Bilateral ocular deposit of chlorpromazine / Depósito ocular bilateral de clorpromazina

ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.

RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.

Sobre la llamada revolución psicofarmacológica: el descubrimiento de la clorpromazina y la gestión de la locura / On the so-called psychopharmacological revolution: the discovery of chlorpromazine and the management of madness

Resumen El artículo analiza la fragilidad y los problemas existentes en la tesis que afirma la existencia de una verdadera revolución en el campo de la psiquiatría biológica, que se habría operado entre 1952 y 1954, con el descubrimiento de la clorpromazina. Para eso se analizan los discursos y las estrategias que posibilitaron el descubrimiento de esta droga que servirá de modelo para la producción de nuevos psicofármacos. Se intenta entender, también, qué es lo que se considera como "eficacia terapéutica" de la droga.

Abstract This article analyzes the shortcomings and problems of the thesis that a true revolution took place in the field of biological psychiatry between 1952 and 1954 thanks to the discovery of chlorpromazine. To do so, it analyzes the discourses and strategies that led to the discovery of this drug, which became a model for the production of new psychopharmaceuticals. It seeks to understand, also, what is meant by "therapeutic efficacy" with regard to this drug.

Study on the antiemetic property of methanolic stem extract of Swertia chirata using chick emesis model

Background: Swertia chirata has been an important herb known for centuries for its various medicinal uses and bitter taste. The stem of the plant is used as a traditional medicine in an array of diseases including the treatment of vomiting. Therefore, the study was undertaken to explore the possible antiemetic property of methanolic extract of its stems by using chick emesis model.Methods: 25 male chicks of four days old weighing 25 to 35 grams were fed with copper sulfate anhydride at 50mg/kg body weight to induce emesis. The chicks were grouped into 5 with each group bearing 5 chicks (n=5). Group I (control) received 10ml/kg normal saline; group II (standard) received 150mg/kg chlorpromazine; group III (experimental-1), group IV (experimental-2) and group V (experimental-3) received 50, 100 and 150mg/kg respectively of the extract. All doses are given intraperitoneally. Assessment of antiemetic activity was done by calculating the percentage of inhibition of the number of retches in the chicks.Results: All the three doses of the extract showed antiemetic activity. The dose of 50 mg/kg showed activity comparable to chlorpromazine, while dose of 100 mg/kg and 150mg/kg showed greater activity than chlorpromazine. Highest antiemetic activity (79.26% inhibition) was shown by a dose of 150mg/kg and lowest (42.22% inhibition) by 50mg/kg.Conclusions: Methanolic extract from the stems of Swertia chirata has excellent anti-emetic property which can be further investigated for development of potential antiemetic medicines.

The Effect of Continuous Subcutaneous Infusion of Chlorpromazine on Refractory Delirium in Advanced Cancer: Retrospective Study

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.

Adjuvant role of testosterone in treatment of schizophrenia and its interaction with combination of first and second generation anti-psychotics, chlorpromazine and risperidone

Background: There is great controversy about role of male sex steroid, testosterone, in mental disorders like schizophrenia. This study assessed the effectiveness of testosterone in schizophrenic patients and probes how it modulates the action of combination of first and second generation anti-psychotic medications (Chlorpromazine + Risperidone) both of which are very commonly used anti-psychotic agents in clinical psychiatric practice.Methods: It Is randomized, double-blind, Clinical study performed in Indian schizophrenic patients (new cases) in the Department of psychiatry from Feb 2003 to March 2004. Patients twelve (12) patients aged 20 to 60 years diagnosed schizophrenics according to ICD-10 Criteria who visited in outpatient department of psychiatry during study period. 12 Patient was treated with combination of oral Chlorpromazine 200mg BD + oral Risperidone 2mg BD, half of the 12 patients also received single dose of testosterone 100mg intramuscularly with above-mentioned treatment. Measure How symptomatology in schizophrenic patients affected is measured by applying various validated psychiatric scales like Brief psychiatric Rating Score (BPRS), Scale for assessment of positive symptom(SAPS), and Scale for Assessment of Negative Symptoms (SANS).Results: Single dose of Testosterone 100mg administered initially by I.M. route potentiated the reduction level in negative symptoms of schizophrenia by 119% in patients receiving oral Chlorpromazine 200mg along with oral Risperidone 4mg/day.Conclusions: In this study, Testosterone potentiated the effects of combination of oral Chlorpromazine 100mg BD + Risperidone 2mg BD, on general psychotic manifestations, positive symptoms and negative symptoms of schizophrenia, assessed on BPRS, SAPS and SANS scoring scales, however the effect is most pronounced in negative symptomology of schizophrenia.

Comparison of therapeutic effects of monotherapy of chlorpromazine, risperidone and their combination in newly diagnosed schizophrenic patients

Background: This study evaluates and compares how negative and positive symptoms of schizophrenia were influenced with monotherapy with a first-generation anti-psychotic medication (Chlorpromazine) and a second generation anti-psychotic medication (Risperidone) and by their combination, both of which are commonly used in clinical psychiatric practice.Methods: It was randomized, double-blind, controlled clinical study performed in Indian newly diagnosed schizophrenic patients in the Department of psychiatry from Feb 2003 to March 2004. Patients 18 (eighteen) patients aged 20 to 60 years diagnosed schizophrenics according to ICD-10 Criteria who visited in outpatient department of psychiatry during study period. Three groups of 6 Patient each, group-1 - was treated with oral Chlorpromazine 100 mg 12 hly, group -2 - was treated with oral Risperidone 2mg 12 hly group 3 -was treated with combination of oral Chlorpromazine 100mg 12 hly + oral Risperidone 2 mg 12 hly. How symptomatology in schizophrenic patients affected, is measured by applying various validated psychiatric scales like Brief psychiatric Rating Score (BPRS), Scale for assessment of positive symptom(SAPS), and Scale for Assessment of Negative Symptoms (SANS).Results: the study showed that the combination therapy of oral Chlorpromazine 100 mg 12 hly + Risperidone 2mg 12 hly had reduced the overall beneficial effects which were achieved with monotherapy of both the drugs.Conclusions: In this study, the therapeutic effects of combination of oral Chlorpromazine 100 mg 12 hly + Risperidone 2 mg 12 hly found to be reduced on positive symptoms and negative symptoms of schizophrenia, assessed on SAPS and SANS scoring scales when compared with beneficial effects which were achieved with monotherapy of both the drugs.

Prolonged Low-dose Chlorpromazine Therapy Induced Skin Pigmentation and Corneal and Lens Opacities / 대한피부과학회지

No abstract available.

Effects of Riboflavin Metabolic Pathways Combination with Cisplatin on Adhesion and Migration of Ovarian Cancer cells / 中国药学杂志

OBJECTIVE: To investigate the effects of interference of riboflavin (RIB) metabolic pathways on adhesion and migration to cisplatin (DDP) in ovarian cancer HO8910 cells. METHODS: Intervention RIB metabolic pathways by lentiviral vector harboring shRNA of riboflavin transporter 2 (RFT2) and chlorpromazine (CHL), a competitive inhibitor of RIB. HO8910 ovarian cancer cell line was divided into normal control group, shRNA control group, RFT2 shRNA group, CHL (50 μmol·L-1) group, DDP (20 μmol·L-1) group, RFT2 shRNA+DDP group, CHL + DDP group and DDP + RIB (20 μmol·L-1) group. Each group cells were collected after treatment 48 h according to the design. And then cell adhesive abilities were detected by adhesion experiment, the cells invasive abilities were observed by transwell method, the protein expressions of VEGF, MMP9 and MMP2 were detected by Western blot, and the expressions of TNF-α, NF-κB/p65 were assayed with laser confocal microscopy. RESULTS: Compared with the sole DDP treatment group, RFT2 shRNA or CHL combination with DDP had great advantages in reducing cell adhesion and migration viabilities, deceasing expressions of MM9 and MMP2, reducing cell expressions of TNF-α and NF-κB/p65. However, the RIB could weaken the effects of DDP on HO8910 cell. CONCLUSION: Interference metabolic pathway of RIB can enhance DDP effects on adhesion and migration viabilities of ovarian cancer HO8910 cell lines, and the effects are associated with blocking the pathway of TNF-α/NF-κB; However, RIB could attenuate the anti-tumor effects of cisplatin on HO8910 cell.

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

ABSTRACT PURPOSE: To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS: Sixteen Wistar rats - split in two groups - have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS: There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION: Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.

Triancinolona intra-vítrea e clorpromazina retrobulbar como alternativas ao manejo do olho cego doloroso / Intravietrea trianciclone and retotubulbar chlorpromazine as alternative to blind paintful eye manegement

RESUMO Objetivo: O objetivo desde estudo foi avaliar a efetividade da triancinolona intra-vítrea e da clorpromazina retrobulbar como alternativas no manejo da dor ocular em olhos cegos. Métodos: Este foi um estudo prospectivo intervencionista não-randomizado de pacientes com olho cego doloroso não responsivo ao tratamento tópico e sem indicação de evisceração atendidos no Serviço de Oftalmologia do Hospital Governador Celso Ramos no ano de 2010. Após exame oftalmológico e ultrassonografia ocular modo B, os pacientes foram divididos em dois grupos. Pacientes do Grupo 1 possuíam glaucoma intratável e receberam injeção retrobulbar de clorpromazina 2,5ml, e pacientes do Grupo 2 possuíam olhos phthisicos com componente inflamatório e receberam injeção intra-vítrea de triancinolona 0,3ml. Foram realizadas avaliações com 1, 3 e 6 meses após o procedimento e a dor quantificada de forma subjetiva em uma escala de 0 a 10 (sem dor e com o máximo de dor, respectivamente). Resultados: Foram incluídos 38 olhos, sendo 15 no Grupo 1 e 21 no Grupo 2. Houve predomínio do sexo masculino e idade média de 54 anos. A causa mais prevalente de olho cego doloroso foi o glaucoma neovascular. Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram-se eficazes no controle da dor ocular em olhos cegos no período do estudo (p<0,001). Ocorreu uma redução de 77,1% no uso de colírios (p<0,01) após a aplicação das medicações. Conclusão: Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram resultados significativos no controle da dor ocular em olhos cegos, além de uma redução no uso de colírios. A clorpromazina é um medicamento de baixo custo, com melhor perfil de efeitos adversos e mostrou resultados discretamente melhores relação à triancinolona. Possíveis viéses identificados no estudo são o de tempo e seleção.

ABSTRACT Objective: The objective of this study was to evaluate the efficacy of intravitreal triamcinolone and retrobulbar chlorpromazine as alternatives in the management of ocular pain in blind eyes. Methods: This was a non-randomized interventional prospective study of patients with painful blind eye unresponsive to topical treatment and without indication of evisceration treated at the Hospital Governador Celso Ramos Ophthalmology Service in 2010. After ocular examination and ocular B mode ultrasound, patients were divided into two groups. Group 1 patients had intractable glaucoma and received retrobulbar injection of chlorpromazine 2.5ml, and Group 2 patients had phthisics eyes with inflammatory component and received intravitreal triamcinolone injection 0.3ml. Evaluations were performed at 1, 3 and 6 months after the procedure and quantified pain subjectively on a scale from 0 to 10 (no pain and maximum pain, respectively). Results: 38 eyes were included, 15 in Group 1 and 21 in Group 2. There was a predominance of males with a mean age of 54 years. The most prevalent cause of painful blind eye was the neovascular glaucoma. Any retrobulbar injection of chlorpromazine as the intravitreal triamcinolone shown to be effective in the control of ocular pain in the eye blind study period (p <0.001). There was a 77.1% reduction in eye drops (p <0.01) after application of medication. Conclusion: Both the retrobulbar injection chlorpromazine as the intravitreal triamcinolone showed significant results in the control of ocular pain in blind eyes, and a reduction in the use of eye drops. Chlorpromazine is a low cost product, with a better adverse effect profile and showed slightly better results compared to triamcinolone. Potential bias identified in the study are the time and selection.

The inhibition effect of Chlorpromazine against the β-lactam resistance of MRSA

OBJECTIVE@#To investigate the gene related to β-lactam resistance and to confirm the mechanism about a synergy effect between CPZ and β-lactam antibiotics.@*METHODS@#To measure antibacterial activity, we performed a minimum inhibitory concentration (MIC) and synergy test. Transmission electron microscopy (TEM) was used in morphological analysis. To analyze gene expression, we conducted reverse transcriptase polymerase chain reaction (PCR).@*RESULTS@#We confirmed a synergy effect between CPZ and β-lactam antibiotics. Furthermore, we observed that CPZ affect the cell envelope of MRSA by using TEM. At the gene level, CPZ reduced the expression of resistance genes.@*CONCLUSIONS@#Through this result, we hypothesize that a decrease of resistance factor expressions was caused by CPZ because it disrupts the activity of a sensor protein located in the cell membrane.

Frequency of Serious Adverse Skin Reactions Caused by Continuous Subcutaneous Administration of Psychotropic Drugs

Continuous subcutaneous injections of medication are effective in controlling symptoms of the terminal stage of cancer. Chlorpromazine and levomepromazine occasionally cause skin irritation. We examined all patients who underwent continuous subcutaneous administration of psychotropic drugs (chlorpromazine, levomepromazine, midazolam) at the palliative care unit of our hospital from April 2010 to March 2013, the frequency of adverse skin reactions of Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade 3 or above. Of the 603 hospitalized patients, 389 (64.5%) underwent continuous subcutaneous administration of one of the three drugs. The frequency of grade 3 or above (ulceration or necrosis) adverse skin reactions was 4 out of 345 chlorpromazine cases (1.2%; 95% CI: 0.0-2.3%), 2 out of 90 levomepromazine cases (2.2%; 95% CI: −0.8-5.2%), and 0 out of 210 midazolam cases (0.0%; 95% CI: 0.0-0.0%). The frequency of serious adverse skin reactions caused by continuous subcutaneous administration of psychotropic drugs was low, suggesting that this treatment is relatively safe for the skin.

Efeito antipsicótico da associação da clorpromazina e ácido lipóico em modelo de esquizofrenia induzido pela cetamina em ratos

A esquizofrenia, síndrome neuropsiquiátrica caracterizada por comprometimento das funções cerebrais, apresenta, além de sintomas comportamentais, alterações eletroencefalográficas, está associada a uma desregulação das respostas imunológicas e componente oxidativo. No entanto, o papel do dano oxidativo nas alterações eletroencefalográficas presentes na esquizofrenia não está completamente esclarecido. Desta maneira, este estudo teve como objetivo avaliar os efeitos antipsicóticos da associação de clorpromazina (CP) e ácido lipóico (ALA), em modelo de esquizofrenia induzido por cetamina (KET), em ratos. Foram utilizados ratos Wistar machos (200-300 g), tratados durante 10 dias e divididos em dois protocolos experimentais. No primeiro, os animais foram divididos em quatro grupos (n = 10) e tratados com solução salina (controle) ou cetamina (10, 50 ou 100 mg/kg). No segundo, os animais foram divididos em nove grupos (n = 10), tratados com solução salina (controle), ácido lipóico (100 mg/kg), cetamina (10 mg/kg), clorpromazina (1 ou 5 mg/kg) sozinha ou associada a cetamina (CP1 ou CP5+KET) ou associada ao ácido lipóico (ALA+CP1 ou CP5+KET)...

Schizophrenia, a neuropsychiatric syndrome characterized by brain functions impairment, presents besides the behavioral symptoms, electroencephalographic changes and it is associated with a dysregulation of immune responses and oxidative component. However, the role of the inflammatory and oxidative damage on the electroencephalographic alterations present in schizophrenia was not completely clarified. Thus, this study aimed to investigate the electroencephalographic, behavioural and neurochemical effects in the hippocampus of rats treated with chlorpromazine alone or associated with lipoic acid in the model of schizophrenia induced by ketamine. However, the role of oxidative damage in electroencephalographic changes present in schizophrenia is not fully understood. As a result, this study aimed to evaluate the effects of the antipsicotics association of chlorpromazine (CP) and lipoic acid (ALA) in the schizophrenia model induced by ketamine (KET) in rats. Wistar male rats (200-300 g) were tested. They were treated for 10 days and divided into two experimental protocols: At first the animals were divided into 4 groups (n = 10) and treated with saline (control) or ketamine (10, 50, or 100 mg/kg). In the second, the animals were divided into 9 groups (n = 10) treated with saline (control), lipoic acid (100mg/kg), ketamine (10mg/kg) and chlorpromazine (1 or 5 mg/kg) alone or and ketamine (CP1 and CP5+KET) or associated with lipoic acid (ALA+CP1 and CP5+KET)...

Agmatine protection against chlorpromazine-induced forebrain cortex injury in rats

This study was conducted to investigate whether agmatine (AGM) provides protection against oxidative stress induced by treatment with chlorpromazine (CPZ) in Wistar rats. In addition, the role of reactive oxygen species and efficiency of antioxidant protection in the brain homogenates of forebrain cortexes prepared 48 h after treatment were investigated. Chlorpromazine was applied intraperitoneally (i.p.) in single dose of 38.7 mg/kg body weight (BW) The second group was treated with both CPZ and AGM (75 mg/kg BW). The control group was treated with 0.9% saline solution in the same manner. All tested compounds were administered i.p. in a single dose. Rats were sacrificed by decapitation 48 h after treatment Treatment with AGM significantly attenuated the oxidative stress parameters and restored antioxidant capacity in the forebrain cortex. The data indicated that i.p. administered AGM exerted antioxidant action in CPZ-treated animals. Moreover, reactive astrocytes and microglia may contribute to secondary nerve-cell damage and participate in the balance of destructive vs. protective actions involved in the pathogenesis after poisoning.

The inhibition effect of Chlorpromazine against the β-lactam resistance of MRSA

Objective To investigate the gene related to β-lactam resistance and to confirm the mechanism about a synergy effect between CPZ and β-lactam antibiotics. Methods To measure antibacterial activity, we performed a minimum inhibitory concentration (MIC) and synergy test. Transmission electron microscopy (TEM) was used in morphological analysis. To analyze gene expression, we conducted reverse transcriptase polymerase chain reaction (PCR). Results We confirmed a synergy effect between CPZ and β-lactam antibiotics. Furthermore, we observed that CPZ affect the cell envelope of MRSA by using TEM. At the gene level, CPZ reduced the expression of resistance genes. Conclusions Through this result, we hypothesize that a decrease of resistance factor expressions was caused by CPZ because it disrupts the activity of a sensor protein located in the cell membrane.

Blue-gray Pigmentation Induced by Chlorpromazine / 대한피부과학회지

No abstract available.

Aspectos morfológicos de la enfermedad hepática inducida por drogas / Morphological Issues of Drug Induced Liver Disease

La enfermedad hepática inducida por drogas es un fenómeno multifacético y su espectro morfológico es muy variado imitando cualquier patrón de daño hepático, tanto en pacientes expuestos en forma aguda o crónica, en aquellos susceptibles en forma idiosincrática a una dosis terapéutica o por toxicidad intrínseca, a su vez puede estar afectada por otros factores como son los genéticos, la edad o el sexo, el estado nutricional, la exposición a otros fármacos o la existencia de una enfermedad de base; puede ser la única manifestación clínica del efecto adverso de una droga o estar acompañado de manifestaciones sistémicas o de otros órganos, e incluso puede llegar a ser fatal (1). Su incidencia no está bien definida, algunos estudios afirman que la incidencia global es variable encontrándose entre 1-15 x 100.000 personas/año, en USA ocurren 20 nuevos casos x 100.000 habitantes/año. Se han descrito como causantes de lesión hepática más de 900 drogas, productos herbales, homeopáticos, suplementos dietéticos o toxinas, sean productos naturales o de la industria farmacéutica, utilizados o no en dosis terapéuticas, que son las responsables de aproximadamente 15% de consultas y hospitalizaciones por ictericia, hepatitis aguda o crónica; en la población adulta, por encima de los 50 años, llega a 40% de todos los casos de hepatitis. Es también la causante de 11-50% de casos de falla hepática aguda. Los datos publicados indican que los antibióticos son responsables entre un 27-46% de los casos, seguidos por medicamentos para enfermedades del sistema nervioso central entre 13-17%, antiinflamatorios y analgésicos de 5-17% y los productos herbales 9%. Nuevos biomarcadores y el uso de microRNA se están estudiando y serán prometedores en un futuro cercano para identificar pacientes que puedan presentar hepatotoxicidad inducida por medicamentos. Son tantos los tipos de lesión hepática atribuidos a estos agentes que solo podremos dar algunos ejemplos en este artículo, basados en los patrones de daño hepático y enfatizando la importancia de una adecuada y profunda correlación clínica (2, 3).

Drug-induced liver disease is a multifaceted phenomenon which has a varied morphological spectrum that mimics other patterns of liver damage both in cases of acute drug exposure and in cases of chronic exposure to drugs. Those patients who are idiosyncratically susceptible at the therapeutic dose or to intrinsic toxicity may also be affected by other factors including genetic factors, age, sex, nutritional status, exposure to other drugs and the existence of an underlying disease. The only clinical manifestation of the disease may be the adverse effect of a drug, but it can also be accompanied by systemic manifestations and manifestations in other organs, and it can even be fatal (1). The incidence of drug-induced liver disease is not well defined, but some studies claim that its overall annual incidence varies between 1/100,000 people and 15/100,000 people. In the United States, twenty new cases per 100,000 inhabitants occur every year. More than 900 natural and pharmaceutical drugs, herbal medicines, homeopathic products, dietary supplements and toxins have been reported to cause liver damage. This can occur whether or not they are used at normal therapeutic doses. These cases are responsible for about 15% of consultations and hospitalizations for jaundice, acute hepatitis, and chronic hepatitis in adults above the age of 50, and in up to 40% of all cases of hepatitis. Drug-induced liver disease also accounts for 11% to 50% of all cases of acute liver failure. Published data indicate that antibiotics are responsible for between 27% and 46% of cases, that drugs for diseases of the central nervous system are responsible for between 13% and 17%, anti-inflammatory and analgesic agents are responsible for between 5% and 17%, and herbal products are responsible for 9%. New biomarkers and the use of microRNA are being studied and may become promising alternatives in the near future for identifying patients susceptible to drug-induced hepatotoxicity. There are so many types of liver damage attributed to these agents that only give some examples can be provided in this article. These examples have been chosen on the basis ofn the patterns of liver damage with emphasis on the importance of proper and thorough clinical correlation (2, 3).

Effects of ziprasidone and chlorpromazine on the ECG and cognitive function of patients with first episode of schizophrenia / 中国基层医药

Objective To investigate the effects of ziprasidone and chlorpromazine on the ECG and cognitive function of patients with first episode of schizophrenia .Methods According to the digital table ,90 patients with first-episode schizophrenia were divided into two groups ,45 cases in each group .The control group was given chlorproma-zine,while the observation group received oral ziprasidone .Clinical efficacy,cognitive function and ECG results were compared before and after treatment .Results The PANSS scores of the study group and the control group were (57.78 ±4.16) points and (58.43 ±4.33) points after treatment,which were significantly lower than (72.62 ± 4.66)points and (72.39 ±4.87)points before treatment (t=7.15,7.46,all P0.05).The total number of tests of WCST ,continuous errors and CT error rate in study group after treatment were (73.32 ±5.08),(40.35 ±4.15) and (12.72 ±2.00)%,which were signif-icantly lower than (86.43 ±5.58),(67.72 ±4.26) and (21.02 ±2.33)%before treatmemt and (84.32 ±5.16), (65.82 ±4.25) and (20.05 ±2.20)%in the control group(t=6.84,7.21,7.85,7.52,8.21,8.12,all P<0.05). WCST categories completed and the number of CT net scores were (5.32 ±0.40) and (125.83 ±11.65) points, which were significantly higher than (3.41 ±0.38) and (102.82 ±10.72) points before treatment and (3.52 ± 0.39) and (108.37 ±10.24)points in the control group,the differences were statistically significant (t=6.72,7.11, 7.01,7.53,all P<0.05).The incidence rate of abnormal ECG in study group was 22.22% after treatment,which was significantly lower than 55.56% in the control group(χ2 =11.02,P<0.05).Conclusion Ziprasidone and chlorpromazine have a equivalent efficacy in the treatment of first-episode schizophrenia ,but ziprasidone can signifi-cantly improve cognitive function and has little effect on ECG ,it is safe.

Chlorpromazine induced ocular myasthenia gravis.

Drug induced bilateral ptosis is a very rare adverse drug reaction. Here we report a case of ten year old male child with chlorpromazine induced bilateral ptosis due to ocular myasthenia.

Comparison of the effects of chlorpromazine, olanzapine and ziprasidone on cognitive function of patients with chronic schizophrenia / 中国基层医药

Objective To compare the effects of chlorpromazine,olanzapine and ziprasidone on cognitive function of patients with chronic schizophrenia.Methods A total of 120 patients with chronic schizophrenia were randomly divided into chlorpromazine group(n =38),olanzapine group(n =41) and ziprasidone group(n =41).The patients were subjected to the Brief Psychiatric Rating Scale(BPRS),Wisconsin Card Sorting Test(WCST),Personal and Social Function of Scale (PSP) and Wechsler Adult Intelligence Scale-Revised (WAIS-RC) assessment respectively,before and after treatment for 12 weeks.Results After treatment for 12 weeks,the score of BPRS significantly decreased in three groups compared with that before treatment [F (5,41) =6.49,P ＜ 0.05].After treatment for 12 weeks,the results of WCST [F (5,47) =18.30,P ＜ 0.05],PSP [F (5,47) =10.02,P ＜ 0.05] and WAIS-RC [F(5,47) =6.74,P ＜ 0.05] test in ziprasidone and olanzapine group were better than that of chlorpromazine group.Conclusion Chlorpromazine,olanzapine and ziprasidone could improve the cognitive function and mental syndrome of patients with chronic schizophrenia.In addition,the effect of ziprasidone and olanzapine was better than chlorpromazine.