[Voiding difficulties in a child attributed to the use of ipratropium and salbutamol]. / Bemoeilijkte mictie bij een kind toegeschreven aan het gebruik van ipratropium en salbutamol.

A 5-year-old child was referred to our clinic because of voiding difficulties. She had been continent for 2.5 years. She had a hesitation of the urinary flow and voided with variable residual volumes. She had been using ipratropium and salbutamol regularly for her asthma. The voiding difficulties disappeared when the inhalation medication was stopped. During provocation with both medications this adverse effect was successively confirmed. The airway complaints were adequately controlled with inhaled steroids and she manifested functional voiding. Voiding difficulties as an adverse effect of ipratropium and salbutamol have not yet been described in children. At the Netherlands Pharmacovigilance Centre Lareb a few cases in children have been reported. Interaction with the sympathetic and parasympathetic activity of the bladder and pelvic floor muscles is a possible explanation for the voiding difficulties. In the assessment of voiding problems one needs to question the patient on the use of asthma medication.

HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre.

The number of patients taking HMG-CoA-reductase inhibitors for hypercholesterolaemia is growing rapidly. Treatment with HMG-CoA-reductase inhibitors significantly reduces the risk of cardiovascular morbidity and mortality, but may rarely cause serious adverse drug reactions (ADRs). The most serious ADRs of HMG-CoA-reductase inhibitors are musculoskeletal symptoms including myopathy and myositis, (life-threatening) rhabdomyolysis and liver failure. Furthermore, peripheral neuropathy might also occur, especially after long-term use of HMG-CoA-reductase inhibitors. Because of the severity and the relative rarity of HMG-CoA-reductase-induced neuropathy, the Netherlands Pharmacovigilance Centre Lareb has analysed its database of reported ADRs for reports concerning neuropathy associated with the use of HMG-CoA-reductase inhibitors. Until June 2005, Lareb received 17 reports of neuropathy, peripheral neuropathy and polyneuropathy and in addition two reports of aggravation of existing polyneuropathy associated with the use of HMG-CoA-reductase inhibitors. The associations neuropathy, peripheral neuropathy and polyneuropathy and the use of hMg-CoA-reductase inhibitors are statistically significantly more often reported to Lareb. The average time to onset supports conclusions of previous studies and case reports that especially long-term exposure increases the risk for peripheral neuropathy. Considering the increasing number of patients taking HMG-CoA-reductase inhibitors, health care professionals should be aware of the possible role of these drugs in neuropathy.

[Near asphyxiation of a neonate due to miconazole oral gel]. / Bijna-verstikking van een zuigeling door miconazol orale gel.

A 17-day-old female infant with thrush was almost asphyxiated by miconazole oral gel that had been applied to the nipples of her mother's breasts. The infant recovered after her mother had removed the gel from her mouth. Thrush is most often self-limiting and medical treatment is usually unnecessary. When treatment is indicated, miconazole oral gel or nystatin can be given. To obtain a therapeutic effect, long-term contact with the oral mucosa is needed and therefore the oral gel is viscous. Small amounts of the gel should be applied to the oral mucosa. When prescribing miconazole oral gel, instructions should be given regarding the mode of administration and the risk of respiratory tract obstruction should be pointed out.