The Annals of pharmacotherapy
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To review the pharmacology, efficacy, and safety of vedolizumab in the treatment of patients with ulcerative colitis (UC) and Crohn's disease (CD). ⋯ Vedolizumab is an effective agent at inducing and maintaining remission in patients with UC or CD. Vedolizumab is generally well tolerated and has not been associated with progressive multifocal leukoencephalopathy.
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Comparative Study
Comparative persistence on β-blockers versus calcium channel blockers for ventricular rate control in nonelderly patients with atrial fibrillation.
For patients with atrial fibrillation (AF), early treatment is essential to prevent serious complications such as stroke. Several randomized clinical trials have shown that rate-control may be as effective as rhythm-control medications, whereas the latter have serious side effects. Little evidence exists, however, about which class of rate-control medication-β-blockers (BBs) or calcium channel blockers (CCBs)-may be superior. ⋯ Evidence suggests that nonelderly AF patients, when prescribed rate-control therapy, persist longer on BBs than CCBs. Because this is the first long-term study comparing the 2 drug classes in the nonelderly population, further research is suggested.
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As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. ⋯ AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.
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Comparative Study Observational Study
Efficacy and safety of tranexamic acid versus ϵ-aminocaproic acid in cardiovascular surgery.
Blood conservation is a major concern in the management of surgical patients because of transfusion-related complications, limited supply, and health care costs. Tranexamic acid (TXA) and ϵ-aminocaproic acid (ϵACA) are lysine analogue antifibrinolytics used to reduce surgical bleeding and transfusions. ⋯ There were no differences in the efficacy and safety outcomes between TXA and ϵACA in the management of cardiovascular surgical bleeding at our institution. Considering the substantial cost difference and comparable efficacy and safety, ϵACA may have better value over TXA for reducing cardiovascular surgical bleeding.
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Patients suffering from moderate to severe serotonin syndrome frequently present with autonomic instability and altered mental status. Management of serotonin syndrome can be complex and may be refractory to treatment with benzodiazepines alone. The objective of this series is to present 3 cases of serotonin syndrome that demonstrated clinical improvement with initiation of dexmedetomidine. ⋯ Accordingly, health care providers may consider using dexmedetomidine as adjunctive therapy for cases of severe serotonin syndrome that are refractory to standard treatment.