RESUMEN
INTRODUCTION: Vitamin B6 is contained in a number of over-the-counter drugs and vitamin supplements. It may cause severe neurological troubles in case of overdosage. CASE REPORT: We report the case of a 92-year-old women with gait disorders. A diagnosis of peripheral neuropathy with both motor and sensitive deficits was established and investigated. Blood level of vitamin B6 was measured to investigate a potential deficiency. Unexpectedly, the results showed hypervitaminosis B6, which appears to be due to self-administration of an over-the-counter drug containing vitamin B6. Discontinuation of this drug was associated with decrease in vitamin B6 level as well as gait improvement. We also discuss the toxicity of vitamin B6. CONCLUSION: Hypervitaminosis B6 remains a possible cause of peripheral neuropathy and it may be caused by self-administration of over-the-counter vitamin-containing drugs.
Asunto(s)
Trastornos Neurológicos de la Marcha/inducido químicamente , Trastornos Nutricionales/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Automedicación/efectos adversos , Vitamina B 6/toxicidad , Anciano de 80 o más Años , Suplementos Dietéticos/toxicidad , Sobredosis de Droga/complicaciones , Sobredosis de Droga/diagnóstico , Femenino , Trastornos Neurológicos de la Marcha/sangre , Humanos , Síndromes de Neurotoxicidad/diagnóstico , Síndromes de Neurotoxicidad/etiología , Trastornos Nutricionales/diagnóstico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Vitamina B 6/administración & dosificación , Vitamina B 6/efectos adversos , Vitamina B 6/sangreRESUMEN
Beta-blockers are widely prescribed in elderly patients and may induce severe adverse drug reactions. We report a case of bisoprolol-induced bradycardia in an elderly patient with impaired renal function and use of cytochrome P450 inhibitors. A literature review has been performed in order to analyze pharmacokinetic risk factors of beta-blockers overdosing in geriatrics. Various mechanisms can result in decreased elimination of beta-blockers. These mechanisms vary according to the beta-blocker agent and may be combined in some individuals, especially elderly patients. This can lead to unexpected overexposure. Knowledge about drug interactions and pharmacokinetic elimination pathways is important for preventing overexposure and adverse drug reactions when using beta-blockers.
Asunto(s)
Antagonistas Adrenérgicos beta/efectos adversos , Envejecimiento , Bisoprolol/efectos adversos , Bradicardia/inducido químicamente , Interacciones Farmacológicas , Sobredosis de Droga , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/farmacocinética , Anciano de 80 o más Años , Fibrilación Atrial/tratamiento farmacológico , Bisoprolol/administración & dosificación , Bisoprolol/farmacocinética , Depresión/tratamiento farmacológico , Femenino , Humanos , Isquemia Miocárdica/tratamiento farmacológico , Paraproteinemias/tratamiento farmacológico , Insuficiencia Renal Crónica/tratamiento farmacológico , Factores de RiesgoAsunto(s)
Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/uso terapéutico , Piracetam/análogos & derivados , Anciano de 80 o más Años , Nivel de Alerta , Electroencefalografía , Geriatría , Humanos , Inyecciones Subcutáneas , Levetiracetam , Masculino , Hipotonía Muscular/tratamiento farmacológico , Mioclonía/tratamiento farmacológico , Piracetam/administración & dosificación , Piracetam/uso terapéuticoAsunto(s)
Neumonía/inducido químicamente , Inhibidores de Proteínas Quinasas/efectos adversos , Pirimidinas/efectos adversos , Tiazoles/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Crisis Blástica/complicaciones , Crisis Blástica/tratamiento farmacológico , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Dasatinib , Dexametasona/administración & dosificación , Doxorrubicina/administración & dosificación , Filgrastim , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Farmacovigilancia , Neumonía/diagnóstico por imagen , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/administración & dosificación , Pirimidinas/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Tiazoles/administración & dosificación , Tomografía Computarizada por Rayos X , Vincristina/administración & dosificaciónRESUMEN
INTRODUCTION: Valpromide and sodium divalproate are indicated in the treatment of maniac episodes of bipolar disorder. These drugs are metabolized into valproic acid. The occurrence of peripheral edema has been described as a very rare adverse reaction of those drugs. CASE REPORT: We report the case of a patient treated with valpromide who presented edema of the lower limbs. The increase in furosemide dose allowed regression of edema, and valpromide discontinuation resulted in rapid normalization. Recurrence of mood disorders led to the reintroduction of valpromide, which was associated with recurrence of edema. The definitive withdrawal of valpromide resulted in resolution of edema. CONCLUSION: Edema of the lower limbs can be induced by valproate. The mechanism of this reaction is unknown. These edema appear to be reversible upon discontinuation of the drug. Clinicians should be aware of a possible relationship between valproate-derived drugs and peripheral edema.
Asunto(s)
Anticonvulsivantes/efectos adversos , Edema/inducido químicamente , Extremidad Inferior , Ácido Valproico/análogos & derivados , Anciano de 80 o más Años , Edema/diagnóstico , Edema/tratamiento farmacológico , Femenino , Furosemida/uso terapéutico , Humanos , Ácido Valproico/efectos adversos , Privación de TratamientoRESUMEN
PURPOSE: Vitamin K antagonist are widely used and clearly useful in the prevention of thrombotic and embolic events. However, they expose to hemorrhagic risk. The aim of this retrospective study was to describe the serious hemorrhagic events that occurred in patients treated with vitamin K antagonist and that required administration of prothrombotic complexes concentrates. METHODS: A comparative analysis of the file of the central pharmacy (that dispensed the prothrombotic complexes concentrates) and patient data of the department of medical information was perform to ascertain the population of patients having received some prothrombotic complexes concentrates. Then, hospitalization reports were consulted to select the patients having presented a severe bleeding while receveiving vitamin K antagonist. We collected patients' characteristics, bleeding location, INR values, emergency care, seriousness and medical issue. Imputability was determined with the French method of pharmacovigilance. RESULTS: In 2008, in Caen University hospital, 80 patients received prothrombotic complexes concentrates in the context of a serious hemorrhage due to vitamin K antagonist. Their mean age was 75years and the most common presentation was a neurological hemorrhage (38,7%). For 63,8% of the patients, there was an overdose in vitamin K antagonist. Twenty-two patients died during their hospitalization and 10 others presented later sequelas. None of the patients included in this study had been spontaneously declared to the pharmacovigilance. High imputability scores were positively correlated with INR (P=0.0002). CONCLUSION: Quality of emergency care of hemorrhagic events due to vitamin K antagonist could be improved with a better application of the professional recommendations and a spontaneous declaration to pharmacovigilance.
Asunto(s)
Factores de Coagulación Sanguínea/uso terapéutico , Hemorragia/inducido químicamente , Hemorragia/tratamiento farmacológico , Vitamina K/antagonistas & inhibidores , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Chronic cavitary pulmonary aspergillosis requires a first-line prolonged treatment with itraconazole or voriconazole. We report a 71-year-old immunocompetent man with polyarteritis and history of multiple lung surgery procedures, who developed a peripheral axonal neuropathy 1 month after voriconazole therapy was started for a chronic cavitary pulmonary aspergillosis. After discontinuation of the treatment and a switch to posaconazole, the neuropathy partly improved. Three other cases of peripheral neuropathy with voriconazole have been already published, all reversible after voriconazole discontinuation.
Asunto(s)
Antifúngicos/efectos adversos , Aspergilosis Broncopulmonar Alérgica/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Pirimidinas/efectos adversos , Triazoles/efectos adversos , Triazoles/uso terapéutico , Anciano , Antifúngicos/uso terapéutico , Enfermedad Crónica , Humanos , Masculino , Dolor/inducido químicamente , Dolor/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Pirimidinas/uso terapéutico , Resultado del Tratamiento , VoriconazolRESUMEN
INTRODUCTION: In France, unlike other countries, the use of colchicine is preferred to other anti-inflammatory drugs for the treatment of gout. CASE REPORTS: We report a case series of four elderly patients (range from 72 to 83 years of age) who presented with colchicine intoxication, all notified to the Basse-Normandie pharmacovigilance centre in 2007. For each patient, one or more risk factors were identified: renal failure, high initial dosage, absence of laboratory monitoring. CONCLUSION: It would be useful to establish specific guidelines for colchicine use in the elderly population.
Asunto(s)
Colchicina/envenenamiento , Supresores de la Gota/envenenamiento , Gota/tratamiento farmacológico , Factores de Edad , Anciano , Anciano de 80 o más Años , Colchicina/administración & dosificación , Femenino , Francia , Supresores de la Gota/administración & dosificación , Humanos , Masculino , Intoxicación/prevención & control , Polifarmacia , Vigilancia de Productos Comercializados , Factores de RiesgoRESUMEN
Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.
Asunto(s)
Anestesia Obstétrica/efectos adversos , Anestésicos Locales/efectos adversos , Lidocaína/efectos adversos , Anestésicos Locales/sangre , Apnea/inducido químicamente , Femenino , Humanos , Recién Nacido , Lidocaína/sangre , Masculino , Intercambio Materno-Fetal , Hipotonía Muscular/inducido químicamente , Midriasis/inducido químicamente , Bloqueo Nervioso , Embarazo , Convulsiones/inducido químicamenteRESUMEN
Trimetazidine is known to induce parkinsonism but choreiform disorders have not yet been described with this drug. A 88-year-old patient treated with trimetazidine developed choreiform movements, gait disorders, tremor and visual hallucinations. These symptoms disappeared after drug withdrawal. Although this drug contains a piperazinic ring like other anti-dopaminergic drugs which are already known to potentially induce chorea like neuroleptics and some anti-convulsive drugs. When a patient treated with trimetazidine develops or worsens motor disorders (parkinsonism or choreiform disorders), this drug must be stopped.
Asunto(s)
Encefalopatías Metabólicas/inducido químicamente , Corea/inducido químicamente , Trimetazidina/efectos adversos , Vasodilatadores/efectos adversos , Anciano de 80 o más Años , Oftalmopatías/tratamiento farmacológico , Humanos , Masculino , Trimetazidina/administración & dosificación , Vasodilatadores/administración & dosificaciónRESUMEN
Pregabalin is similar in structure to gamma-aminobutyric acid. It is used for neuropathic pain, generalized anxiety disorders and as an adjunct therapy for partial seizures. Tachycardia is a rare side-effect. A 92-year-old patient with a history of paroxystic fibrillation was hospitalised for zoster. She developed a sinusal tachycardia followed by atrial fibrillation and congestive heart failure 15 h after a first dose of pregabalin. The imputation was considered as plausible. Even though the mechanism remains unclear, pregabalin might induce tachycardia in predisposed old patients.
Asunto(s)
Analgésicos/efectos adversos , Fibrilación Atrial/inducido químicamente , Taquicardia Paroxística/inducido químicamente , Ácido gamma-Aminobutírico/análogos & derivados , Anciano de 80 o más Años , Aminas/uso terapéutico , Analgésicos/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Femenino , Gabapentina , Insuficiencia Cardíaca/inducido químicamente , Herpes Zóster/tratamiento farmacológico , Humanos , Neuritis/tratamiento farmacológico , Pregabalina , Ácido gamma-Aminobutírico/efectos adversos , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
INTRODUCTION: Herpetic meningoencephalitis is treated with acyclovir (15 mg/kg/8 h). This higher dosage enhance the risk of acute renal failure. CASE REPORT: We report the case of a previously healthy 42 years old man treated by intravenous aciclovir 1g/8 h for a herpetic meningoencephalitis. He presented an acute renal failure and an acute confusional state at the end of the treatment. Renal function and neurologic status improved rapidly with increased hydration and stop of the antiviral therapy. CONCLUSION: If acyclovir is usually well tolerated, there is also a risk of acute nephropathy, especially dose-dependent. We point out the need to monitor renal function when high dosage of acyclovir is indicated.