Clinical pharmacology and therapeutics
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Clin. Pharmacol. Ther. · Aug 2011
Prediction of torsade de pointes from the QT interval: analysis of a case series of amisulpride overdoses.
Electrocardiograms (ECGs) from a case series of 86 amisulpride overdose events in 66 patients were reviewed for abnormal QT intervals and torsade de pointes (TdP). Eight patients exhibited TdP. In this investigative case series, the magnitude of prolongation of the QT interval was a stronger predictor of TdP than the mere presence of a prolongation per se.
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In this issue, Hysek and colleagues present new data describing the impact of treatment with reboxetine on the effects produced by 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") in human volunteers. They demonstrate that several effects of MDMA are mediated by reboxetine's actions on norepinephrine (NE) transporters, an unexpected finding. Building on earlier work, their new data provide new insights into the pharmacodynamics of MDMA and other monoamine-releasing agents.
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Clin. Pharmacol. Ther. · Jul 2011
Randomized Controlled Trial Comparative StudyA randomized study of the efficacy and safety of intravenous acetaminophen vs. intravenous placebo for the treatment of fever.
This randomized, double-blind, placebo-controlled study evaluated the antipyretic effect and safety of intravenous (i.v.) acetaminophen using an endotoxin-induced fever model. Subjects exhibiting sufficient fever response following administration of reference standard endotoxin (RSE) were randomly assigned to receive i.v. acetaminophen 1,000 mg (n = 31) or matching placebo (n = 29). The primary efficacy end point was the weighted sum of temperature differences from baseline through 6 h. ⋯ Temperature differences from baseline reached statistical significance at T30 min after endotoxin administration (15 min after completing the study medication infusion). Acetaminophen administered i.v. was well tolerated, and the frequency of adverse events was comparable to that after administration of i.v. placebo. This study shows that i.v. acetaminophen in a single 1,000-mg dose is safe and effective in reducing fever.
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Clin. Pharmacol. Ther. · Jul 2011
The importance of high-quality evidence of the long-term impact of nonfatal events used in randomized controlled trials: a case study of prasugrel.
Randomized controlled trials (RCTs) are the centerpiece of evidence-based medicine. However, because of the limited follow-up, additional evidence on the long-term consequences of the outcomes used in trials is commonly required for clinical and policy decision making. This article provides insights into the importance and challenges of using such evidence through the case study of nonfatal myocardial infarction (MI) and nonfatal bleeding with prasugrel.