Sideroblastic anaemia during fusidic acid treatment.

OBJECTIVES AND METHODS: To describe cases of fusidic acid-associated sideroblastic anaemia from the French Pharmacovigilance database. RESULTS: Six cases of sideroblastic anaemia associated with oral fusidic acid treatment were retrieved. Four females and two males (mean age 65.3 yr) developed severe anaemia (mean haemoglobin level: 6.9 g/dL) within 32-190 d (mean: 81 d) of treatment. Bone marrow aspirates showed dyserythropoiesis and ringed sideroblasts in all patients. Four patients required repeated blood transfusions. After fusidic acid discontinuation in five patients, complete recovery was obtained. In one patient, rechallenge with fusidic acid resulted in recurrence of anaemia that resolved after definitive discontinuation of the drug. CONCLUSION: Our data indicate that fusidic acid should be added to the list of drugs that can cause sideroblastic anaemia.

Reports of withdrawal syndrome with the use of SSRIs: a case/non-case study in the French Pharmacovigilance database.

The SSRIs can be associated with withdrawal reactions and the objective of this study is to test the existence of an association between reports of withdrawal syndromes with the selective serotonin re-uptake inhibitors in the French spontaneous reports database. All reactions are coded according to the WHO ART dictionary. Cases are reports of reactions of interest (withdrawal syndrome). Non-cases are all reports of reactions other than those being studied. We calculated the odds ratio (OR) as the ratio of the odds of the association of reports of withdrawal syndrome with SSRIs in cases and non-cases. SSRIs are clearly associated with a higher risk of withdrawal syndrome (OR: 5.05, 95% CI: 3.81-6.68) and in particular with venlafaxine and paroxetine (OR: 12.16, 95% CI: 6.17-23.35 and OR: 8.47, 95% CI: 5.63-12.65, respectively). The risk of withdrawal reactions appears to be greater with short half-life drugs such as paroxetine and venlafaxine. The precise mechanisms have not been identified.

Seizure induced by ropivacaine.

OBJECTIVE: To report development of a seizure after administration of ropivacaine. CASE SUMMARY: A 26-year-old woman was scheduled for a cesarean section because of a stagnation of the uterine neck dilatation after 4.5 hours. After peridural administration of 279 mg of ropivacaine (total dose) over five hours, she presented with oculogyric movements and slurred speech that preceded convulsions of the face and of the upper limbs. DISCUSSION: Convulsions are well-known complications of local anesthetics. Ropivacaine, a relatively new agent, is considered safer for the central nervous system. Currently, there are only four published reports that implicate ropivacaine as being associated with convulsions. The likelihood that ropivacaine caused the seizure in our patient was possible based on the Naranjo probability scale. CONCLUSIONS: Clinicians should be aware of the possibility of seizures as an adverse effect of ropivacaine.

[Current aspects of the use of clozapine in the Châlons-sur-Marne Psychiatric Hospital: intestinal occlusion with clozapine]. / Actualité de l'utilisation de la clozapine à l'Hôpital psychiatrique de Châlons-sur-Marne: occlusions intestinales sous clozapine.

The authors report three cases--one of them lethal--of intestinal occlusion among 30 patients treated with clozapine between 1991 and 1994 in Châlons-sur-Marne Psychiatric Hospital. The responsibility of clozapine seems to be linked with its potent anticholinergic property. The attention of prescriptors is necessary and the monitoring of the drug should not be limited to the hematologic aspect.

Imputability of heparin in heparin induced thrombocytopenia: a 10 year experience of the Centre Regional de Pharmacovigilance of Reims-Champagne Ardenne.

The imputability of heparin in heparin induced thrombocytopenia (HIT) was analysed retrospectively in the chart records of 86 cases documented by the Centre Regional de Pharmacovigilance (CRPV) of Reims-Champagne Ardenne over a period of 10 years. Considerable difficulties are encountered in evaluating the degree of imputability. Chronological criteria seem to be determinant in the final imputability score, whereas semiological criteria are particularly difficult to interpret, especially as it is not yet clearly established whether biological tests should be taken into account. The method of assessment requires more precise adaptation to the specific case of HIT and could be improved by redefinition of the criteria in collaboration between pharmacologists and haematologists.