Pharmacotherapy
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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.
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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.
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To investigate the dosing, tolerability, and outcomes associated with the use of concomitant beta-blockers and inotropic therapy in patients with refractory heart failure during the first 6 months of their therapy. ⋯ Inotrope-dependent patients with refractory end-stage heart failure tolerated continuous intravenous milrinone plus beta-blockers in addition to diuretics and vasodilators for the 6-month observation period. Beta-blocker dosages were titrated, and three patients achieved the target beta-blocker dosage established for stage A-C heart failure. Additional studies are needed to determine the optimal selection and dosing of drug combinations in this population.