Medication use in patients with restless legs syndrome compared with a control population.

Primary restless legs syndrome (RLS) is a sensorimotor disorder causing chronic sleep deprivation in those with moderate to severe symptoms. It has been associated with other medical conditions, such as high blood pressure, depression and attention deficit hyperactive disorder (ADHD). If these conditions are more prevalent for RLS patients, then it would be expected RLS patients would use relatively more of the medications treating these conditions. Current medication use was obtained from 110 RLS patients and 54 age, race and gender-matched local-community controls. Each subject was diagnosed as primary RLS or having no indications for RLS by a clinician board-certified in sleep medicine. The RLS group used more medications than the control group even when medications used for treating RLS were excluded. Significantly more of the RLS patients than controls used anti-depressants, gastro-intestinal (GI) medications and asthma/allergy medications. RLS patients compared with those without RLS are more likely to use medications not related to treating RLS. Moreover they use medications for conditions that have not previously been considered related to RLS, i.e. GI and asthma/allergy conditions.

Galantamine: a new alzheimer drug with a past life.

OBJECTIVE: To review the historic, pharmacologic, pharmacokinetic, therapeutic, and toxicologic features of galantamine, a new acetylcholinesterase inhibitor, and to assess its role in the treatment of Alzheimer disease symptoms. DATA SOURCES: A search of articles was conducted using MEDLINE, TOXLINE, and the literature database Psychinfo, from 1966 to June 1999. The manufacturers, Janssen and SoPharm (Bulgaria), were contacted to obtain relevant preclinical data. Published textbooks of meeting symposia were also reviewed. STUDY SELECTION: Studies with animals and humans addressing preclinical pharmacology, human studies on pharmacokinetics, open clinical trials, and controlled studies were evaluated. DATA EXTRACTION: Relevant data were extracted from published studies and meeting abstracts only. DATA SYNTHESIS: Galantamine has an extensive record of activity as a reversal agent for neuromuscular blockade. Galantamine is also effective in the treatment of mild to moderate Alzheimer disease symptoms. Its efficacy versus similar Alzheimer treatment agents has yet to be determined. Adverse effects are gastrointestinal in nature and usually appear during the first weeks of therapy. CONCLUSIONS: Galantamine is a useful agent for the treatment of Alzheimer disease and for the reversal of neuromuscular blockade. It acts as both an acetylcholinesterase inhibitor and a nicotinic receptor agonist.

Angioedema due to losartan.

OBJECTIVE: To report a case of angioedema associated with the angiotensin II receptor antagonist losartan. CASE SUMMARY: A 62-year-old African-American woman was admitted to the hospital for acute renal failure and uncontrolled hypertension. After attempting blood pressure control with three different agents, captopril was combined with metoprolol. The patient noted swelling of the lips combined with shortness of breath after four days of captopril. Losartan was substituted for captopril, which then produced similar swelling of the lips (without shortness of breath) after only one dose. These symptoms resolved after discontinuation of losartan and administration of antihistamines. DISCUSSION: Losartan, like other angiotensin II receptor antagonists, blocks the action of angiotensin II at the receptor level. Five published case reports involved patients with a prior history of intolerance to the angiotensin-converting enzyme inhibitors. Two published case reports of similar reactions also occurred in patients with renal compromise. The mechanism for this reaction from losartan is not known, but may not be due to bradykinin excess. CONCLUSIONS: Clinicians should be aware that angiotensin receptor antagonists may not be safe alternatives in patients who have a history of angioedema secondary to the angiotensin-converting enzyme inhibitors.

An analysis of potential and real cost savings by the addition of ranitidine to total parenteral nutrition solutions.

The results of two analyses that assessed the potential savings and the actual savings derived from the addition of ranitidine to total parenteral nutrition solutions are discussed. A clinical pharmacist determined on a daily basis the number of patients receiving concurrent total parenteral nutrition solutions and intermittent intravenous ranitidine in a critical care unit. The cost of each mode of administration was determined and the savings were calculated to be over +16,000/year. Once the practice of adding ranitidine to total parenteral nutrition solutions became routine, total parenteral nutrition solution orders for April-June 1991 were collected and the number of patient days were counted and the accrued savings were determined to be slightly more than +10,000 each year. Differences are explained by discrepancies in expected and true number of patient days. The authors conclude that there are savings to be realized by adding ranitidine, or any H2 antagonist, to total parenteral nutrition TPN solutions and avoiding intermittent infusions.