RESUMO
Imatinib is a tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia (CML). Cutaneous adverse reactions of imatinib therapy have been reported in 7%-88.9% patients. We sought to evaluate the prevalence rates of cutaneous adverse reactions of imatinib therapy and to investigate the clinical and pathological characteristics of these reactions. Sixty-six patients (36 men, 30 women; age range 19-83 years) with CML treated with imatinib between 2008 and 2014 were included in the study. Clinical and pathological features of the adverse reactions were investigated. Cutaneous adverse reactions were the most common adverse effects of imatinib therapy and were seen in nine patients with a prevalence rate of 13.6%. The second most common adverse effect was musculoskeletal pain (12.1%). The following cutaneous reactions were observed in patients: edema, rash, pigmentary changes, aphthous stomatitis, alopecia, cutaneous dryness, hyperhidrosis and cheilitis. Imatinib therapy was discontinued in four patients because of various adverse effects. Although the prevalence rate of cutaneous adverse reactions in our study was lower than that in several other studies, cutaneous reactions were common in our study. The relatively low prevalence rate of adverse reactions may be related to the low dosage of imatinib (400 mg/day) used to treat our patients and may have been affected by pharmacogenetic characteristics of our population.
Assuntos
Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Mesilato de Imatinib/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Alopecia/induzido quimicamente , Antineoplásicos/uso terapêutico , Queilite/induzido quimicamente , Estudos Transversais , Toxidermias/patologia , Edema/induzido quimicamente , Exantema/induzido quimicamente , Feminino , Seguimentos , Humanos , Hiperidrose/induzido quimicamente , Mesilato de Imatinib/uso terapêutico , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/induzido quimicamente , Estomatite Aftosa/induzido quimicamente , Fatores de Tempo , Adulto JovemAssuntos
Alfentanil/uso terapêutico , Analgésicos Opioides/uso terapêutico , Hiperidrose/induzido quimicamente , Oxicodona/efeitos adversos , Dor/tratamento farmacológico , Dor/etiologia , Síndrome de Abstinência a Substâncias , Carcinoma de Células Escamosas/complicações , Feminino , Humanos , Neoplasias Pulmonares/complicações , Pessoa de Meia-Idade , Oxicodona/uso terapêuticoRESUMO
Diffuse and abundant sweating in a middle age patient evolving for several weeks should raise suspicion of malignant lymphoma and infectious or neuroendocrine disorders before considering a drug origin. We report a patient who presented with severe and invalidating excessive sweating related to hydromorphone therapy for vertebral pain. Amongst their many reported side-effects, excessive sweating disappearing with discontinuation of the drug have been reported with some opiates.
Assuntos
Analgésicos Opioides/efeitos adversos , Hidromorfona/efeitos adversos , Hiperidrose/induzido quimicamente , Idoso , Analgésicos Opioides/administração & dosagem , Dor nas Costas/tratamento farmacológico , Humanos , Hidromorfona/administração & dosagem , MasculinoAssuntos
Hiponatremia/metabolismo , Hiponatremia/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Síndrome Maligna Neuroléptica/fisiopatologia , Cloreto de Sódio/metabolismo , Doenças das Glândulas Suprarrenais/induzido quimicamente , Doenças das Glândulas Suprarrenais/metabolismo , Doenças das Glândulas Suprarrenais/fisiopatologia , Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Doenças do Sistema Nervoso Autônomo/metabolismo , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Humanos , Hiperidrose/induzido quimicamente , Hiperidrose/metabolismo , Hiperidrose/fisiopatologia , Hiponatremia/induzido quimicamente , Síndrome Maligna Neuroléptica/etiologia , Síndrome Maligna Neuroléptica/metabolismo , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologia , Desequilíbrio Hidroeletrolítico/induzido quimicamente , Desequilíbrio Hidroeletrolítico/metabolismo , Desequilíbrio Hidroeletrolítico/fisiopatologiaAssuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Hiperidrose/induzido quimicamente , Morfina/administração & dosagem , Administração Oral , Feminino , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Dor/prevenção & controle , Neoplasias Retais/terapiaAssuntos
Analgésicos Opioides/efeitos adversos , Antidepressivos/efeitos adversos , Hiperidrose/induzido quimicamente , Iproniazida/efeitos adversos , Inibidores da Monoaminoxidase/efeitos adversos , Mioclonia/induzido quimicamente , Taquicardia/induzido quimicamente , Tramadol/efeitos adversos , Analgésicos Opioides/administração & dosagem , Antidepressivos/administração & dosagem , Dor nas Costas/tratamento farmacológico , Sinergismo Farmacológico , Humanos , Iproniazida/administração & dosagem , Masculino , Inibidores da Monoaminoxidase/administração & dosagem , Reflexo Anormal/efeitos dos fármacos , Tramadol/administração & dosagem , Tremor/induzido quimicamenteRESUMO
BACKGROUND: Granulocyte-colony-stimulating factor (G-CSF) has been used in patients to increase the level of circulating hematopoietic progenitors. Although G-CSF has been administered to some healthy individuals, the kinetics of mobilization of peripheral blood stem cells (PBSCs), the optimum dose schedule and the incidence and nature of adverse reactions in normal individuals are not completely defined. STUDY DESIGN AND METHODS: Normal individuals (n = 102) who received G-CSF for 5 or 10 days at doses of 2, 5, 7.5, or 10 micrograms per kg per day were studied. The subjects were observed for symptoms and physical changes, and blood samples were obtained for a variety of laboratory tests. After 5 or 10 days of G-CSF treatment, PBSCs were collected by apheresis and analyzed. RESULTS: Overall, 89 percent of the individuals completed the 5-day treatment protocol and 88 percent completed the 10-day protocol without modification of the dose of G-CSF administered. Ninety percent of donors experienced some side effect of G-CSF. The most frequent effects noted were bone pain (83%), headache (39%), body aches (23%), fatigue (14%), and nausea and/or vomiting (12%). The dose of G-CSF administered directly affected the proportion of people with bone pain (p = 0.025) or body aches (p = 0.045) or who were feeling hot or having night sweats (p = 0.02) or taking analgesics (p = 0.01). With the 5-day dose schedule, several changes in serum chemistries occurred, including increases in alkaline phosphatase (p = 0.001), alanine aminotransferase (p = 0.0013), lactate dehydrogenase (p = 0.0001), and sodium (p = 0.0001). Decreases occurred in glucose (p = 0.045), potassium (p = 0.0004), bilirubin (p = 0.001), and blood urea nitrogen (p = 0.0017). In donors who received G-CSF for 5 days, the absolute neutrophil count was increased after one G-CSF dose, and it reached a maximum on Day 6, as did the number of CD34+ cells (64.6 +/- 55.9 x 10(6) cells/L). In those same donors, the platelet count after apheresis on Day 6 was 32 +/- 13 percent lower than pretreatment values (250 +/- 42 x 10(9) cells/L). In donors receiving G-CSF for 10 days, the neutrophil count reached a maximum on Day 8, but the number of CD34+ cells peaked on Day 6 (58.3 +/- 52.1 x 10(5) cells/L) and then declined. The platelet count decreased from pretreatment values by 28 +/- 12 percent prior to apheresis on Day 11. When individuals were treated for 5 days with G-CSF, the quantity of CD34+ cells collected was directly related to the G-CSF dose. When 5 micrograms per kg per day was given, 2.80 +/- 1.81 x 10(8) cells were collected, compared with collection of 4.67 +/- 3.11 x 10(8) cells when 10 micrograms per kg per day was given (p = 0.04). More important, PBSCs collected after 10 days of G-CSF administration (5 micrograms/kg/day) had significantly fewer CD34+ cells (0.82 +/- 0.37 x 10(8) cells, p = 0.01) than did PBSCs collected after 5 days of G-CSF (5 micrograms/kg/day). CONCLUSION: Most normal donors receiving G-CSF experience side effects, but these are mild to moderate in degree. Some alterations in blood chemistries occur, but none were clinically serious. Because of the symptoms associated with G-CSF, these individuals must be monitored closely. The treatment of normal donors with G-CSF for more than 5 days significantly decreased the number of circulating CD34+ cells and the quantity collected by apheresis.