Expert opinion on drug safety
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Expert Opin Drug Saf · Jul 2009
ReviewCyclosporine A for neuroprotection: establishing dosing guidelines for safe and effective use.
Numerous neuroprotective compounds have been investigated to ameliorate secondary changes and the progression of injury after the primary insult in traumatic brain injury (TBI). This cascade of events is complex and difficult to abate once initiated following the primary injury. The clinical consequences of this secondary injury are unpredictable and often permanently incapacitating. ⋯ This review discusses the physiologic responses following TBI that may affect CsA efficacy and safety when used for neuroprotective indications. So far, CsA seems to be safe in the TBI population. The role of CsA after acute TBI will be better defined after the completion of upcoming planned clinical trials.
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Expert Opin Drug Saf · May 2009
ReviewOseltamivir for treatment and prophylaxis of influenza infection.
Influenza infection is a global problem affecting millions of people worldwide, despite efficacious vaccines. Treatment and prophylaxis against influenza have been successful using antiviral medications such as adamantanes and neuraminidase inhibitors. ⋯ Oseltamivir is effective in reducing symptom burden in those with influenza A or B infection, and is preventative against developing infection after exposure. Emergence of naturally occurring or post-treatment oseltamivir-resistant influenza as well as an avian influenza pandemic may limit its future use as a monotherapeutic antiviral treatment agent.
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Expert Opin Drug Saf · May 2009
ReviewStatins and the risk of Parkinson disease: an update on the controversy.
Parkinson disease (PD) is the second most common neuro- degenerative disease and the number of affected patients is growing. Until now, information on either risk factors (genetic or environmental) or neuro- protective agents is still scarce. Recently, hydroxymethylglutary-coenzyme A reductase inhibitors have been related to protective as well as to potential harmful effects with regard to the development of a PD diagnosis. ⋯ Results of the available observational studies were inconsistent with most studies reporting a protective effect of statins on the risk of PD. Others found no altered risk of PD in statin users compared to non-users or even an increased risk. Studies largely varied in size and analysis methods. Thus, comparison of the results is difficult. Until now, no definite conclusion on this topic can be made.
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Expert Opin Drug Saf · Mar 2009
ReviewHeparin-induced anaphylactic and anaphylactoid reactions: two distinct but overlapping syndromes.
Heparin-induced anaphylactic and anaphylactoid reactions are of increasing clinical and scientific interest, particularly given the recent identification of a syndrome of heparin-induced anaphylaxis due to oversulfated chondroitin sulfate (OSCS), a contaminant in certain heparin preparations. However, heparin-induced anaphylactoid reactions also have been reported to be a consequence of immune-mediated heparin-induced thrombocytopenia (HIT). ⋯ Two distinct syndromes of heparin-induced anaphylaxis and anaphylactoid reactions exist. These seem to share certain epidemiologic features, given that OSCS-contaminated heparin can produce anaphylaxis through contact system activation but also could increase risk of HIT and HIT-associated anaphylactoid reactions.
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Expert Opin Drug Saf · Mar 2009
ReviewAntiplatelet therapy and coronary artery bypass graft surgery: perioperative safety and efficacy.
Antiplatelet therapy is critical in the management of coronary artery disease. For patients undergoing coronary artery bypass graft surgery (CABG), controversy remains regarding the safety of preoperative antiplatelet therapy and the optimal postoperative antiplatelet regimen to maintain graft patency and reduce ischemic complications. ⋯ Despite > 30 years of experience with antiplatelet agents during CABG, questions remain regarding their perioperative safety and efficacy. The results of continuing randomized controlled trials should further clarify the role of perioperative aspirin and clopidogrel therapy and help redefine the modern antiplatelet management of coronary artery bypass patients.