basis of very low quality evidence we are unable to determine the effects of pericyazine in comparison with typical or atypical antipsychotics for the treatment of schizophrenia. However, there is some evidence that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics, and again this was judged to be very low quality evidence. Large, robust studies are still needed before any firm conclusions can be drawn.
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Affiliation(s)
- Hosam E Matar
- St Helens and Knowsley Hospitals NHS TrustDepartment of Trauma and OrthopaedicsWhiston HospitalPrescotMerseysideUKL35 5DR
| | | | - Samer Makhoul
- Al Noor Hospitals Group PlcAirport Road branchAirport Road CampusP.O. Box 48481Abu DhabiUnited Arab Emirates
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Pamela Humphreys
- Glyndwr UniversityDepartment of Nursing and HealthMold RoadWrexhamUKLL11 2AW
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Vasilyeva I, Biscontri RG, Enns MW, Metge CJ, Alessi-Severini S. Movement disorders in elderly users of risperidone and first generation antipsychotic agents: a Canadian population-based study. PLoS One 2013; 8:e64217. [PMID: 23696870 PMCID: PMC3656145 DOI: 10.1371/journal.pone.0064217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/12/2013] [Indexed: 11/18/2022] Open
Abstract
Background Despite concerns over the potential for severe adverse events, antipsychotic medications remain the mainstay of treatment of behaviour disorders and psychosis in elderly patients. Second-generation antipsychotic agents (SGAs; e.g., risperidone, olanzapine, quetiapine) have generally shown a better safety profile compared to the first-generation agents (FGAs; e.g., haloperidol and phenothiazines), particularly in terms of a lower potential for involuntary movement disorders. Risperidone, the only SGA with an official indication for the management of inappropriate behaviour in dementia, has emerged as the antipsychotic most commonly prescribed to older patients. Most clinical trials evaluating the risk of movement disorders in elderly patients receiving antipsychotic therapy have been of limited sample size and/or of relatively short duration. A few observational studies have produced inconsistent results. Methods A population-based retrospective cohort study of all residents of the Canadian province of Manitoba aged 65 and over, who were dispensed antipsychotic medications for the first time during the time period from April 1, 2000 to March 31, 2007, was conducted using Manitoba's Department of Health's administrative databases. Cox proportional hazards models were used to determine the risk of extrapyramidal symptoms (EPS) in new users of risperidone compared to new users of FGAs. Results After controlling for potential confounders (demographics, comorbidity and medication use), risperidone use was associated with a lower risk of EPS compared to FGAs at 30, 60, 90 and 180 days (adjusted hazard ratios [HR] 0.38, 95% CI: 0.22–0.67; 0.45, 95% CI: 0.28–0.73; 0.50, 95% CI: 0.33–0.77; 0.65, 95% CI: 0.45–0.94, respectively). At 360 days, the strength of the association weakened with an adjusted HR of 0.75, 95% CI: 0.54–1.05. Conclusions In a large population of elderly patients the use of risperidone was associated with a lower risk of EPS compared to FGAs.
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Affiliation(s)
- Irina Vasilyeva
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert G. Biscontri
- Department of Accounting and Finance, Asper School of Business, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W. Enns
- Department of Psychiatry, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colleen J. Metge
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Fernandes IC, Vilaça S, Lobo I, Sanches M, Costa V, Selores M. Photoallergic reaction to cyamemazine. Dermatol Online J 2013; 19:15. [PMID: 23473285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A 50-year-old man presented with a scaly erythema of the face, upper chest, forearms, and dorsum of the hands. He has been treated with cyamemazine for 6 months. Photopatch tests were performed and the patient was diagnosed with photoallergic reaction to cyamemazine. The drug was discontinued and a course of oral steroids was prescribed. The patient was advised to avoid light exposure. There has been no evidence of recurrence during a six-month follow-up period. Photoallergic reactions are much less frequent than phototoxic disorders. It is well known that several drugs including neuroleptics of the phenothiazine family may produce a skin eruption on light-exposed areas by dose-dependent (phototoxic) or photoallergic mechanisms. It is believed that photopatch testing, which is the clinical investigation of choice for suspected photoallergic reactions, is significantly underused in Europe and probably world-wide.
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Futsukaichi K, Matsumoto K, Fujita K, Abe R, Noguchi T. [Severe hypotension and ventricular fibrillation during combined general and epidural anesthesia in a patient on major tranquilizers]. Masui 2012; 61:1121-1124. [PMID: 23157101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 54-year-old man (height 155 cm, weight 49 kg) was scheduled for retroperitoneoscopic nephrectomy. He had a history of schizophrenia that had been controlled with propericiazine 10 mg and bromperidol 3 mg daily for 34 years. After induction of anesthesia, 1% mepivacaine 5 ml was administered via an epidural catheter. Blood pressure decreased 15 minutes later to 47/25 mmHg and heart rate dropped to 50 beats x min(-1). Ventricular fibrillation occurred despite titrated injection of ephedrine (40 mg total), phenylephrine (1 mg total), atropine (0.5 mg total), and rapid infusion of crystalloid and colloid solutions. Chest compression and defibrillation were required to restore spontaneous circulation. Surgery was cancelled and he was extubated 45 minutes later without any complications. These findings suggest that caution must be exercised when combining general and epidural anesthesia for patients on long-term major tranquilizers. In the event of refractory hypotension, the use of direct-acting vasoconstrictors such as noradrenaline or vasopressin should be considered.
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Affiliation(s)
- Kanako Futsukaichi
- Department of Anesthesiology, Faculty of Medicine, Oita University, Yufu 879-5593
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Shiio Y. [Drug induced parkinsonism]. Nihon Rinsho 2012; 70 Suppl 6:660-665. [PMID: 23156593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
Multiple hematological side effects have been reported to result from treatment with psychoactive phenothiazines. These reported toxicities include leucopenia, granulocytopenia, thrombocytopenia, agranulocytosis, and bone marrow aplasia. The physiological mechanism causing these potentially life-threatening blood dyscrasias is unknown. Recently, we discovered that phenothiazines exhibit antagonistic properties towards the VLA-4 integrin, an adhesion molecule that is responsible for homing and retention of hematological stem/progenitor cells (HSPCs) in the bone marrow. After administration of thioridazine we detected rapid mobilization of HSPCs into the peripheral blood. We propose that in patients receiving phenothiazines over a prolonged time period, continuous mobilization of stem cells out of the stem cell niche, results in a disorder of hematopoiesis. Furthermore, we also postulate that such cytopenias are caused by a loss of the niche environment, which is known to be essential for stem cell maintenance.
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Affiliation(s)
- Alexandre Chigaev
- Department of Pathology and Cancer Center, University of New Mexico, Albuquerque, NM 87131, United States.
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Volkov VP. [Peculiarities of ECG in patients with phenothiazine-induced cardiomyopathy]. Klin Med (Mosk) 2011; 89:27-30. [PMID: 21932558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ten most common and clinically significant pathological changes of ECG in schizophrenic patients with and without phenothiazine-induced cardiomyopathy (PCMP) at different stages of neuroleptic therapy are considered. A total of 46 men and 10 women were available for observation. The results of ECG studies in schizophrenics with PCMP and psychically healthy patients with DCMP were virtually identical. Dynamics of certain characteristics was shown to be of value for early diagnostics of phenothiazine cardiotoxic side-effects. These data confirm the advisability of regarding PCMP as a separate nosological entity in the group of seconfary cardiomyopathies.
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Bel'diev SN. [What is behind phenotiazinic cardiomyopathy?]. Klin Med (Mosk) 2011; 89:63-64. [PMID: 21574449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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[About secondary phenothiazine-induced cardiomyopathy]. Klin Med (Mosk) 2011; 89:30-3. [PMID: 22242263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A total of 830 autopsy protocols and medical histories of schizophrenic patients who died between 1952 and 2007 were analysed. Dilated cardiomyopathy (DCMP) occurred much more frequently than in the study of analogous material from the general population and patients with psychiatric disorders. The difference is attributed to the prolonged neuroleptic therapy with phenothiasine preparations in schizophrenics. This inference is confirmed by their significantly smaller heart mass compared with that in the period preceding this treatment. The frequency of DCMP in these patients significantly increased with duration of neuroleptic therapy. It is concluded that phenothiasine neuroleptics are etiological factors of DCMP. It is suggested to regard DCMP as an independent nosological form and call it phenothiasine-induced cardiomyopathy (FCMP).
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Abstract
Previously we reviewed the incidence and causes of drug-induced neutropenia in the Stockholm region during the years 1973-75. We here present an equivalent study for the years 1976-77. The yearly incidence of drug-induced neutropenia, cytostatics excluded, remained around 0.01%. About one half of the cases were caused by sulphonamides. Among the other causes, antithyroid drugs and phenothiazines were most frequent. The mortality rate was 27%, in contrast to only 2% in our previous study. Of the seven patiets who died, 5 had taken sulphonamides.
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Abstract
The records of 133 patients, discharged with a diagnosis of "agranulocytosis" (i.e. blood neutrophil levels less than 1.0 x 109/1) during the years 1973-75 in the Stockholm county region, were reviewed. In 45 cases the neutropenia was probably caused by drugs other than cytostatics, giving an annual incidence of drug-induced neutropenia of 0.01%. The most common drugs were thenalidine, sulfonamides and thyreostatics. Only one of the 45 patients died during the neutropenic phase. It is concluded that the pattern of drugs causing neutropenia has changed in Sweden compared with studies from the latter half of the 1960's, and only about 40% of the cases have been reported to the authorities.
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Volkov VP. [Somatic pathology and causes of death in schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2009; 109:14-19. [PMID: 19491813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Autopsy records (protocols) and medical histories of 850 patients with schizophrenia (death cases from 1952 to 2007) have been studied using statistical analysis. There were substantial changes of indicators studied which were most distinctly seen over the last two decades: the dramatic increase of frequency of cardiac pathology, in particular, chronic ischemic heart disease; appearance of such diseases as acute myocardial infarction and dilatation cardiomyopathy; increase in the number of cases of chronic obstructive lung diseases and active lung tuberculosis as well as malignant tumors, mainly lung cancer. Some changes may be caused by the long-term treatment of schizophrenic patients with neuroleptics of phenothiazine group. The author suggests a term tanatomorphosis for such changes.
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Volkov VP. [Phenothiazine-induced dilatation cardiomyopathy: selected aspects of clinical course and morphology]. Klin Med (Mosk) 2009; 87:13-16. [PMID: 19827523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The author considers selected clinical and morphological characteristics of secondary dilatation cardiomyopathy in patients with schizophrenia after long-term treatment with phenotiazine neuroleptics for the purpose of substantiating nosological self-sufficiency of this pathology (PCMP). 65 cases of PCMP (46 in men and 19 in women) were revealed at postmortem examination (2% of all autopsies or significantly higher than the general incidence of idiopathic dilatation cardiomyopathies (DCMP). Analysis of the patients" medical histories, dynamics of clinical conditions, and results of electrocardiography did not show significant differences between patients with schizophrenia and PCMP compared with mentally healthy DCPM subjects DCMP. Slightly lower heart mass was documented in the former group due to cardiovascular hypoplasia. It is concluded that phenothiazine-induced dilatation cardiomyopathy should be regarded as a separate nosological form belonging to a group of secondary DCMPs and designated as PCMP.
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Fried KW, Schneider CM, Schramm KW, Datta A, Chahbane N, Corsten C, Powell DR, Lenoir D, Kettrup A, Terranova P, Georg GI, Rozman KK. From dioxin to drug lead--the development of 2,3,7,8-tetrachlorophenothiazine. ChemMedChem 2008; 2:890-7. [PMID: 17394264 DOI: 10.1002/cmdc.200700005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Polychlorinated dibenzo-p-dioxins are persistent environmental pollutants. The most potent congener, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), causes a wasting syndrome and is a potent carcinogen and immunosuppressant in the rat at high doses. However, low doses cause opposite effects to some of those observed at higher doses, resulting in chemoprevention, stimulation of the immune system, and longevity in experimental animals. The new TCDD analogue, 2,3,7,8-tetrachlorophenothiazine (TCPT), was developed to take advantage of the low-dose effects of dioxins that have potential application as therapeutics. Its development marked a deviation from the traditional scope of phenothiazine drug design by deriving biological effects from aryl substituents. TCPT was synthesized in three steps. The key ring-closing step was performed utilizing a Buchwald-Hartwig amination to provide TCPT in 37% yield. Its potency to induce CYP1A1 activity over 24 h was 370 times lower than that of TCDD in vitro. The elimination half-life of the parent compound in serum was 5.4 h in the rat and 2.7 h in the guinea pig, compared to 11 and 30 days, respectively, for TCDD. These initial findings clearly differentiate TCPT from TCDD and provide the basis for further studies of its potential as a drug lead.
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Affiliation(s)
- Kristian W Fried
- Dept. of Pharmacology, Toxicology & Therapeutics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66212, USA
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Affiliation(s)
- Junping Li
- Eye Clinic, VA Medical Center, Salem, VA, USA
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Shiio Y. [Drug-induced parkinsonism]. Nihon Rinsho 2007; 65 Suppl 8:377-381. [PMID: 18072346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Kristiansen JE, Hendricks O, Delvin T, Butterworth TS, Aagaard L, Christensen JB, Flores VC, Keyzer H. Reversal of resistance in microorganisms by help of non-antibiotics. J Antimicrob Chemother 2007; 59:1271-9. [PMID: 17403708 DOI: 10.1093/jac/dkm071] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intracellular efflux pumps have been largely the research focus in multidrug-resistant (MDR) Gram-positive and Gram-negative microorganisms and parasites including cancers. However, drug efflux mechanisms other than pumps per se have been observed, supported by the effects of isomeric, non-antibiotic depressant (DPR), phenothiazines and thixenes, and antidepressant (ADPR) phenylpiperidine neurotropic drugs, alone or in combination with classical antimicrobials on MDR Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes and Streptococcus pneumoniae. Of the non-antibiotics we investigated, the DPR l-thioridazine, trans-clopenthixol and isomers of phenylpiperidines NNC 20-4962 (isomer of femoxetine) and NNC 20-7052 (isomer of paroxetine) were potent antimicrobials with the least neurotropic activity, pointing to a possible general isomeric structure-activity relationship. These compounds may be regarded as new efflux inhibitors. Moreover, these isomers have considerably reduced, in some cases absent, neurotropism and reduced mammalian toxicity. This may alleviate concerns about adverse effects and therapeutic safety for infected patients in life-threatening situations where the non-antibiotic dosage would be in the lower, non-chronic dosage ranges generally prescribed for individuals with mild mental health problems. The results point to the prokaryotic and eukaryotic microorganisms' phospholipid/protein domain involvement of the cationic, amphiphilic, non-antibiotic DPR and ADPR, with the phospholipids being the initial sites attracting and concentrating the neurotropes to induce a form of suspended animation, followed by gross changes of cell wall and membrane structure, and thereby potentiating their destructive or immobilizing effects on various as yet only hinted at resistance and efflux mechanisms. Combination of appropriate isomeric non-antibiotic DPR and ADPR of low neurotropism and toxicity with conventional and classical antimicrobials promises early, new therapeutic strategies salutary against microbial resistance, resistance development, pathogenicity and virulence.
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Affiliation(s)
- Jette E Kristiansen
- International Non-Antibiotic Research Group, Department of Research and Department of Microbiology, University of Southern Denmark, Sønderborg, Denmark.
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Garenfeld W, Wilting I. [Oculotoxic and dermatotoxic side effects of phenothiazines]. Tijdschr Psychiatr 2007; 49:251-5. [PMID: 17436211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Phenothiazines can give rise to serious and sometimes irreversible dermatological and oculotoxic side effects. These effects can take the form of photosensitivity, grey-purple discoloration and hyperpigmentation of the skin and hyperpigmentation of the conjunctiva, cornea, lens, retina, choroidea and macula. Involvement of the retina or macula can lead to impaired vision, blurred vision, disturbed colour perception and night blindness. We describe the mechanisms that are currently believed to underlie these side-effects. We advise annual ophthalmic monitoring of patients receiving long-term treatment with phenothiazianes.
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Saruwatari J, Matsunaga M, Ikeda K, Nakao M, Oniki K, Seo T, Mihara S, Marubayashi T, Kamataki T, Nakagawa K. Impact of CYP2D6*10 on H1-antihistamine-induced hypersomnia. Eur J Clin Pharmacol 2006; 62:995-1001. [PMID: 17089107 DOI: 10.1007/s00228-006-0210-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 08/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study investigated the relevance of the cytochrome P450 (CYP) 2D6 genotype to the adverse drug reactions (ADRs) of H1-antihistamines and the level of sedation. METHODS Japanese participants in a health screening program were asked to describe any past history of ADRs. Any subjects reporting ADRs induced by H1-antihistamines were then individually interviewed and defined as cases. Excessive daytime sleepiness, which had occurred in the cases as an H1-antihistamine-induced ADR, was assessed by the Epworth sleepiness scale (ESS), and an ESS score >or=12 was considered hypersomnia. CYP2D6*4, *5, *14, and *10 were genotyped by a panel of polymerase chain reaction techniques. RESULTS Out of 2,074 participants, 100 cases (M:F = 37:63, mean age 51.9 +/- 9.2 years) were eligible for analysis. The most common etiological drug was chlorpheniramine, which is the most frequently used H1-antihistamine in Japan. CYP2D6*10 allele and genotypes were more frequently found in the cases than in the healthy Japanese population in a large study (P < 0.005 and P = 0.039, respectively), but no difference was observed in the null alleles and genotypes. The ESS scores in 75 cases (M:F=25:50) who had experienced excessive daytime sleepiness were 9.5 +/- 5.5 in men and 12.9 +/- 6.1 in women (P < 0.001, cases vs. 34 subjects without symptoms; P = 0.001 men vs. women). The occurrence of hypersomnia increased as the number of CYP2D6 mutant alleles increased (P = 0.045). CONCLUSION The results suggest that the presence of the CYP2D6*10 allele is a risk factor for development of H1-antihistamine-induced ADRs in Japanese.
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Affiliation(s)
- Junji Saruwatari
- Division of Pharmacology and Therapeutics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Oe-honmachi 5-1, Kumamoto 862-0973, Japan
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Landerholm L, Lennestål R. [Treatment of sleep disorders during pregnancy and breast feeding]. Lakartidningen 2006; 103:3012-3; discussion 3014-6. [PMID: 17115673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Abstract
Phenothiazines, a kind of sulfur-containing tricyclic compounds, have diverse biological activities including tranquilizer, antibacterial, antitumor and antihelmintic activities due to the relatively lower cytotoxicity. Phenothiazines have been used for clinical treatments as psychotropics. In contrast to the psychotropic preparations, their information of other biological activities of phenothiazines and their related compounds has been limited. This review article summarizes the interaction with DNA (using quantum calculation), antitumor activity, differentiation or apoptosis-inducing activity, tumor necrosis factor (TNF)-induction, antiproliferative activity, radical scavenging activity, antimutagenic activity, antiplasmid activity, antibacterial activity, reversal of multidrug resistance (MDR), blast transformation activity of phenothiazines, benz[c]acridines and benzo[a]phenothiazines.
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Affiliation(s)
- Noboru Motohashi
- Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan.
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Abstract
Phenothiazine is an aromatic tricyclic compound that first emerged from the furtive chemical activity surrounding the aniline dye industry at the latter half of the 19th century. It contains both nitrogen and sulphur atoms and is the parent molecule of a multitude of drugs that have enjoyed varied and extensive use throughout medical and veterinary practice. The compound itself is not without biological activity and has been shown to possess insecticidal, antifungal, antibacterial and anthelmintic properties. It was this latter vermifugal application that has earned the molecule a place alongside penicillin and DDT for its colossal impact on mankind. Following its extensive usage over many years, unwanted reactions including neuromuscular incoordination, photosensitization and haemolytic anaemia have been reported and these have limited its use in the present climate. Investigations into the mode of action of phenothiazine and its underlying biochemical properties have been undertaken but the molecule has yet to reveal its secrets and still poses problems of understanding at the molecular level. This article reviews the literature, both established and current, and presents a contemporary view on phenothiazine and its interaction with biological systems.
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Affiliation(s)
- S C Mitchell
- Section of Biological Chemistry, Division of Biomedical Sciences, Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, SW7 2AZ, UK.
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Uchida H, Suzuki T, Watanabe K, Kashima H. Antipsychotics-induced hypersensitivity of visual perception. Eur Psychiatry 2006; 21:343-4. [PMID: 16860706 DOI: 10.1016/j.eurpsy.2005.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022] Open
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Mukoyama M, Nakao K. [Syndrome of inappropriate secretion of antidiuretic hormone]. Nihon Rinsho 2006; Suppl 1:200-5. [PMID: 16776127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Masashi Mukoyama
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine
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Yamamoto H, Okada Y, Taniguchi H, Handa R, Naoi Y, Oshima S, Kato T, Tsujie M, Iijima S, Kurokawa E, Kikkawa N, Kadone K. Intracystic papilloma in the breast of a male given long-term phenothiazine therapy: A case report. Breast Cancer 2006; 13:84-8. [PMID: 16518066 DOI: 10.2325/jbcs.13.84] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We experienced a very rare case of intracystic papilloma in a 57-year-old man who came to our hospital complaining of a left subareolar mass and nipple discharge. The patient had a history of chronic schizophrenia, necessitating long-term treatment with phenothiazines. His serum prolactin levels were elevated. Mammography demonstrated a well defined mass with microcalcifications. Ultrasonography revealed a cyst with an intracystic component. The inner lesion of the mass enhanced on contrast-enhanced computed tomography. The carcinoembryonic antigen concentration of the cyst fluid was 400 ng/mL and no malignant cells were found by aspiration biopsy cytology. Excisional biopsy was performed under local anesthesia. Pathological examination revealed the intracystic component to be intracystic papilloma. There are ten reports of male intracystic papilloma including ours. We report the second case of a patient given long-term phenothiazine therapy, which is known to increase serum prolactin levels.
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Affiliation(s)
- Hitoshi Yamamoto
- Department of Surgery, Minoh City Hospital, 5-7-1, Kayano, Osaka 562-8562, Japan
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Beraru V. [Drug-induced retinopathies]. Oftalmologia 2006; 50:86-93. [PMID: 17144513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Drug-induced retinopathies are rare conditions produced by a large variety of medications. There are several specific patterns of retinal toxicity, which should be recognized and correlated with the clinical state.
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Affiliation(s)
- V Beraru
- Spitalul Militar Central, Bucuresti
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Favre JD, Allain H, Aubin HJ, Frija-Orvoen E, Gillet C, Lejoyeux M, Payen A, Weber M, Garcia-Acosta S, Kermadi I, Dib M. Double-blind study of cyamemazine and diazepam in the alcohol withdrawal syndrome. Hum Psychopharmacol 2005; 20:511-9. [PMID: 16118830 DOI: 10.1002/hup.718] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cyamemazine is an original phenothiazine derivative which showed similar efficacy and tolerability to lorazepam during ethanol withdrawal in mice. This study investigated cyamemazine for its efficacy and tolerability in alcohol-dependent patients electing an alcohol withdrawal procedure, in comparison with diazepam. METHOD A multicenter, randomized, double-blind study in 89 alcohol-dependent patients (CIWA-Ar score between 10 and 30), electing an alcohol withdrawal procedure, was used to find effective doses of cyamemazine and to compare it with diazepam for efficacy and tolerability. On day 1 (D(1)), cyamemazine or diazepam (50 mg and 10 mg capsule, respectively) were administered at hourly intervals to reduce CIWA-Ar = 5, up to a maximum of eight administrations. Starting from D(2), the compounds were given twice a day in progressively decreasing doses during a maximum period of 13 days (D(end)). RESULTS At h(8) (8 h after the first treatment of D(1)), therapeutic success (CIWA-Ar score </= 5) was achieved in 32 out of 43 ITT patients treated with cyamemazine (74.4%), a value very similar to that of diazepam (32/44; 72.7%). Most such patients (29/32) were controlled with 2-6 capsules of cyamemazine (100-300 mg). In the PP population, cyamemazine (n = 28) was significantly non-inferior to diazepam (n = 33), with a threshold of 10% for non-inferiority bound and 2.5% for one-sided type I error rate. Such therapeutic similarity was confirmed by the analysis of other efficacy criteria. Safety analysis did not show substantial differences between the two treatments. CONCLUSIONS Cyamemazine showed similar efficacy and tolerability to diazepam for the treatment of alcohol withdrawal symptoms at therapeutic doses in the range 100-300 mg.
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Affiliation(s)
- Jean-Daniel Favre
- Service de Psychiatrie, Hôpital d'Instruction des Armées Percy, Clamart, France
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Chen CW, Chang MH. Rhabdomyolysis induced by fenoverine: a case report and literature review. Acta Neurol Taiwan 2005; 14:143-6. [PMID: 16252617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Fenoverine is a derivative of phenothiazine. It is commonly used in the treatment of gastrointestinal and gynecological spasmodic disorders. Myalgia is a common side effect, but rhabdomyolysis has only been scarcely reported before. A 77-year-old patient without previous history of liver diseases received fenoverine therapy for four days due to abdominal pain. Acute onset of myalgia, proximal muscle weakness and high creatinine phosphokinase (CK) occurred. The foregoing symptoms and signs and abnormal biochemistry improved gradually after discontinuation of fenoverine use. The pathophysiology of fenoverine-induced rhabdomyolysis is unclear. Some predisposing factors, especially liver cirrhosis, had been reported. However, our patient had none of the well-known precipitating factors. Physicians should be aware of the possibility of rhabdomyolysis in patients receiving fenoverine, whether they are healthy or have musculoskeletal or liver dysfunction.
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Affiliation(s)
- Chung-Wen Chen
- Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
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Glaser C, Sitzwohl C, Wallner T, Lerche A, Marhofer P, Schindler I. Dixyrazine for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2004; 48:1287-91. [PMID: 15504190 DOI: 10.1111/j.1399-6576.2004.00526.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study assessed the efficacy and safety of dixyrazine, an alternative neuroleptic drug to droperidol, in the prophylaxis of postoperative nausea and vomiting (PONV). METHODS A total of 197 patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomized to receive either dixyrazine 10 mg or placebo double-blinded at the end of surgery. Scores pertaining to PONV episodes, analgetic supply, rescue medication, adverse events and patient satisfaction were collected over the first 2 h in the PACU and the next 22 h in the ward. RESULTS The incidence of PONV over the entire 24-h period was reduced from 32% in the placebo group to 13% in the dixyrazine group (P< or =0.004). The incidence of nausea in the first 2 h was reduced from 15% in the placebo group to 4% in the dixyrazine group (P< or =0.02) and from 12% to 5% in the next 22 h. The incidence of emetic episodes was not different between the two groups. Postoperative shivering was significantly less prevalent in the dixyrazine than in the placebo group (2% vs. 13%; P< or =0008), and opioid analgesics were required significantly less often (61% vs. 75%; P< or =0.01). No significant adverse effects were observed. Patient satisfaction was similar in both groups. CONCLUSION Prophylactic dixyrazine is an effective, safe, and cheap antiemetic drug for laparoscopic cholecystectomy without involving any significant adverse events.
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Affiliation(s)
- C Glaser
- Division of Anesthesiology and Intensive Care, Vienna City Hospital, Floridsdorf, Austria
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Murak-Kozanecka E, Rabe-Jabłońska J. [Prevalence and type of dermatologic disorders in psychiatric patients treated with psychotropic drugs]. Psychiatr Pol 2004; 38:491-505. [PMID: 15199658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM The aim of the study was to establish prevalence and type of dermatologic symptoms in patients with mental disorders, treated with psychotropics drugs, and comparison of the frequency and type of dermatologic disorders after typical psychotropics and new psychotropic drugs, and assessment of relationships between diagnosis of mental disorders and type of dermatologic symptoms. METHOD In the study 4041 patients hospitalized and treated with psychotropic drugs in a psychiatric hospital took part. Dermatologic consultation was conducted in 340 patients, but only 98 were in monotherapy. This group was assessed with a next procedure: questionnaire regarding demographic dates, early and family dermatologic disorders, treatment with other than psychotropics--drugs, diet, addictions and analysis of medical documentation (psychiatric and dermatologic diagnosis, actual pharmacotherapy). RESULTS AND CONCLUSIONS 8.4% of the subjects had dermatologic symptoms, which were consulted by dermatologists. 1/2 of this group had their first treatment with psychotropics. Dermatologic symptoms appeared more often in patients treated with more than 2 psychotropics than in patients in monotherapy, usually in the first weeks of pharmacotherapy. Nearly 1/3rd of these subjects had allergic disorders. In subjects treated with psychotropics the most frequent dermatologic symptoms (allergic diseases, psoriasis and psoriasislike disorders) were noted after therapy with antipsychotics, next anxiolytics. In 3/4 patients treated with antidepressants had vascular diseases of the skin. In the whole group, dermatologic disorders appeared most frequently after treatment with BZD, phenothiazines and butyrophenones. New psychotropic drugs caused less dermatologic symptoms than typical antipsychotics and antidepressants.
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Affiliation(s)
- Ewa Murak-Kozanecka
- Ze Specjalistycznego Psychiatrycznego ZOZ Szpital im. J. Babińskiego w Łodzi
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Abstract
BACKGROUND Although recent research has focused on the possible role of antipsychotic medications in the development of diabetes mellitus, studies conducted in the pre-neuroleptic era suggest that schizophrenia itself might predispose individuals to diabetes. AIMS To test the hypothesis that diabetes mellitus is an integral part of schizophrenia. METHOD Historical literature review. RESULTS Many people with severe mental illnesses, including dementia praecox, showed abnormal responses to insulin and diabetes-like glucose tolerance curves long before the advent of phenothiazines. Early studies with chlorpromazine suggested that a latent tendency towards diabetes in patients with schizophrenia could be unmasked by this treatment. CONCLUSIONS Diabetes and disturbed carbohydrate metabolism may be an integral part of schizophrenia. Further research is required to explain how metabolic factors, medications and lifestyle factors might precipitate diabetes in patients with this mental disorder.
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Affiliation(s)
- Dora Kohen
- Lancashire Postgraduate School of Medicine and Health, Psychiatric Department, Mental Health Management Block, Leigh Infirmary, Leigh WN7 1HS, UK.
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Binggeli C, Candinas R, Brunckhorst C. Psychopharmaka und Herzrhythmusstörungen. Therapeutische Umschau 2004; 61:279-83. [PMID: 15137522 DOI: 10.1024/0040-5930.61.4.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Psychopharmaka verschiedener Stoffklassen werden seit vier Jahrzehnten mit Herzrhythmusstörungen assoziiert. Bis in die frühen 90er Jahre beschränkte sich das Problem scheinbar auf Intoxikationen oder auf Patienten mit vorbestehenden Herzerkrankungen. In den letzten zehn Jahren hat sich jedoch gezeigt, dass auch normal dosierte, nicht-kardiale Medikamente bei gesunden Personen unter bestimmten Umständen lebensbedrohliche Rhythmusstörungen auslösen können. Die Gemeinsamkeit dieser Medikamente ist die Eigenschaft, das QT-Intervall zu verlängern. Unter den Neuroleptika ist das niedrig potente Phenothiazin Thioridazin (Melleril) dafür am besten belegt. Auch von hochpotenten Neuroleptika existieren einige Berichte über proarrhythmische Eigenschaften. Während eine QT-Verlängerung auch bei neuen, atypischen Neuroleptika beschrieben wurde, sind Torsade de pointes und plötzliche Todesfälle bisher nur in Einzelfällen beschrieben worden. Medikamente mit Klasse I antiarrhythmischer Wirkung sind nach Myokardinfarkt potenziell gefährlich, und damit sollten trizyklische Antidepressiva mit ihrer Klasse I Wirkung bei ischämischer Herzkrankheit vermieden werden. Selektive Serotonin Re-uptake Inhibitoren können aufgrund bisher verfügbarer Daten bei dieser Patientengruppe als sicher bezeichnet werden. Bei Patienten mit vorbestehender QT-Verlängerung oder bei Patienten nach Torsade de pointes unter anderer Medikation sind Substanzen mit QT-verlängernder Wirkung zu vermeiden. Wechselwirkungen mit andern Medikamenten können sehr bedeutsam sein. Lithium ist bekannt für seine Sinusknoten- und Reizleitungsstörungen.
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Affiliation(s)
- C Binggeli
- HerzKreislaufZentrum, Kardiologie, DIM, Universitätsspital Zürich
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Lewis CL, Moutoux M, Slaughter M, Bailey SP. Characteristics of individuals who fell while receiving home health services. Phys Ther 2004; 84:23-32. [PMID: 14992674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Many patients receiving home health services are at risk for falling, but fall risk factors have not been previously investigated in this population. A retrospective record review was used to describe individuals who fell while being served by a home health agency. SUBJECTS The 98 individuals who fell while receiving home health services were compared with a random sample of 98 subjects served by the home health agency during the same period who did not report falling. METHODS Subjects were compared by age, sex, days of receiving home health services, number of falls prior to admission to the home health agency, diagnosis, medication category, home health services received, and type of health care coverage. In the group with falls, causes of falls and interventions were described. RESULTS The group with falls had comorbidities of neurological and cardiovascular impairment, took more medications associated with increased risk of falling, and had almost 3 times the number of falls prior to admission than the group without falls. DISCUSSION AND CONCLUSION Home care providers should consider medical history, medication usage, and fall history as risk factors for falls in the home environment.
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Affiliation(s)
- Cynthia L Lewis
- Department of Physical Therapy Education, Elon University, Campus Box 2085, Elon, NC 27244-2085, USA.
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Watanabe H, Tominaga K, Ogino A, Sekino K, Aoba A. [Dementia induced by antipsychotic drugs]. Nihon Rinsho 2004; 62 Suppl:466-9. [PMID: 15011407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Hiroyuki Watanabe
- Department of Neuropsychiatry, St. Marianna University School of Medicine
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Wen F, Tan J. Effects of phenothiazine drugs on serum levels of apolipoproteins and lipoproteins in schizophrenic subjects. Acta Pharmacol Sin 2003; 24:1001-5. [PMID: 14531942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
AIM To investigate the risk factors and clinical significance of blood-lipid metabolic disorder in schizophrenic patients caused by phenothiazine treatment for long term (from 1 month to 25 years). METHODS Serum levels of apolipoprotein AI (apoAI), apolipoprotein B (apoB), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TC) were measured in 120 chronic schizophrenia patients, 50 vascular dementia, and 100 normal controls by the enzyme method and immune fluoroscopy turbidimetric method. RESULTS The patients with schizophrenia and vascular dementia had significantly lower content of apoAI, HDL-C, and apoAI/apoB than those in normal control (P<0.01). Their apoB and TG levels were higher than the healthy control group (P<0.01). The TG contents in the negative group and the vascular dementia group were obviously higher than the positive group (P<0.01) while there was no marked difference between the TC levels in the three groups and the normal control group (P>0.05). CONCLUSION The chronic schizophrenic patients have a blood-lipid metabolic disorder by long-term intake of phenothiazine drugs. It is suggested that the traditional treatment with antipsychotic should reformed, and that drugs of degrading lipid and coagulation should be used to prevent and reduce the risk factors causing the onset of cardiovascular and cerebrovascular diseases and delay the development of the disturbance of intelligence and dementia.
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Affiliation(s)
- Fang Wen
- Institute of Neuropsychiatry, People's Hospital of Wuhan University, Wuhan 430060, China.
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Krasiuk MN. [Hepatotoxic effect of etacizin in acute pneumonia]. Lik Sprava 2003:93-4. [PMID: 14723147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The paper describes one acute toxic hepatitis event in a woman of 60 with pleuropneumonia and exudative pleurisy. She had been treated with ethacizinum in small dose. To solve the problem, antioxidant and drug with hepato protective action should be prescribed along with ethacizinum.
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Il'ina NI, Latysheva TV, Varfolomeeva MI. [Experience in clinical use of primalan (mequitazine) in allergology]. TERAPEVT ARKH 2003; 75:58-60. [PMID: 12793141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
AIM To study efficacy of primalan (mequitasine) in the treatment of allergic rhinoconjunctivitis and chronic recurrent urticaria. MATERIAL AND METHODS The study included 140 patients. Of them, 60 patients had allergic rhinitis, 80 patients had chronic recurrent urticaria. All the patients received primalan (mequitasin) in a dose 10 mg/day (5 mg twice daily or a single dose 10 mg). The disease symptoms and side effects of primalan were assessed for 28 days of the treatment. RESULTS Primalan (mequitasin) proved to be highly effective against allergic rhinitis (good and very good response--76%, satisfactory--20%) and chronic recurrent urticaria (the response in 90% patients). Good primalan tolerance was reported. Side effects were moderate and did not require the drug withdrawal (sleepiness in 6.6%, dryness of the mucosa in 5%). CONCLUSION Primalan (mequitasin) can be recommended for wide application in therapy of allergic rhinitis and chronic recurrent urticaria.
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Abstract
OBJECTIVE Restraint use is not monitored in the US, and only institutions that choose to do so collect statistics. In 1999, investigative journalists reported lethal consequences proximal to restraint use, making it a life-and-death matter that demands attention from professionals. This paper reviews the literature concerning actual and potential causes of deaths proximal to the use of physical restraint. METHOD Searching the electronic databases Medline, Cinahl, and PsycINFO, we reviewed the areas of forensics and pathology, nursing, cardiology, immunology, psychology, neurosciences, psychiatry, emergency medicine, and sports medicine. CONCLUSIONS Research is needed to provide clinicians with data on the risk factors and adverse effects associated with restraint use, as well as data on procedures that will lead to reduced use. Research is needed to determine what individual risk factors and combinations thereof contribute to injury and death.
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Affiliation(s)
- Wanda K Mohr
- Rutgers University, College of Nursing, Newark, New Jersey, USA.
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Raevskiĭ KS. [Antipsychotic agents: from phenothiazines to atypical neuroleptics of the second generation]. Eksp Klin Farmakol 2003; 66:6-9. [PMID: 12962040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The paper addresses evolution of the problem of creation, characterization of the pharmacological properties, and elucidation of the mechanisms of action of antipsychotic drugs (neuroleptics)--one of the most important classes of modern psychotropic drugs. The appearance of these drugs marked the onset of a new era in psychiatry, the era of psychopharmacology. Special attention is devoted to the investigations in this direction at the Institute of Pharmacology, which were headed by V. V. Zakusov.
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Affiliation(s)
- K S Raevskiĭ
- Zakusov Institute of Pharmacology, Russian Academy of Medical Sciences, Baltiiskaya ul. 8, Moscow, 125315 Russia
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