The frequency of bleeding and height of adolescent haemophiliacs.

The relation between the height of adolescent haemophiliacs and their bleeding frequency has been studied. 45 haemophiliacs aged 10--19 years were divided into 3 groups: small, medium and tall, using a Height Standard Deviation Score. The average bleeding frequency per 100 days in the group of small haemophiliacs was 8.71 +/- SD 4.47, in the medium height group 10.18 +/- SD 6.71, while the tall individuals bled in average 15.97 +/- SD 3.15 every 100 days. There was no relationship between age and bleeding frequency.

Dextromethorphan. An overview of safety issues.

Dextromethorphan is a highly effective and widely used nonopioid antitussive drug. As it has been in use for more than 30 years, a large body of clinical experience has been used to formulate a safety profile. An anthology of adverse drug events has been analysed, drawn both from published case records and a data base recording dextromethorphan-related adverse events spontaneously reported by physicians or pharmacists. The resulting safety profile indicates that adverse drug reactions are infrequent and usually not severe. The predominant symptoms are usually dose related and include neurological, cardiovascular and gastrointestinal disturbances. Particular safety concerns arise when monoamine oxidase inhibiting (MAOI) drugs and dextromethorphan are coadministered. In addition to adverse drug reactions, the safety profile of dextromethorphan is affected by episodic and sporadic abuse. In fact, abuse appeared to be the most significant hazard identified by analysis of spontaneous adverse event reporting. No evidence could be found that the well documented pharmacokinetic polymorphism observed with dextromethorphan is correlated with any clinically significant safety risk if it is used for short term treatment. In summary, the safety profile of dextromethorphan is reassuring, particularly relating to overdose in adults and children.

Mefloquine prophylaxis: an overview of spontaneous reports of severe psychiatric reactions and convulsions.

Since the time of its introduction in 1985, mefloquine (Lariam) has been used extensively for malaria prophylaxis. The international Drug Safety Department of the manufacturer gathered all spontaneous adverse drug reactions reported in association with this drug from all available sources and monitored the literature on a world-wide basis. The serious neurologic and psychiatric adverse events reported in association with Lariam prophylaxis from the time of introduction until May 1991 were reviewed. During this time, 59 serious neurologic and psychiatric adverse reactions were reported as follows: 26 convulsions, 12 depressions, 20 psychotic episodes, and one toxic encephalopathy; none were fatal. While spontaneous reporting systems are biased by under-reporting, they provide useful instruments for analysis of clinical risks factors. The neurologic and psychiatric adverse events reported in association with mefloquine prophylaxis were of the same types as those reported with other quinine derivative antimalarials. The precise mechanism of serious neurologic and psychiatric reactions is unknown. The only patient population identified at this time as having an increased risk of developing these serious reactions to mefloquine are persons with a history of seizures or manic-depressive illness. Mefloquine prophylaxis should not be prescribed to such patients.

An examination of joint laxity in haemophilia.

An adolescent haemophiliac group (all less than 1 per cent Factor VIII) and a normal, similarly aged, 'control group' of boys were examined to measure joint laxity in an effort to identify a causative factor for bleeding. Definitive laxity was found in the thumb joints and in finger extension of haemophiliacs compared with normal boys. The haemophiliacs who were more lax-jointed showed no tendency towards an increased number of bleeds when they were followed for 100 days. Possible explanations for these phenomena are discussed.

Review of yellow cards (1986): report to the Committee on the Safety of Medicines.

1. In 1986 the CSM received 15,527 yellow cards. This was the highest number received in any one year since the scheme started in 1964. Much of the increase was due to the use by doctors of the yellow cards now included in the British National Formulary and NHS prescription pads. 2. The overall profile of reports of serious reaction, in 1986, was broadly similar to that of the previous years. The most commonly reported serious suspected adverse reactions involved the gastro-intestinal tract (801 reports), the skin (539 reports), the central nervous system (535 reports), and the blood (505 reports). 3. Of the drugs introduced between 1984 and 1986 appreciable numbers of reports of serious reactions were received in association with the use of diltiazem (33 reports), mitozantrone (30 reports), enalapril (173 reports) and etodolac (27 reports).