Expert opinion on drug safety
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Expert Opin Drug Saf · Jan 2006
ReviewCoagulopathy and the role of recombinant human activated protein C in sepsis and following polytrauma.
Recombinant human activated protein C (rhAPC) also known as drotrecogin alfa (activated) has known antithrombotic, anti-inflammatory, and profibrinolytic properties in severe sepsis. Treatment with rhAPC (Xigris) has been shown to reduce mortality in patients with severe sepsis. The lack of any trials of rhAPC in trauma patients means that a definitive recommendation regarding its use in the polytraumatised patient, in whom severe head trauma or other contraindications for the use of rhAPC have been excluded remains controversial at present. This article describes the current evidence of its efficacy and safety in severe sepsis with relation to surgery and trauma.
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Expert Opin Drug Saf · Nov 2005
ReviewThe safety and efficacy of the use of vasopressin in sepsis and septic shock.
Sepsis remains a significant problem and cause of morbidity and mortality in intensive care. Vasopressin infusions are currently used as rescue therapy for the treatment of vasodilatory, catecholamine-resistant septic shock. ⋯ A review of the safety data for vasopressin in this indication is included. Recommendations for the use of vasopressin in septic shock, along with suggestions for the direction of further work in the field are presented.
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Expert Opin Drug Saf · Nov 2005
EditorialInteractions between herbal remedies and antirheumatic drugs.
Many patients with rheumatological conditions use herbal remedies as an adjunct to their conventional antirheumatic medication, often without seeking advice. Herbal remedies are exempt from the usual drug safety requirements and may be a cause of both adverse effects and drug interactions. ⋯ Interactions are likely between herbal remedies with antiplatelet or nephrotoxic effects and NSAIDs, hepatotoxic herbal remedies and disease-modifying antirheumatic medication, and between St. John's Wort and cyclosporin.
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Clozapine is a distinctive antipsychotic agent, having a unique clinical profile and an idiosyncratic safety profile. More so than with other agents, the weighting of its adverse event profile is critical, in order to counterbalance its clear clinical advantages. ⋯ These include haematological (neutropenia and agranulocytosis), CNS (seizures), cardiovascular (myocarditis and cardiomyopathy), metabolic (diabetes), gastrointestinal and neuromuscular. Understanding the safety profile of clozapine allows an informed use of the agent that can maximise its clear clinical benefit and minimise the known risks.
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Remifentanil is the newest of the fentanyl family of short-acting phenylpiperidine derivatives to be released into clinical practice. Remifentanil is a pure agonist at the mu opioid receptor with relatively little binding at the kappa, sigma or delta receptors. This is precisely the same profile as the other opioids currently popular in anaesthetic practice (fentanyl, alfentanil, sufentanil) and it offers the same advantages (profound analgesia, sedation, attenuation of the stress response). ⋯ The untoward effects of remifentanil, given by continuous infusion, are well-described in the literature. They are predictable and easily managed by experienced clinicians. This review will concentrate on the adverse effects of remifentanil given by bolus injection, either alone or in the context of a background infusion.