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Aschenbrenner DS. Stronger Warnings for Promethazine Hydrochloride Injection. Am J Nurs 2024; 124:22. [PMID: 38511703 DOI: 10.1097/01.naj.0001010556.28403.79] [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: 03/22/2024]
Affiliation(s)
- Diane S Aschenbrenner
- Diane S. Aschenbrenner is a former member of the faculty at Notre Dame of Maryland University and the Johns Hopkins University School of Nursing. She coordinates Drug Watch :
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Dike CM, Okere PCN. PROMETHAZINE-INDUCED THROMBOPHLEBITIS IN A NIGERIAN MAN: A CASE REPORT. West Afr J Med 2023; 40:S38. [PMID: 38070188] [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: 12/18/2023]
Abstract
Introduction Promethazine is a phenothiazine derivative that possesses antihistamine, anti-dopaminergic and anticholinergic properties. It is commonly used to treat motion sickness, allergic conditions, nausea and vomiting, in addition to its use as a sedative. Promethazine has vesicant properties and is highly caustic to the intima of blood vessels and surrounding tissues. Intravenous administration may result in thrombophlebitis, unintentional intra-arterial administration, perivascular extravasation and tissue necrosis. To the best of our knowledge there is no previous published report of promethazine-induced thrombophlebitis from sub- Saharan Africa. Case Report A 29-year-old Nigerian male was admitted at our hospital on account of malaria with acute gastroenteritis. Due to persistent vomiting, he was administered 25 mg of promethazine injection via a size 22G intravenous cannula which was inserted the previous day on the anteromedial aspect of his right forearm and maintained with continuous intravenous crystalloid infusion. Upon administration of promethazine, he experienced intense burning and erythema. The cannula was removed immediately, another cannula was inserted on the contralateral arm, and promethazine was replaced with ondansetron. Subsequently, he developed a tender, subcutaneous cord-like swelling extending from the middle-third of the anteromedial aspect of his right forearm, corresponding with the site of previous venous cannulation. Ultrasonography revealed a hypoechoic, non-compressible basilic vein, with no flow on colour Doppler interrogation, in keeping with superficial thrombophlebitis. He was treated with a topical anti-inflammatory agent, and the pain and redness subsided after four weeks. Conclusion The preferred parenteral route of administration of promethazine is deep intramuscular injection. Recommendations to prevent promethazine-induced thrombophlebitis include: use of large and patent veins, use of lower doses, drug dilution and slow administration, use of alternative therapies, and patient education. Promethazine-induced tissue injury is under-reported in this part of the world. Creating awareness through this case report would help reduce the morbidity following promethazine administration.
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Affiliation(s)
- Chinedu Michael Dike
- Department of Family Medicine, Niger Foundation Hospital and Diagnostic Centre, 5 Presidential close, Independence Layout, Enugu, Nigeria
| | - Philip Chinedu Ndubuisi Okere
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku- Ozalla Campus, Enugu, Nigeria
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Abeysundera H, Craig B, Pullich Z. Promethazine-induced delirium with perceptual abnormalities: are we thinking broadly when assessing patients? BMJ Case Rep 2021; 14:e241784. [PMID: 33858904 PMCID: PMC8054040 DOI: 10.1136/bcr-2021-241784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 03/27/2021] [Indexed: 11/04/2022] Open
Abstract
There is limited information about promethazine-induced delirium with psychotic symptoms. The aim is to highlight the importance of taking a detailed history including medication use/abuse of both prescribed, illicit and over-the-counter preparations. This paper describes a patient who presented with delirium in the context of overuse of promethazine (Phenergan) which was initially missed. The patient was treated successfully, following the diagnosis of promethazine-induced delirium. Clinicians should be aware of assessing patients presenting with delirium to explore the possibility of over-the-counter medication misuse.
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Affiliation(s)
- Hesitha Abeysundera
- Psychiatry, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Bailey Craig
- Psychiatry, Bond University, Robina, Queensland, Australia
| | - Zelle Pullich
- Psychiatry, Gold Coast University Hospital, Southport, Queensland, Australia
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Affiliation(s)
- Jenna M Moodley
- Jenna Moodley is a PGY-1 resident at Mount Carmel Health in Columbus, Ohio Julia Gardner is a PGY-1 resident at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio. Daniel Sheridan is medication safety pharmacist at OhioHealth Marion General Hospital in Marion, Ohio, and a member of the Nursing2020 editorial board
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Abstract
RATIONALE Promethazine is an antihistamine agent used commonly for nausea and allergy. Along with its anticholinergic and antidopaminergic functions, promethazine is also used for psychiatric symptoms, such as troubling sleep, anxiety, and agitation. Previous studies have reported that promethazine may occasionally elicit acute dystonia in some individuals, especially for young children and pregnant women. PATIENT CONCERNS The 68-year-old female patient was admitted to our hospital because of feeling anxious and intermittent palpitation for over 1 year. She developed acute orofacial dystonia following promethazine treatment. DIAGNOSES Her diagnoses was generalized anxiety disorder. INTERVENTIONS Discontinuation of the offending agent, promethazine, and injection of Botulinum toxin. OUTCOMES The acute orofacial dystonia was finally alleviated by local injection of Botulinum toxin. LESSONS Careful assessment of the risk of developing acute dystonia is also needed in old patients when initiating the promethazine treatment.
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Affiliation(s)
- Ruili Zhang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
- Brain Research Institute of Zhejiang University, Hangzhou, China
| | - Jinwen Huang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province
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Abstract
BACKGROUND Paediatric neurodiagnostic investigations, including brain neuroimaging and electroencephalography (EEG), play an important role in the assessment of neurodevelopmental disorders. The use of an appropriate sedative agent is important to ensure the successful completion of the neurodiagnostic procedures, particularly in children, who are usually unable to remain still throughout the procedure. OBJECTIVES To assess the effectiveness and adverse effects of chloral hydrate as a sedative agent for non-invasive neurodiagnostic procedures in children. SEARCH METHODS We used the standard search strategy of the Cochrane Epilepsy Group. We searched MEDLINE (OVID SP) (1950 to July 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 7, 2017), Embase (1980 to July 2017), and the Cochrane Epilepsy Group Specialized Register (via CENTRAL) using a combination of keywords and MeSH headings. SELECTION CRITERIA We included randomised controlled trials that assessed chloral hydrate agent against other sedative agent(s), non-drug agent(s), or placebo for children undergoing non-invasive neurodiagnostic procedures. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for their eligibility, extracted data, and assessed risk of bias. Results were expressed in terms of risk ratio (RR) for dichotomous data, mean difference (MD) for continuous data, with 95% confidence intervals (CIs). MAIN RESULTS We included 13 studies with a total of 2390 children. The studies were all conducted in hospitals that provided neurodiagnostic services. Most studies assessed the proportion of sedation failure during the neurodiagnostic procedure, time for adequate sedation, and potential adverse effects associated with the sedative agent.The methodological quality of the included studies was mixed, as reflected by a wide variation in their 'Risk of bias' profiles. Blinding of the participants and personnel was not achieved in most of the included studies, and three of the 13 studies had high risk of bias for selective reporting. Evaluation of the efficacy of the sedative agents was also underpowered, with all the comparisons performed in single small studies.Children who received oral chloral hydrate had lower sedation failure when compared with oral promethazine (RR 0.11, 95% CI 0.01 to 0.82; 1 study, moderate-quality evidence). Children who received oral chloral hydrate had a higher risk of sedation failure after one dose compared to those who received intravenous pentobarbital (RR 4.33, 95% CI 1.35 to 13.89; 1 study, low-quality evidence), but after two doses there was no evidence of a significant difference between the two groups (RR 3.00, 95% CI 0.33 to 27.46; 1 study, very low-quality evidence). Children who received oral chloral hydrate appeared to have more sedation failure when compared with music therapy, but the quality of evidence was very low for this outcome (RR 17.00, 95% CI 2.37 to 122.14; 1 study). Sedation failure rates were similar between oral chloral hydrate, oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam.Children who received oral chloral hydrate had a shorter time to achieve adequate sedation when compared with those who received oral dexmedetomidine (MD -3.86, 95% CI -5.12 to -2.6; 1 study, moderate-quality evidence), oral hydroxyzine hydrochloride (MD -7.5, 95% CI -7.85 to -7.15; 1 study, moderate-quality evidence), oral promethazine (MD -12.11, 95% CI -18.48 to -5.74; 1 study, moderate-quality evidence), and rectal midazolam (MD -95.70, 95% CI -114.51 to -76.89; 1 study). However, children with oral chloral hydrate took longer to achieve adequate sedation when compared with intravenous pentobarbital (MD 19, 95% CI 16.61 to 21.39; 1 study, low-quality evidence) and intranasal midazolam (MD 12.83, 95% CI 7.22 to 18.44; 1 study, moderate-quality evidence).No data were available to assess the proportion of children with successful completion of neurodiagnostic procedure without interruption by the child awakening. Most trials did not assess adequate sedation as measured by specific validated scales, except in the comparison of chloral hydrate versus intranasal midazolam and oral promethazine.Compared to dexmedetomidine, chloral hydrate was associated with a higher risk of nausea and vomiting (RR 12.04 95% CI 1.58 to 91.96). No other adverse events were significantly associated with chloral hydrate (including behavioural change, oxygen desaturation) although there was an increased risk of adverse events overall (RR 7.66, 95% CI 1.78 to 32.91; 1 study, low-quality evidence). AUTHORS' CONCLUSIONS The quality of evidence for the comparisons of oral chloral hydrate against several other methods of sedation was very variable. Oral chloral hydrate appears to have a lower sedation failure rate when compared with oral promethazine for children undergoing paediatric neurodiagnostic procedures. The sedation failure was similar for other comparisons such as oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam. When compared with intravenous pentobarbital and music therapy, oral chloral hydrate had a higher sedation failure rate. However, it must be noted that the evidence for the outcomes for the comparisons of oral chloral hydrate against intravenous pentobarbital and music therapy was of very low to low quality, therefore the corresponding findings should be interpreted with caution.Further research should determine the effects of oral chloral hydrate on major clinical outcomes such as successful completion of procedures, requirements for additional sedative agent, and degree of sedation measured using validated scales, which were rarely assessed in the studies included in this review. The safety profile of chloral hydrate should be studied further, especially the risk of major adverse effects such as bradycardia, hypotension, and oxygen desaturation.
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Affiliation(s)
- Choong Yi Fong
- Faculty of Medicine, University of MalayaDivision of Paediatric Neurology, Department of PaediatricsKuala LumpurMalaysia50603
| | - Chee Geap Tay
- Faculty of Medicine, University of MalayaDivision of Paediatric Neurology, Department of PaediatricsKuala LumpurMalaysia50603
| | - Lai Choo Ong
- Faculty of Medicine, University of MalayaDivision of Paediatric Neurology, Department of PaediatricsKuala LumpurMalaysia50603
| | - Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
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Kigen G, Busakhala N, Ogaro F, Chesire E, Saat N, Too R, Nyandiko W. A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants? PLoS One 2015; 10:e0142092. [PMID: 26540251 PMCID: PMC4634956 DOI: 10.1371/journal.pone.0142092] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature. Methods Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed. Results There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose. Conclusion The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers.
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Affiliation(s)
- Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
- * E-mail:
| | - Naftali Busakhala
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Francis Ogaro
- Department of Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Emily Chesire
- Department of Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Nathan Saat
- Department of Pharmacy, Moi University Health Services, Eldoret, Kenya
| | - Robert Too
- Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya
| | - Winstone Nyandiko
- Department of Child Health and Pediatrics, Moi University School of Medicine, Eldoret, Kenya
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Onifer DJ, Butler FK, Gross K, Otten EJ, Patton R, Russell RJ, Stockinger Z, Burrell E. Replacement of Promethazine With Ondansetron for Treatment of Opioid- and Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care. J Spec Oper Med 2015; 15:17-24. [PMID: 26125161 DOI: 10.55460/23qe-hgo7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 06/04/2023]
Abstract
The current Tactical Combat Casualty Care (TCCC) Guidelines recommend parenteral promethazine as the single agent for the treatment of opioid-induced nausea and/or vomiting and give a secondary indication of "synergistic analgesic effect." Promethazine, however, has a well-documented history of undesired side effects relating to impairment and dysregulation of the central and autonomic nervous systems, such as sedation, extrapyramidal symptoms, dystonia, impairment of psychomotor function, neuroleptic malignant syndrome, and hypotension. These may be particularly worrisome in the combat casualty. Additionally, since 16 September 2009, there has been a US Food and Drug Administration (FDA) black box warning for the injectable form of promethazine, due to "the risk of serious tissue injury when this drug is administered incorrectly." Conversely, ondansetron, which is now available in generic form, has a well-established favorable safety profile and demonstrated efficacy in undifferentiated nausea and vomiting in the emergency department and prehospital settings. It has none of the central and autonomic nervous system side effects noted with promethazine and carries no FDA black box warning. Ondansetron is available in parenteral form and an orally disintegrating tablet, providing multiple safe and effective routes of administration. Despite the fact that it is an off-label use, ondansetron is being increasingly given for acute, undifferentiated nausea and vomiting and is presently being used in the field on combat casualties by some US and Allied Forces. Considering the risks involved with promethazine use, and the efficacy and safety of ondansetron and ondansetron?s availability in a generic form, we recommend removing promethazine from the TCCC Guidelines and replacing it with ondansetron.
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Yasnetsov VV, Karsanova SK, Yasnetsov VV. [A new approach to the search for vestibuloprotectors]. Aviakosm Ekolog Med 2015; 49:5-12. [PMID: 25958460] [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: 06/04/2023]
Abstract
The results of experimental clinical testing of the antinaupathia action of as new compounds, so motion sickness medications (promethazine, ikaron-1 etc.) are presented. Russian medication mexidol, a derivative of 3-hydroxypyridine (3-HP) demonstrated the ability to control motion sickness in humans and animals; however, unlike reference vestibuloprotector scopolamine, it does not practically produce side-effects. Mexidol acts through ion pathways with the involvement of glutamate and GABA-ergic components. Revealed 9 of new 3-HP derivates with an antimotion sickness effect in rats, three exceeded in efficacy mexidol, and also reference medications (i.e. scopolamine and promethazine). Melatonin achieves a better vestiboloprotective effect in rats than promethazine and melatonin-ergic antidepressant agomelatine through the involvement of melatonin MT1-, MT2- and GABA(A)-receptors. Also, combinations of melatonin with mexidol or promethazine possess a distinct vestibuloprotective effect, as melatonin enhances the action of equally mexidol and promethazine. Analysis of our results and investigations of other authors infer that search for potent vestibuloprotectors should be extended to new 3-HP derivatives and melatoninergic compounds. Individual medications by themselves and in combinations can become a solution to the problem.
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Cantisani C, Ricci S, Grieco T, Paolino G, Faina V, Silvestri E, Calvieri S. Topical promethazine side effects: our experience and review of the literature. Biomed Res Int 2013; 2013:151509. [PMID: 24350243 PMCID: PMC3852816 DOI: 10.1155/2013/151509] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/19/2013] [Accepted: 09/24/2013] [Indexed: 12/13/2022]
Abstract
Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects. The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.
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Affiliation(s)
- C. Cantisani
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - S. Ricci
- Section of Legal Medicine, Department of Anatomical, Histological, Medical Legal and Locomotive System Sciences, University of Rome “Sapienza”, Viale Regina Elena 336, 00161 Rome, Italy
| | - T. Grieco
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - G. Paolino
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - V. Faina
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - E. Silvestri
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - S. Calvieri
- Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Agnich LE, Stogner JM, Miller BL, Marcum CD. Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures. Addict Behav 2013; 38:2445-9. [PMID: 23688907 DOI: 10.1016/j.addbeh.2013.03.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 09/14/2012] [Revised: 02/05/2013] [Accepted: 03/27/2013] [Indexed: 11/29/2022]
Abstract
A mixture of codeine cough syrup with alcohol and/or a soft drink known as "purple drank" has gained media attention in recent years as a drug associated with professional athletes and southern rap music. The existing research on purple drank consumption has primarily utilized samples of African Americans residing in the Houston, Texas area. This is the first scholarly study of purple drank use outside of the Houston, Texas area among a general population of young adults, and indicates that purple drank use is not limited to African American males. The findings depict higher odds of the use of purple drank among other racial and ethnic groups, males, and homosexual, bisexual, and transgender college students from urban areas.
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Affiliation(s)
- Laura E Agnich
- Department of Criminal Justice and Criminology, Georgia Southern University, P.O. Box 8105, Statesboro, GA 30460-8105, United States.
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Duke JD, Han X, Wang Z, Subhadarshini A, Karnik SD, Li X, Hall SD, Jin Y, Callaghan JT, Overhage MJ, Flockhart DA, Strother RM, Quinney SK, Li L. Literature based drug interaction prediction with clinical assessment using electronic medical records: novel myopathy associated drug interactions. PLoS Comput Biol 2012; 8:e1002614. [PMID: 22912565 PMCID: PMC3415435 DOI: 10.1371/journal.pcbi.1002614] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 06/02/2012] [Indexed: 11/18/2022] Open
Abstract
Drug-drug interactions (DDIs) are a common cause of adverse drug events. In this paper, we combined a literature discovery approach with analysis of a large electronic medical record database method to predict and evaluate novel DDIs. We predicted an initial set of 13197 potential DDIs based on substrates and inhibitors of cytochrome P450 (CYP) metabolism enzymes identified from published in vitro pharmacology experiments. Using a clinical repository of over 800,000 patients, we narrowed this theoretical set of DDIs to 3670 drug pairs actually taken by patients. Finally, we sought to identify novel combinations that synergistically increased the risk of myopathy. Five pairs were identified with their p-values less than 1E-06: loratadine and simvastatin (relative risk or RR = 1.69); loratadine and alprazolam (RR = 1.86); loratadine and duloxetine (RR = 1.94); loratadine and ropinirole (RR = 3.21); and promethazine and tegaserod (RR = 3.00). When taken together, each drug pair showed a significantly increased risk of myopathy when compared to the expected additive myopathy risk from taking either of the drugs alone. Based on additional literature data on in vitro drug metabolism and inhibition potency, loratadine and simvastatin and tegaserod and promethazine were predicted to have a strong DDI through the CYP3A4 and CYP2D6 enzymes, respectively. This new translational biomedical informatics approach supports not only detection of new clinically significant DDI signals, but also evaluation of their potential molecular mechanisms.
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Affiliation(s)
- Jon D. Duke
- Regenstrief Institute, Indianapolis, Indiana, United States of America
| | - Xu Han
- Department of Pharmacology and Toxicology, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Zhiping Wang
- Center for Computational Biology and Bioinformatics; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Abhinita Subhadarshini
- Center for Computational Biology and Bioinformatics; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Shreyas D. Karnik
- Center for Computational Biology and Bioinformatics; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Xiaochun Li
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Stephen D. Hall
- Eli Lilly Inc., Indianapolis, Indiana, United States of America
| | - Yan Jin
- Eli Lilly Inc., Indianapolis, Indiana, United States of America
| | - J. Thomas Callaghan
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | | | - David A. Flockhart
- Department of Pharmacology and Toxicology, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Center for Computational Biology and Bioinformatics; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Indiana Institute of Personalized Medicine, School of Medicine, Indianapolis, Indiana, United States of America
| | - R. Matthew Strother
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Division of Hematology and Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Sara K. Quinney
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Indiana Institute of Personalized Medicine, School of Medicine, Indianapolis, Indiana, United States of America
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Lang Li
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Center for Computational Biology and Bioinformatics; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Indiana Institute of Personalized Medicine, School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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Injectable promethazine: gangrene. Prescrire Int 2010; 19:216-7. [PMID: 21188805] [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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Xu FL, Zhang YM, Jin YJ. [Promethazine should not be used for infants]. Zhonghua Er Ke Za Zhi 2010; 48:557. [PMID: 21055103] [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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Wang XC, Hong JG, Yang XQ. [Discussions on the use of promethazine]. Zhonghua Er Ke Za Zhi 2010; 48:557-558. [PMID: 21055102] [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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Schröder S, Surmann P. Photoallergenic potential testing by online irradiation and HPLC. Pharmazie 2010; 65:339-342. [PMID: 20503925] [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: 05/29/2023]
Abstract
A simple screening method was developed for testing the photoallergenic potential of drugs. The photolysis of the drugs under UV-A irradiation was investigated in aqueous buffer solution alone and in combination with a model dipeptide. As an useful tool for this, high performance liquid chromatography (HPLC) based on an automated column-switching system with aqueous online UV-A irradiation was used. For testing the system, hydrochlorothiazide (HC) with well-known photoallergenic properties was used as a drug and alanyltryptophane (ALATRP) as a model for proteins. Promethazine (PMZ) as a second drug was investigated by the developed screening system. The screening was performed at pH 3 and pH 7. Both cleavage of the peptide binding and formation of new products could indicate a photoallergenic potential.
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Affiliation(s)
- S Schröder
- Department of Pharmacy, Free University of Berlin, Germany
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Affiliation(s)
- George J Annas
- Department of Health Law, Bioethics, and Human Rights, Boston University School of Public Health, Boston, USA
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Nair P. Recent developments in health law. Wyeth v. Levine: challenging implied pre-emption for drugs. J Law Med Ethics 2009; 37:527-530. [PMID: 19791315] [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: 05/28/2023]
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Bártfai Z, Kocsis J, Puhó EH, Czeizel AE. A population-based case-control teratologic study of promethazine use during pregnancy. Reprod Toxicol 2007; 25:276-85. [PMID: 18272326 DOI: 10.1016/j.reprotox.2007.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 11/20/2007] [Accepted: 12/19/2007] [Indexed: 11/19/2022]
Abstract
Objective of the study was to investigate the teratogenic effect of oral promethazine, a phenothiazine derivate in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities during the years 1980-1996. Of 22,843 cases with 25 congenital abnormalities, 3648 (16.0%) were born to mothers treated orally with promethazine during pregnancy. Of 38,151 matched population controls without congenital abnormalities, 6025 (15.8%) had mothers with promethazine treatment during the study pregnancy. Of 834 malformed controls (Down syndrome), 142 (17.0%) had mothers with treatment of promethazine in the study pregnancy. The case-all matched population controls analysis showed a higher rate of cleft lip+/-cleft palate (adjusted OR with 95% CI: 1.5, 1.1-2.0) and poly/syndactyly (OR with 95% CI: 1.3, 1.0-1.8) after promethazine treatment during the 2nd and 3rd months of gestation. However, these risks were explained by recall bias, because these associations were not confirmed after the evaluation of only medically recorded promethazine uses. The comparison of promethazine treatment between 25 congenital abnormality groups and malformed controls did also not show any risk. Thus, the overall evidence from analysis presented did not suggest that clinical doses of promethazine increased the rate of congenital abnormalities in humans.
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Affiliation(s)
- Zoltán Bártfai
- Semmelweis University, School of Medicine, Department of Respiratory Medicine, Hungary
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Arrue I, Rosales B, Ortiz de Frutos FJ, Vanaclocha F. [Photoaggravated eczema due to promethazine cream]. Actas Dermosifiliogr 2007; 98:717-718. [PMID: 18035034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Abstract
Following ten years of continuous olanzapine therapy a 51 years old man developed a Gilles de la Tourette syndrome which disappeared after changing to amisulprid. The Tourette-syndrome will be attributed to a tardive dyskinesia induced by olanzapine.
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Affiliation(s)
- Susan Paparella
- Consulting Services, Institute for Safe Medication Practices (ISMP), Huntingdon Valley, PA 19006, USA.
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Promethazine and sudden infant death. Prescrire Int 2006; 15:226. [PMID: 17171816] [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: 05/13/2023]
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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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Al Khaja KAJ, Al-Ansari TM, Sequeira RP, Damanhori AHH. Use of promethazine in infants in primary care. Int J Clin Pharmacol Ther 2006; 44:393-4. [PMID: 16961170 DOI: 10.5414/cpp44393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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[Use of promethazine in pediatric asthmatic disorders]. Zhonghua Er Ke Za Zhi 2006; 44:477; discussion 478. [PMID: 16836869] [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: 05/10/2023]
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Keene JR, Buckley KM, Small S, Geldzahler G. Accidental Intra-Arterial Injection: A Case Report, New Treatment Modalities, and a Review of the Literature. J Oral Maxillofac Surg 2006; 64:965-8. [PMID: 16713815 DOI: 10.1016/j.joms.2005.11.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- John R Keene
- Division of Oral and Maxillofacial Surgery, New York Medical College, Valhalla, NY 10595, USA.
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Affiliation(s)
- Darren Braude
- Department of Emergency Medicine, MSC 10-5560, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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van der Hooft CS, Jong GW', Dieleman JP, Verhamme KMC, van der Cammen TJM, Stricker BHC, Sturkenboom MCJM. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria--a population-based cohort study. Br J Clin Pharmacol 2006; 60:137-44. [PMID: 16042666 PMCID: PMC1884923 DOI: 10.1111/j.1365-2125.2005.02391.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [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: 11/29/2022] Open
Abstract
BACKGROUND In 1997, Beers and colleagues developed explicit criteria for potentially inappropriate drug prescribing in ambulatory older adults aged 65 years and over. Several studies have been performed to estimate the prevalence of inappropriate drug prescribing based on these criteria. In 2002, the criteria were updated. AIMS To examine the extent and trend of inappropriate drug prescribing to ambulatory older adults in the Netherlands between 1997 and 2001, according to the 1997 and the updated Beers criteria. METHODS Data were retrieved from the Integrated Primary Care Information (IPCI) project, a general practice research database with data from computer-based patient records of a group of 150 general practitioners in the Netherlands. All subjects aged 65 and over were included. Prescriptions were classified as inappropriate if they fulfilled the Beers criteria of prescriptions that generally should be avoided in older adults because of a high risk of adverse effects, while also considering dose and comorbidity. RESULTS Between 1997 and 2001, the 1-year risk of receiving at least one inappropriate drug prescription for older adults ranged between 16.8% (95% CI: 16.3-17.3%) and 18.5% (18.3-18.7%) according to the 1997 criteria and between 19.1% (18.6-19.6%) and 20.0% (19.5-20.5%) according to the updated Beers criteria. According to the updated criteria, the most frequently prescribed inappropriate drugs were nitrofurantoin, long-acting benzodiazepines, amitriptyline, promethazine and cimetidine. Temazepam and zolpidem were mostly prescribed in supratherapeutic dose. Conventional NSAIDs in persons with a history of gastric/duodenal ulcer were the most frequently prescribed contra-indicated drugs. CONCLUSIONS Prescribing potentially inappropriate prescriptions to ambulatory older people in the Netherlands is substantial. Compared with other studies using the 1997 Beers criteria, inappropriate prescribing to the elderly is lower than in the USA but similar to Finland. Despite a restrictive medication policy and a growing attention for medication surveillance in Europe, inappropriate drug prescribing is still a substantial problem.
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Affiliation(s)
- Cornelis S van der Hooft
- Pharmaco-epidemiology Unit, Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, The Netherlands
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Habib AS, Breen TW, Gan TJ. Comment: promethazine adverse events after implementation of a medication shortage interchange. Ann Pharmacother 2005; 39:1370; author reply 1370-1. [PMID: 15956221 DOI: 10.1345/aph.1e361a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dong ZQ. [An answer to the question: can promethazine be routinely used in asthmatic disease in childhood?]. Zhonghua Er Ke Za Zhi 2005; 43:506. [PMID: 16083550] [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: 05/03/2023]
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Abstract
We report the case of a multiple fixed drug eruption (FDE) after taking 1 g of PL and 100 mg of levofloxacin (Cravit) at the same time. Patch tests with PL alone, levofloxacin alone and the combination of PL and levofloxacin were all negative on the involved and uninvolved sites. Lymphocytic stimulation tests were also negative for PL alone, levofloxacin alone and the combination of PL and levofloxacin. Oral provocation tests with PL alone or levofloxacin alone produced no reactivation. However, we could provoke multiple erythematous plaques on the involved areas by taking a 1/10th dose of the combination of PL and levofloxacin at the same time. Drug eruption due to a drug combination appears to be very rare. This is the first case of multiple FDE caused by taking PL-levofloxacin combination.
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Affiliation(s)
- A Yokoyama
- Department of Dermatology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-0032, Japan.
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Abstract
BACKGROUND Prochlorperazine and droperidol were commonly used antiemetics at the University of Pittsburgh Medical Center-Presbyterian Hospital until a shortage of prochlorperazine occurred and a black box warning was added to droperidol prescribing information. Subsequently, promethazine was selected as the approved intravenous antiemetic for therapeutic interchange in December 2001. Promethazine use and adverse drug events (ADEs) were investigated following review of a serious ADE that identified promethazine use as a probable contributing factor. OBJECTIVE To illustrate ADEs associated with promethazine and characterize high-risk patients. METHODS An ADE database analysis identified promethazine ADEs reported from 2000 to 2003. Promethazine utilization and ADEs were compared with those of other antiemetics during the pre- and post-interchange periods. RESULTS Promethazine utilization increased significantly during the post-interchange period compared with all other antiemetics (p < 0.001). Promethazine ADEs increased from one event during the pre-interchange period to 13 events during the post-interchange period. Causality assessment using the Naranjo algorithm ranged from possible to probable. The promethazine ADE rate per 10 000 doses was significantly higher than the combined ADE rate for all other antiemetics (p < 0.001; incident rate ratio [IRR] 4.32). Elderly patients (aged > or =65 y) experienced more promethazine ADEs than younger patients (p = 0.005; IRR 4.68). Concurrent use of opioids and/or sedating drugs contributed to promethazine ADEs in 11 of 14 (78.6%) patients. CONCLUSIONS Geriatric status is a significant risk factor for promethazine ADEs. Concomitant use of sedating drugs may further increase the risk for ADEs. Therapeutic interchange programs should be monitored for both ADEs and utilization.
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Affiliation(s)
- Heena S Sheth
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582, USA.
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Paule MG, Chelonis JJ, Blake DJ, Dornhoffer JL. Effects of drug countermeasures for space motion sickness on working memory in humans. Neurotoxicol Teratol 2004; 26:825-37. [PMID: 15451046 DOI: 10.1016/j.ntt.2004.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 07/06/2004] [Accepted: 07/06/2004] [Indexed: 11/17/2022]
Abstract
Space motion sickness (SMS) is a problem during the first 72 h of space flight and during transitions from different gravity environments. There currently are no effective drug countermeasures for SMS that also accommodate the retention of optimal cognitive function. This creates a dilemma for astronauts because cognitive skills are particularly important during gravity transitions (e.g., take-off and landing). To quantify the cognitive side effects of potential drug countermeasures, an automated delayed matching-to-sample (DMTS) procedure was used to assess visual working memory before and after drug countermeasures (meclizine 25 mg, scopolamine 0.4 mg, promethazine 25 mg, or lorazepam 1 mg, given orally approximately 45 min prior to testing) and/or the induction of SMS by vestibular stimulation in a rotary chair (spinning). Sixty-seven normal healthy volunteers (mean age, in years, 26.6+/-4.8 S.D.; 24 females and 43 males) each participated in two test sessions, one 'off' drug and one 'on' drug. Spinning by itself significantly decreased task accuracy (Acc) and choice response speed, especially at longer recall delays. Meclizine alone had no effect on Acc or speed with or without spinning. Scopolamine alone decreased Acc, and with spinning, slowed speed. Promethazine alone had no adverse effect, but combined with spinning, decreased Acc and speed. Lorazepam alone decreased speed, and with spinning, decreased Acc. The data suggest that, at clinically useful doses, the rank order of the drugs with the best cognitive profiles is meclizine>scopolamine>promethazine>lorazepam.
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Affiliation(s)
- Merle G Paule
- Behavioral Toxicology Laboratories, Division of Neurotoxicology, HFT-132, USFDA's National Center for Toxicological Research, 3900 NCTR Road, Jefferson, AR 72079-9502, USA.
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Chia YY, Lo Y, Liu K, Tan PH, Chung NC, Ko NH. The effect of promethazine on postoperative pain: a comparison of preoperative, postoperative, and placebo administration in patients following total abdominal hysterectomy. Acta Anaesthesiol Scand 2004; 48:625-30. [PMID: 15101860 DOI: 10.1111/j.1399-6576.2004.00369.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [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: 11/28/2022]
Abstract
BACKGROUND Histamine receptors are involved in the development of inflammatory pain and hyperalgesia, and the use of antihistamines is advocated as an alternative for pain therapy and treatment of postoperative nausea and vomiting. We investigated the influence of timing of promethazine administration on postoperative pain outcomes. METHODS Ninety female patients undergoing total abdominal hysterectomy were randomly divided into three groups. All individuals received infusions of promethazine and normal saline before anaesthesia induction, and postoperatively the Pre group received promethazine 0.1 mg kg(-1) before anaesthesia and saline postoperatively, and the Post group received saline before anaesthesia and promethazine 0.1 mg kg(-1) postoperatively, while the Control group received two equivalent volumes of saline. Patients were treated using patient-controlled intravenous analgesia (PCA). The primary endpoint was pain intensity and morphine consumption. The secondary endpoint was postoperative nausea and vomiting. RESULTS Postoperative morphine usage was significantly lower in the Pre group (24.1 +/- 3.9 mg) relative to the Post (30.0 +/- 4.6 mg) and Control groups (32.1 +/- 4.8 mg) during the first 24 h postoperatively (P<0.05). The number and incidence of patients suffering from postoperative nausea in the first 24 h was six (21%), seven (23%), and 15 (47%) in the Pre, Post, and Control groups, respectively (P<0.05). The number and incidence of patients vomiting in the first 24 h was three (10%), two (7%), and 10 (32%) in the Pre, Post, and Control groups, respectively (P<0.05). The number of patients asking for rescue antiemetic in the first 24 h was one (3%), two (7%), and seven (22%) in the Pre, Post, and Control groups, respectively (P<0.05). CONCLUSIONS Our results suggest that preoperative administration of promethazine 0.1 mg kg(-1) reduces postoperative morphine consumption compared with postoperative and placebo administration, and that use of promethazine reduces PONV and the number of patients asking for rescue antiemetic in the first 24 h after surgery when compared with placebo.
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Affiliation(s)
- Y Y Chia
- Department of Anaesthesiology, Kaohsiung Veterans General Hospital and School of Medicine, National Yang-Ming University, Kaohsiung, Taiwan.
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Oduola OO, Happi TC, Gbotosho GO, Ogundahunsi OAT, Falade CO, Akinboye DO, Sowunmi A, Oduola AMJ. Plasmodium berghei: efficacy and safety of combinations of chloroquine and promethazine in chloroquine resistant infections in gravid mice. Afr J Med Med Sci 2004; 33:77-81. [PMID: 15490800] [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: 05/01/2023]
Abstract
Efficacy and safety of combinations ofChloroquine (CQ) and doses of Promethazine (PR) against CQ resistant Plasmodium berghei infections in gravid mice was evaluated. Parasites were cleared faster in mice treated with CQ combined with doses of PR ranging from 20mg/kg to 50mg/kg (3.4 +/- 0.5 to 2.7 +/- 0.7) compared with CQ alone (4.7 +/- 0.8) (P<0.5). Parturition resulting in live pups in animals treated with CQ and 20mg/ kg and 30mg/kg of PR (81%) was significantly higher than in animals treated with CQ alone (44%) or saline (13%). Mean birth weight of pups delivered by infected gravid animals treated with CQ and 30mg/kg or 40mg/kg of PR (1.51 +/- 0.16 or 1.56 +/- 0.16) was significantly higher than animals treated with CQ alone (1.33 +/- 0.13) (P=0.00004, 0.0014 respectively). No gross malformations were observed in pups delivered by infected or non-infected animals treated with the combinations of chloroquine and Promethazine.
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Affiliation(s)
- O O Oduola
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
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MI: did nurse's administration of drug injure pt.?: failure to meet 'more probable than not' test. Nurs Law Regan Rep 2004; 44:3. [PMID: 15085701] [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: 04/29/2023]
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TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ 2003; 327:708-13. [PMID: 14512476 DOI: 10.1136/bmj.327.7417.708] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2003] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare two widely used drug treatments for people with aggression or agitation due to mental illness. DESIGN Pragmatic, randomised clinical trial. SETTING Three psychiatric emergency rooms in Rio de Janeiro, Brazil. SUBJECTS 301 aggressive or agitated people. INTERVENTIONS Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine. MAIN OUTCOME MEASURES Patients tranquil or sedated at 20 minutes. SECONDARY OUTCOMES patients tranquil or asleep by 40, 60, and 120 minutes; restrained or given extra drugs within 2 hours; severe adverse events; another episode of agitation or aggression; needing extra visits from doctor during first 24 hours; overall antipsychotic load in first 24 hours; and not discharged by two weeks. RESULTS 151 patients were randomised to midazolam, and 150 to haloperidol-promethazine mix. Follow up for the primary outcome was available for 298 (99%): 134/151 (89%) of patients given midazolam were tranquil or asleep after 20 minutes compared with 101/150 (67%) of those given haloperidol plus promethazine (relative risk 1.32 (95% confidence interval 1.16 to 1.49)). By 40 minutes, midazolam still had a statistically and clinically significant 13% relative advantage (1.13 (1.01 to 1.26)). After 1 hour, about 90% of both groups were tranquil or asleep. One important adverse event occurred in each group: a patient given midazolam had transient respiratory depression, and one given haloperidol-promethazine had a grande mal seizure. CONCLUSIONS Both treatments were effective. Midazolam was more rapidly sedating than haloperidol-promethazine, reducing the time people are exposed to aggression. Adverse effects and resources to deal with them should be considered in the choice of the treatment.
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Supiyaphun P, Kerekhanjananarong V, Saengpanich S, Cutchavaree A. Treatment of the common cold. J Med Assoc Thai 2003; 86 Suppl 2:S362-72. [PMID: 12930012] [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
BACKGROUND Common colds are usually treated by the patients themselves with over-the-counter (OTC) cold medications. Many cough and cold remedies are available and sold freely without prescription. The authors conducted a study to compare the efficacy, adverse effects, the quality of life (QOL) and the patient's opinion and appreciation on the drugs (POD) between Dayquil/Nyquil and Actifed DM plus paracetamol syrup. METHOD In this prospective, investigator-blinded clinical trial, 120 patients, aged between 15 and 60 years old, with common colds within 72 hours, who accepted the trial and gave informed written consent, were randomized into two treatment groups. One patient was excluded due to evidence of bacterial infection. Fifty-nine patients were treated with Dayquil/Nyquil (D/N group), while the other 60 patients had Actifed DM plus paracetamol (ADM/P group) for three days. On day 1 the patient's demographic data (sex, age, body weight, blood pressure, co-existing diseases/conditions, drug use, and allergy to any drugs), the most prominent symptoms and its duration were recorded. All patients were screened for bacterial infection by physical examination, complete blood count and sinus radiographs. The symptoms (nasal obstruction, rhinorrhea, sneezing, cough, sore throat, fever and headache) and signs (injected nasal mucosa, nasal discharge and pharyngeal discharge) were scored, based on 4-point scale (0 to 3), on days 1 and 4. Changing of the symptoms and QOL were recorded on the diary card. The patient's opinion and appreciation on the drugs (POD) was assessed on day 4. The effectiveness (the ability to lessen the symptoms and signs), QOL and POD between two treatments were compared. RESULTS The demographic data between the two groups were similar. The four most common prominent symptoms of common colds in our series were cough (47.9%), sore throat (26.17%), rhinorrhea (8.4%) and headache (8.4%). However, both treatments were equally effective in lessening the symptoms (P = 0.426) and signs (P = 0.716) of common cold from days 1 to 4. The adverse effects were significantly higher in ADM/P group than in D/N group (p = 0.006). In contrast, QOL in terms of alertness, freshness and sound sleep improved from day 1 to day 3 in both treatments, but the overall day-3 score was significantly higher in the D/N group than the ADM/P group (1.85 +/- 1.83; 1.25 +/- 1.94: p = 0.024). POD in terms of convenience, flavour of drug, effectiveness of the drug and a need to repeat the drug assessed on day 4, was also significantly higher in the D/N group than the ADM/P group (10.68 +/- 2.56; 8.92 +/- 2.27: p < 0.001). CONCLUSION Dayquil/Nyquil are as effective as Actifed DM plus paracetamol in controlling the symptoms and signs of the common cold, but have fewer adverse effects. The quality of life assessed during the use of the drugs was significantly higher in the Dayquil/Nyquil group, and according to the patients, they prefered Dayquil/Nyquil more than Actifed DM plus paracetamol.
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Affiliation(s)
- Pakpoom Supiyaphun
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Ng EHY, Miao B, Ho PC. Anxiolytic premedication reduces preoperative anxiety and pain during oocyte retrieval. A randomized double-blinded placebo-controlled trial. Hum Reprod 2002; 17:1233-8. [PMID: 11980744 DOI: 10.1093/humrep/17.5.1233] [Citation(s) in RCA: 21] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of anxiolytic premedication remains unclear and significant postoperative side-effects may result from routine use. METHODS In this double-blinded study, 100 infertile patients were randomized on the day of ultrasound-guided oocyte retrieval (TUGOR) by a computer-generated randomization list in sealed envelopes to receive either (i) 50 mg pethidine and 25 mg promethazine (premedication group) or (ii) normal saline (placebo group) i.m. 30 min prior to TUGOR. Anxiety level, pain levels and severity of postoperative side-effects were recorded. RESULTS No differences were seen in demographic data, TUGOR duration, number of follicles punctured and clinical outcome. Preoperative anxiety level was significantly higher than the basal anxiety level in the placebo group only. The vaginal and abdominal pain levels during TUGOR and 4 h after TUGOR were significantly higher in the placebo group than the premedication group. Significantly more patients complained of drowsiness after TUGOR in the premedication group than the placebo group and other side-effects were comparable in both groups. CONCLUSION Routine use of anxiolytic premedication prevented an increase of preoperative anxiety level, reduced pain levels during oocyte retrieval but was associated with a higher percentage of moderate/severe drowsiness in the postoperative period.
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Affiliation(s)
- Ernest Hung Yu Ng
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China.
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Radev P. [The activity of enzymes and free radical oxidation in acute and chronic fetal hypoxia in general anesthesia during cesarean section]. Akush Ginekol (Sofiia) 2002; 41:12-6. [PMID: 12577498] [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: 04/20/2023]
Abstract
The following study dwells on a basic problem in obstetrics anaesthesia. It shows a present view of the in NLA and ataractics having effect on free radical oxygenation process in mother-fetus system in Cesarean section. 101 pregnant women have been studied as the values of FROq serum antioxygenase activityq serum enzymes activity in women blood and in blood of umbilical cord have been compared.
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Affiliation(s)
- P Radev
- ICU-University Hospital-Pleven
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Affiliation(s)
- T F Tong
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
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