Expert opinion on drug safety
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At present, cephalosporins represent one of the most prescribed classes of antibiotics. Although allergic reactions have been estimated to be infrequent, the number of reactions to cephalosporins is increasing due to their wide use. Cross-reactivity with penicillins has mainly been evaluated in patients with penicillin allergy. ⋯ Unlike penicillins, cephalosporin haptens or determinants have not been defined, and therefore the diagnosis is complicated. Nevertheless, skin tests with cephalosporins are useful in the evaluation of several allergic reactions. Although more studies are necessary, a negative result in skin testing to penicillin and cephalosporins with different side chains seems to be a good predictor of tolerance, and could be used in select cases.
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There is still uncertainty concerning the risk of fetal malformation associated with the intake of various individual antiepileptic drugs in pregnant women. ⋯ There is reasonable evidence that valproate is a significant teratogen during therapeutic use in women; the other older antiepileptic drugs (phenobarbitone, phenytoin, carbamazepine) probably have some teratogenic potential, but less than valproate; the situation regarding the more recently marketed antiepileptic drugs is not yet clear.
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Expert Opin Drug Saf · Mar 2008
ReviewSudden cardiac death secondary to antidepressant and antipsychotic drugs.
A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over QT prolongation and the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. Some antidepressants and antipsychotics have been linked to QT prolongation and the development of Torsade de pointes arrhythmias, whereas others have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This review examines the mechanisms and predisposing factors underlying the development of cardiac arrhythmias, and sudden cardiac death, associated with antidepressant and antipsychotic drugs in clinical use.
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Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. ⋯ The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.
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Expert Opin Drug Saf · Sep 2007
ReviewA review of the safety of 50% nitrous oxide/oxygen in conscious sedation.
Few studies into conscious sedation with 50% nitrous oxide/oxygen premix (50% N2O/O2) have been conducted in accordance with Good Clinical Practice in Clinical Trials. Of the 140 articles retained in this review, the incidence of adverse events (AEs) varied in the range of 0-68% according to the indications. ⋯ Only one study examined potential causal relationship between serious AEs and the 50% N2O/O2 gas itself, giving a risk for a serious AE directly due to the gas of 3/10,000 administrations. No analysis of the effect of the method of administration was possible, nor could conclusions be drawn relating to the risk of occupational exposure.