Expert opinion on drug safety
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The application of sedation/analgesia in paediatric patients is rapidly expanding as less invasive, non-operative techniques of diagnosis and treatment are applied to the paediatric population. Medical providers who are asked to provide sedation may include radiologists, paediatricians, nurses and emergency physicians, as well as anaesthesiologists and intensive care physicians. ⋯ It is imperative that practitioners using drugs for sedation/analgesia in children be aware of the adverse effect profile(s) of these drugs, both individually and in combination. The purpose of this review is to describe the adverse effects of sedative and reversal agents currently used in paediatric sedation/analgesia.
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Bupropion hydrochloride is a monocyclic antidepressant which is used in a slow-release formulation as a smoking cessation aid. Its side effects include insomnia and dry mouth with seizures occurring in 1 in 1000 patients. ⋯ It is, however, effective in smoking cessation in approximately 20% of patients and may be more effective if combined with nicotine replacement therapy. The key question is whether the risks associated with the drug are justified by the obvious benefits to health from smoking cessation.
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Patients suffering from frequent migraine attacks or chronic tension-type headache are at risk of developing drug-induced headache (now called 'medication overuse headache' [MOH]) as described by the new classification of the International Headache Society. This headache entity is caused by frequent use of antiheadache compounds (non-opioid analgesics, ergot alkaloids, 5-HT agonists, combined preparations with caffeine or codeine) for more than 15 days/month. Most patients, however, use the medication daily. ⋯ Several medical (e.g., class of overused drugs) and psychological (e.g., standard of performance) predictors were recently identified. Medication overuse in headache patients is based on multiple factors with physical, social and psychological impact. In view of the high prevalence and relapse rate, it is necessary to establish a structured post-treatment programme for patients after the acute withdrawal phase, which considers the predictors for relapse.