Pharmacotherapy
-
Comparative Study Clinical Trial
Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome.
To evaluate the efficacy of a single, low-dose injection of botulinum toxin type A in relieving pain in Korean patients with piriformis syndrome resistant to conventional therapy, and to assess the drug's influence on these patients' quality of life. ⋯ A low dose of botulinum toxin type A relieved pain and improved quality of life in patients with refractory piriformis syndrome.
-
Case Reports
Severe lactic acidosis associated with linezolid use in a patient with the mitochondrial DNA A2706G polymorphism.
Linezolid, an oxazolidinone antimicrobial, exerts its effect by binding to bacterial 23S ribosomal RNA, preventing the formation of the initiation complex. Its use is associated with reversible hyperlactatemia and lactic acidosis, and inhibition of mitochondrial protein synthesis may be the mechanism underlying this adverse effect. ⋯ This patient was found to have the mitochondrial DNA polymorphism A2706G, a variation previously suggested to predispose individuals to linezolid-associated lactic acidosis. In the future, increased understanding of the mitochondrial genome and its associated polymorphisms may allow us to identify patients at risk for adverse effects that were previously classified as idiosyncratic.
-
To characterize the safety of concomitant aspirin, clopidogrel, and warfarin therapy after percutaneous coronary intervention (PCI), and to identify patient characteristics that increase the risk of hemorrhage. ⋯ Warfarin was an independent predictor of major bleeding after PCI in patients receiving dual antiplatelet therapy. Prospective data to further characterize the safety of concomitant warfarin and dual antiplatelet therapy after PCI are needed.
-
Randomized Controlled Trial
The effect of acetaminophen on the international normalized ratio in patients stabilized on warfarin therapy.
To determine whether an interaction exists between acetaminophen and warfarin that alters the international normalized ratio (INR). ⋯ These findings support the existence of a clinically significant interaction between warfarin and daily use of acetaminophen 2-4 g, necessitating close monitoring of patients who receive this drug combination. Whether this interaction occurs when acetaminophen is taken in lower doses or is used sporadically requires further study.
-
Review Comparative Study
Iontophoretic drug delivery system: focus on fentanyl.
Fentanyl iontophoretic transdermal system (ITS) is a novel, patient-activated drug delivery device used for the management of acute postoperative pain in the hospital setting. This credit-card-sized device uses an imperceptible current of 170 milliampere to actively deliver a fentanyl hydrochloride 40-microg dose into the vasculature over a 10-minute interval. The unit is programmed to lock out further doses after either 80 doses or 24 hours, whichever is reached first. ⋯ Although adverse effects were congruent with those expected from pure-agonist opioids, subjects assigned to the ITS group did experience a higher rate of mild, clinically nonsignificant erythema at the system placement site. Judicious monitoring for opioid-induced respiratory depression is recommended for fentanyl ITS, although this adverse effect has not been observed in clinical trials. Fentanyl ITS may provide another useful alternative in the management of acute postoperative pain.