Clin-Alert
Identifieur interne : 002593 ( Istex/Corpus ); précédent : 002592; suivant : 002594Clin-Alert
Auteurs :Source :
- Clin-Alert® [ 0069-4770 ] ; 2001-10-15.
English descriptors
- Teeft :
- Abnormal psychomotor activity, Acenocoumarol therapy, Adverse event, Adverse events, Alveolar hemorrhage, Bladder, Breast cancer, Cognitive decline, Concurrent medications, Continuous fentanyl infusion, Cytomegalovirus infection, Diphenhydramine, Diphenhydramine group, Discontinuation, Distended bladder, Dosage reduction, Female patient, Fentanyl, Fentanyl patch, First report, Hypersensitivity reactions, Infusion, Initial symptoms, Intensive care, Ischemic, Ischemic disease, Ischemic heart disease, Isotretinoin, Isotretinoin therapy, Letrozole, Medication, Months post transplantation, Mycophenolate mofetil, Ocular, Ocular side effects, Ocular syndrome, Older patients, Quetiapine, Relative risk, Renal, Renal transplant patient, Renal transplantation, Renal ultrasound, Risk factor, Rituximab, Rituximab therapy, Severe depression, Sirolimus, Skin necrosis, Subacute cutaneous lupus erythematous, Suicidal ideation, Surgical warming blanket, Tamoxifen therapy, Tardive dyskinesia, Temporal relationship, Terbinafine, Terbinafine therapy, Topiramate, Transplantation, Tricyclic antidepressant, Trough sirolimus concentrations, Urinary retention, Urine output, Valproic acid, Vision changes, Warming blanket.
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DOI: 10.1177/00694770122244471
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ISTEX:1FB903A881F25DDF7579925001C6EF2D669212B7Le document en format XML
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wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="other" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spcla</journal-id><journal-id journal-id-type="publisher-id">CLA</journal-id><journal-title>Clin-Alert®</journal-title><issn pub-type="ppub">0069-4770</issn><publisher>
<publisher-name>Sage Publications</publisher-name>
<publisher-loc>Thousand Oaks • London • New Delhi</publisher-loc>
</publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/00694770122244471</article-id><article-id pub-id-type="publisher-id">10.1177_00694770122244471</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Clin-Alert</article-title></title-group><pub-date pub-type="ppub"><day>15</day><month>10</month><year>2001</year></pub-date><volume>39</volume><issue>19</issue><fpage>1</fpage><lpage>8</lpage><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Other</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> Volume 39, Number 19 October 15, 2001 QUETIAPINE Tardive Dyskinesia No. 263 A 25-year-old female patient with type I bipolar disorder developed repetitive involuntary jaw movements approximately six weeks after quetiapine (125 mg daily) was substituted for olanzapine. Concurrent medications included gabapentin (4400 mg daily) and lithium (900 mg daily). Previous medications, olanzapine and risperidone, were discon- tinued due to rash and significant weight gain, respectively. Other previ- ous medications also included carbamazepine, divalproex, lamotrigine, fluoxetine, and bupropion. Jaw movements persisted despite a dosage reduction. Quetiapine was eventually discontinued after 13 weeks of therapy. However, at a 10-month follow-up visit, only involuntary lower jaw movements remained. The patient was maintained on gabapentin, lithium, and topiramate without the development of further symptoms. The authors concluded that this patient experienced tardive dyskinesia related to quetiapine therapy. They noted that this is the sec- ond published report of this adverse event associated with the drug. Quetiapine ["Seroquel"] Ghaemi SN & Ko JY (Boston, MA) Quetiapine related tardive dyskinesia. Am J Psychiatry 158:1737 (Oct) 2001 Acenocoumarol (268) Diphenhydramine (272) Dothiepin (275) Fentanyl* (267, 276) Gemcitabine* (270) Infliximab (273) Isotretinoin (274) Letrozole* (271) Quetiapine (263) Rituximab (265) Sirolimus (269) Terbinafine (277) Topiramate (264, 266) DOI: 10.1106/MP25-C2N7-RNEV Sage Publications Thousand Oaks London New Delhi Available online at http://techpub.metapress.com TOPIRAMATE Depression, Suicidal Ideation No. 264 Three cases of topiramate-induced depression were reported in three adults. Patient 1. A 24-year-old female patient developed severe depression and suicidal ideation approximately two days after a topiramate dosage was increased from 25 mg daily to 50 mg daily. Concurrent medications included gabapentin and zolpidem. Symptoms, including suicidal ideation, resolved approximately one week post discontinuation. Patient 2. A 40-year-old female patient developed severe depression, anhedonia, and anergia approxi- mately one week after titration of topiramate to 50 mg daily for the treatment of racing thoughts. Concurrent therapy included valproic acid, risperidone, and cetirizine. Dosage reduction over a two-day period was suc- cessful in reversing symptoms. Patient 3. A 34-year-old female patient developed severe depression and suicidal ideation approximately three weeks after starting topiramate (50 mg daily) for psychomotor agitation and anxiety. Concurrent medi- cations included fluoxetine, thyroxine, and valproic acid. After dosage tapering and discontinuation, adverse symptoms resolved within three days. The authors concluded that topiramate-induced depression occurred in these patients based on the tem- poral relationship between drug administration and appearance and disappearance of symptoms. They also suggested that the sudden onset of depression might have been related to an interaction with topiramate and other medications. Topiramate ["Topamax"] Klufas A & Thompson D (Pittsburgh, PA) Topiramate induced depression. Am J Psychiatry 158:1736 (Oct) 2001 RITUXIMAB Fatal Reactivation of Cytomegalovirus Infection No. 265 A 64-year-old patient developed bilateral interstitial nephritis after receiving the fourth dose of rituximab (375 mg/m2/course of therapy) for post transplant lymphoma, which developed 10 years after her kidney transplant. At the time of transplantation, 10 years earlier, the patient and the donor both tested positive for cytomegalovirus (CMV). The immunosuppressive regimen post transplantation consisted of cyclosporine (140 mg daily) and prednisone (10 mg daily). The development of cutaneous and nodal post transplant lym- phoma necessitated the discontinuation of cyclosporine and required tapering of the prednisone. Serological screening for infectious etiologies after rituximab therapy revealed positive titers for CMV. Treatment with ganciclovir was unsuccessful, and the patient died. The authors suggested that the occurrence of CMV infection 10 years post transplantation is rare and is possibly related to rituximab therapy. They noted that rituximab may impair humoral immunity, which is not involved in defending against CMV infection. They suggested that immunosuppressed patients should be tested for CMV prior to the initiation of rituximab. Rituximab ["Rituxan"] Suzan F et al (Inst Gustave Roussy, 94805 Villejuif, France) Fatal reactivation of cytomegalovirus infec- tion after use of rituximab for a post transplantation lymphoproliferative disorder. N Engl J Med 345:1000 (Sep 27) 2001 No. 264 2 No. 265 TOPIRAMATE Acute Myopia, Glaucoma, FDA Safety Alert No. 266 On September 26, 2001, the FDA and Ortho McNeil Pharmaceuticals notified health professionals with re- gard to an ocular syndrome associated with topiramate use. Specific adverse effects included acute myopia and secondary angle closure glaucoma, with a typical onset within the first month of therapy. Initial symptoms included decreased visual acuity and/or ocular pain. Post marketing surveillance revealed a total of 23 re- ported cases, primarily occurring in adults (22/23). Ophthalmological examination often revealed myopia, redness, and elevated ocular pressure with or without pupil dilatation. Supraciliary effusion may displace the lens and iris anteriorly, possibly causing angle closure glaucoma. Recommended treatment includes the dis- continuation of topiramate. Untreated elevated intraocular pressure may result in serious sequelae, including permanent vision loss. Patients should be instructed to contact their physician if vision changes or ocular pain occurs during topiramate therapy. Topiramate ["Topamax"] FDA Safety Alert. Topiramate induced ocular syndrome. http://www.fda.gov/medwatch/safety/2001/ topamax_deardoc.PDF (Sep 26) 2001 FENTANYL PATCH Opioid Overdose Due to Surgical Warming Blanket (First Report*) No. 267 A 57-year-old female patient developed decreased respirations (three breaths per minute) within one hour after an upper-body warming blanket was placed during a surgical procedure for stress fracture. Additional symptoms included a tidal volume of 800 mL and pinpoint bilateral pupils. Medications prior to surgery in- cluded transdermal fentanyl (75 mg/hr), gabapentin (600 mg once daily), baclofen (5 mg three times daily), sertraline (50 mg once daily), zolpidem (as needed), and acetaminophen/codeine (325 mg/5 mg as needed). The fentanyl patch, placed on the left side of the chest, was not removed prior to surgery. However, once symptoms occurred during surgery, the patch was removed immediately. Additional treatment included intra- venous naloxone (60 mcg total). Respirations increased to seven breaths per minute within 20 minutes after naloxone administration. The remainder of surgery and post surgical recovery was uneventful. The authors concluded that this is the first case of fentanyl patch overdose related to a surgical warming blanket. A suggested mechanism of action proposed that fentanyl absorption is dependent on the diffusion characteristics of the patch as well as the skin. Skin warming may increase drug perfusion through the skin, resulting in rapid dosing. The authors noted that the product labeling recommends avoidance of direct exter- nal heat sources but does not mention surgical warming blankets. The authors recommended that surgical patients with fentanyl patches should be closely monitored during surgery. Fentanyl transdermal patch ["Duragesic"] Frlich M et al (Dept Anesthesiology, Univ Florida Coll Med, PO Box 100254, Gainesville, FL 32610; e-mail: froelich@anest1.anest.ufl.edu) Opioid overdose in a patient using a fentanyl patch during treat- ment with a warming blanket. Anesth Analg 93:647648 (Sep) 2001 No. 266 3 No. 267 ACENOCOUMAROL Skin Necrosis No. 268 A 56-year-old obese inpatient developed painful indurated areas on both thighs approximately 15 days af- ter starting acenocoumarol therapy for atrial fibrillation. Previous therapy included intravenous heparin ther- apy for five days. Acenocoumarol therapy was stopped after 40 days. Despite therapy with intravenous hepa- rin, vitamin K, and fresh frozen plasma for 10 days, the necrotic areas expanded to both buttocks. The skin of the abdominal wall also developed large erythematous areas, which progressed to necrotic patches. Further laboratory testing revealed that the patient had a protein C deficiency, although no indication of lupus was ev- ident. At approximately two months after the initiation of therapy, the skin lesions had extended to 20% of the patient's body, requiring surgical debridement and skin autografting. The patient eventually died from septic shock and multiorgan failure. The authors concluded that this patient developed coumarin-induced skin necrosis resulting from type I protein C deficiency as a result of liver cirrhosis. They suggested that patients with previous liver disease might benefit from a testing for protein C levels prior to anticoagulation. Acenocoumarol ["Sinthrome," "Sintrom"] Argaud L et al (Serv de Reanimation Medicale et d'Assistance Respiratore, Hopital de la Croix-Rousse, 69317 Lyon, France; e-mail: argaud.laurent@wanadoo.fr) Extensive coumarin induced skin necrosis in a pa- tient with acquired protein C deficiency. Intensive Care Med 27:1555 (Sep) 2001 SIROLIMUS Premature Osteonecrosis No. 269 Two cases of osteonecrosis or avascular necrosis were reported in patients after renal transplantation. Patient 1. A 39-year-old renal transplant patient developed acute leg pain approximately seven months post transplantation. Medications included prednisone (10 mg), cyclosporine (300 mg), and sirolimus (5 mg daily). Trough sirolimus concentrations were 20.7 mg/mL. X-rays revealed avasculature necrosis of both hips. Treatment included the discontinuation of sirolimus and substitution with tacrolimus and myco- phenolate mofetil. Symptoms also improved during therapy with pamidronate disodium. Patient 2. A 49-year-old renal transplant patient developed hip pain approximately six months post trans- plantation. Medication included prednisone (10 mg), cyclosporine (200 mg), and sirolimus (5 mg). Trough sirolimus concentrations were 5.8 ng/mL. Bilateral avascular necrosis of the hips was verified. Myco- phenolate mofetil was substituted for sirolimus. The patient eventually required bilateral hip replacement. The authors suggested that sirolimus may have been the cause of early post transplant avascular necro- sis. The suggested mechanism of action was possibly related to the adverse effect of sirolimus on lipid pro- files or potent bone marrow suppression. The event may also be considered an idiosyncratic effect. Sirolimus ["Rapamune"] Bhandari S et al (Hull and East Yorkshire Hospitals, NHS Trust, Hull Royal Infirmary, Hull HU3 2JZ, UK) Premature osteonecrosis and sirolimus treatment in renal transplantation. Br Med J 323:665 (Sep 22) 2001 No. 268 4 No. 269 GEMCITABINE Fatal Alveolar Hemorrhage (First Report*) No. 270 A 72-year-old male patient with lung cancer was hospitalized for fever and dyspnea approximately one week after receiving the second dose of gemcitabine (1500 mg weekly). Previous chemotherapy drugs in- cluded vinorelbine, cisplatin, and ifosfamide. A chest x-ray upon admission demonstrated bilateral interstitial infiltrates. Despite antibiotic therapy for suspected pneumonia, the patient's condition deteriorated, requiring admission to the intensive care setting. Other relevant laboratory data included platelet count (87,000/mm3 ), hemoglobin (10.2 g/dL), serum urea nitrogen (7.6 mg/dL), and proteinuria (0.21 g/day). Bronchoscopy was indicative of alveolar hemorrhage. Treatment included methylprednisolone (240 mg for three days) and transfusions. Although the patient initially improved clinically, he died seven days later of pulmonary obstruc- tion. Autopsy results demonstrated diffuse alveolar damage. The authors concluded that the temporal relationship between the onset of symptoms and the administra- tion of gemcitabine was indicative of a drug-induced reaction. They suggested that the drug was a possible causative agent and noted that this is the first case report of its kind. A mechanism of action was not provided. Gemcitabine ["Gemzar"] Carron PL et al (Service de Reanimation et Transplantation, 149 rue de Sevres, Hopital Necker, 75743 Paris, France) Gemcitabine associated diffuse alveolar hemorrhage. Intensive Care Med 27:1554 (Sep) 2001 LETROZOLE Hyperlipidemia (First Report*) No. 271 In a prospective study, 20 post menopausal women (mean age: 54 years) with advanced breast cancer re- ceived letrozole (2.5 mg once daily) after tamoxifen therapy. The median time from the discontinuation of tamoxifen therapy to the initiation of letrozole was 11 months (range, 2-72 months). At eight and 16 weeks post initiation of therapy, significant increases were noted in total cholesterol (239 vs. 259 vs. 258 mg/dL), LDL cholesterol (148 vs. 169 vs. 176 mg/dL), apolipoprotein B (109 vs. 120 vs. 117), total cholesterol/HDL cholesterol ratio (3.94 vs. 4.53 vs. 4.48), and LDL cholesterol/HDL cholesterol (2.46 vs. 2.97 vs. 3.00). No significant changes occurred in serum triglycerides, lipoprotein (a), apolipoprotein A or E, HDL cholesterol, and apolipoprotein A1 levels. There were no significant differences in serum lipid levels between patients with and without metastatic disease. The authors concluded that letrozole significantly increased total serum cholesterol and LDL cholesterol, including apolipoprotein B levels. Suggested mechanisms of action included the drug's effect on lowering es- trogen activity or possible interference with the cholesterol synthesis via liver enzymatic pathways. They sug- gested that these deleterious changes might increase the risk of cardiovascular mortality and morbidity and that larger clinical trials are needed to validate these initial results. Letrozole ["Femara"] Elisaf MS et al (Dept Internal Med, Med School, Univ Ioannina, GR 451 10, Ioannina, Greece; e-mail: melisaf@cc.uoi.gr) Effect of letrozole on the lipid profile in postmenopausal women with breast cancer. Eur J Cancer 37:15101513 (Aug) 2001 No. 270 5 No. 271 DIPHENHYDRAMINE Cognitive Adverse Events in Hospitalized Older Patients No. 272 In a prospective cohort study, 426 hospitalized older (> 70 years) patients were enrolled in a study to moni- tor cognitive effects associated with diphenhydramine administration. Approximately 27% (114) patients re- ceived diphenhydramine during their hospital stay. The maximum cumulative dose in these patients was 100 mg, with patients receiving a mean of 2.1 doses. The most common indications for use included sleep (68%), blood transfusion prophylaxis (21%), and treatment for allergic or pruritic reactions (3%). Cognitive decline was more likely to occur in those patients receiving diphenhydramine than those who did not receive the drug (relative risk: 1.7). Patients in the diphenhydramine group also were associated with an increased risk of inat- tention (relative risk: 3.0), disorganized speech (relative risk: 5.5), altered level of consciousness (relative risk: 3.1), abnormal psychomotor activity (relative risk: 2.3), altered sleep-wake cycle (relative risk: 2.0), and behavioral disturbances (relative risk: 5.6). In addition, length of hospital stay was longer in the diphenhydramine group (seven vs. six days). Approximately 24% of the doses were administered inappropri- ately. Four delirium symptoms (e.g., inattention, altered consciousness, abnormal psychomotor activity, al- tered sleep wake cycles) were associated with significant dose response. The authors concluded that diphenhydramine use in hospitalized older patients is associated with a signifi- cant risk of cognitive decline. These symptoms appear to be dose related. They suggested that diphenhy- dramine use in hospitalized older patients should be reviewed. Diphenhydramine ["Benadryl"] Agostini JV et al (Inouye SK: Yale Univ Sch Med, Yale-New Haven Hosp, 20 York St, Tompkins 15, New Haven, CT 06504) Cognitive and other adverse effects of diphenhydramine use in hospitalized older pa- tients. Arch Intern Med 161:20912097 (Sep 24) 2001 INFLIXIMAB Mortality No. 273 A 35-year-old female patient with Crohn's disease developed sudden chest pain and dyspnea shortly after the initiation of an infliximab infusion (5 mL). The patient had received the first two doses (5 mg/kg three weeks apart) without adverse event. Concurrent medications included azathioprine and prednisolone. Previ- ous unsuccessful therapy also included metronidazole. The patient had experienced hypersensitivity reactions to mesalamine and sulfasalazine. The initial symptoms at this time progressed to include cyanosis, produc- tive cough, generalized skin rash, and hypotension. Treatment with epinephrine, high-dose hydrocortisone, and promethazine was unsuccessful. A chest x-ray revealed bilateral diffuse alveolar infiltrate suggestive of adult respiratory syndrome. The patient died six hours later, with refractory hypotension and respiratory failure. The authors suggested that this patient's history of hypersensitivity reactions to mesalamine may have been a predisposing risk factor in the development of an anaphylactic reaction to infliximab. They suggested that this drug be used with caution. Infliximab ["Remicade"] Lankarani KB (Dept Internal Med, Shiraz Univ Med Sciences, Shiraz, Islamic Republic of Iran) Mortality associated with infliximab. J Clin Gastroenterol 33:255256 (Sep) 2001 No. 272 6 No. 273 ISOTRETINOIN Ocular Side Effects No. 274 A total of 1741 post marketing reports described 2379 adverse ocular events associated with isotretinoin use. These reports were reviewed at the National Registry of Drug Induced Ocular Side Effects. Adverse events occurred within days or up to years after starting isotretinoin therapy. The most common specific events included blurred vision (473), keratitis (394), blepharoconjunctivitis (259), decreased dark adaptation (14), opacities (119), idiopathic intracranial hypertension (109), and refractory changes (85). Vision changes were most commonly reported (613), followed by events that affected either the cornea (545) or the eyelids or conjunctiva (305). The authors noted that voluntary post marketing surveillance reports often lack complete information and follow-up data. However, these types of reports may be useful in following trends with new information. The au- thors suggested that ocular examinations might be useful in monitoring patients during isotretinoin therapy. Isotretinoin ["Accutane"] Fraunfelder FT et al (Casey Eye Inst, 3375 SW Terwilliger Blvd, Portland, OR 97201; e-mail: fraunfel@ ohsu.edu) Ocular side effects possibly associated with isotretinoin usage. Am J Ophthalmol 132:299 305 (Sep) 2001 DOTHIEPIN Increased Risk for Ischemic Heart Disease No. 275 In a matched-case control study of nine general practices, 933 patients with ischemic heart disease were matched to 5516 controls. Significant increased risks for ischemic heart disease included the use of any anti- depressant ever (P < .0001), any use of a tricyclic antidepressant (P = .001), use of a tricyclic antidepressant only (P = .004), and dothiepin use ever (P = .005). On univariate analysis, selective serotonin reuptake inhibi- tors were also associated with an increased risk for ischemic heart disease. However, no risk was found for this group when adjustments were made for cofounders. Risks for ischemic disease were not significantly in- creased with the use of other antidepressants or the use of amitriptyline. Increased doses of dothiepin were associated with increased risks of ischemic disease, particularly maximum doses greater than 50 mg or greater than 100 mg (odds ratio: 1.72 and 1.77, respectively). The authors concluded that patients with recent ischemic heart disease were more likely to have taken an- tidepressants than were matched controls. Prescriptions for dothiepin were also significantly associated with ischemic events in a dose response relationship. Dothiepin ["Dopin," "Dosulepin"] Hippisley-Cox J et al (Div General Practice, Univ Nottingham, Nottingham NG7 2RD, UK) Antidepres- sants as risk factor for ischaemic heart disease: case-control study in primary care. R Med J 323:666 669 (Sep 22) 2001 No. 274 7 No. 275 FENTANYL Urinary Retention in Infants (First Report*) No. 276 Two cases of urinary retention are reported in infants receiving continuous infusions of fentanyl. Patient 1. A 30-week-old (gestational age) infant weighing 1.5 kg developed hypertension on the third day of hospitalization. Concurrent medications at the time included surfactant via endotracheal administration and a continuous fentanyl infusion (3 mcg/kg/hr). The hypertension was treated with enalapril. Also at this time, the serum urea nitrogen and creatinine peaked at 36 and 1.3, respectively. A renal ultrasound did not reveal renovascular disease, but it did indicate a distended bladder, severe bilateral hydronephrosis, and se- vere bilateral hydroureter. Initially, the decreased urine output was attributed to a congenital malformation or neurogenic bladder. However, once urine drainage was completed via an indwelling catheter, follow-up renal ultrasound was within normal limits. A voiding cystourethrogram was also normal at nine days of age. Patient 2. A 31-week-old (gestational age) male infant weighing 1.335 kg developed respiratory distress and required intubation and treatment with surfactant. Sedation was also started with continuous fentanyl in- fusion dosed at 3 mcg/kg/hr. Shortly after starting the fentanyl drip, the patient's urine output decreased. A re- nal ultrasound revealed hydronephrosis with a distended bladder. Catheterization resulted in voidance of ap- proximately 40 mL. A repeat renal ultrasound at seven days of age was normal. The fentanyl infusion had been stopped on the second day. The authors concluded that these infants experienced urinary retention unrelated to anatomic etiology and in both cases had symptoms shortly after fentanyl infusions were started. Possible mechanisms include inhi- bition of the parasympathetic innervation of the bladder, thus interfering with control tone and bladder con- traction. Another possible effect may be increases in urethral sphincter pressure. The authors suggested that indwelling urinary catheters should be used in preterm infants who are receiving continuous fentanyl infu- sions. Alternate methods may include close clinical observation for the development of bladder distention. Fentanyl ["Sublimaze"] Das UG & Sasidharan P (Dept Pediatrics, Div Neonatology, Children's Hosp Wisconsin, Med Coll Wis- consin, Milwaukee, WI 53226) Bladder retention of urine as a result of continuous intravenous infusion of fentanyl: 2 case reports. Pediatrics 108:10121015 (Oct) 2001 TERBINAFINE Cutaneous Lupus Erythematous No. 277 Five adult patients (mean age: 43.8 years) experienced an exacerbation or new onset of subacute cutane- ous lupus erythematous during terbinafine therapy for suspected onychomycosis. Onset of drug-induced eruption occurred within two months of therapy initiation. Doses ranged from 250 mg daily in four patients to 250 monthly pulses administered as twice daily. Antinuclear antibody titers were positive in all patients. All patients received several concurrent medications for a variety of comorbidities. Treatment included therapy with dapsone, prednisone, triamcinolone acetonide, topical clobetasol, or hydroxychloroquine. All patients experienced full resolution of symptoms within six to eight weeks after the discontinuation of terbinafine. In one patient, disease recurred within three weeks after prednisone treatment. Based on these reports, the authors suggested a link between terbinafine therapy and the onset or exacer- bation of subacute cutaneous lupus erythematous. They suggested that the drug should be used only in pa- tients with documented dermatophyte infections. Terbinafine ["Lamisil"] Callen JP et al (Div Dermatology, Dept Med, Univ Louisville, Sch Med, Louisville, KY 40208) Subacute cutaneous lupus erythematous induced or exacerbated by terbinafine. Arch Dermatol 137:1196-98 (Sep) 2001 No. 276 8 No. 277 </meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Clin-Alert</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Clin-Alert</title></titleInfo><typeOfResource>text</typeOfResource><genre type="other" displayLabel="other" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-7474895G-0">other</genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Thousand Oaks • London • New Delhi</placeTerm></place><dateIssued encoding="w3cdtf">2001-10-15</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><relatedItem type="host"><titleInfo><title>Clin-Alert®</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0069-4770</identifier><identifier type="eISSN">1530-812X</identifier><identifier type="PublisherID">CLA</identifier><identifier type="PublisherID-hwp">spcla</identifier><part><date>2001</date><detail type="volume"><caption>vol.</caption><number>39</number></detail><detail type="issue"><caption>no.</caption><number>19</number></detail><extent unit="pages"><start>1</start><end>8</end></extent></part></relatedItem><identifier type="istex">1FB903A881F25DDF7579925001C6EF2D669212B7</identifier><identifier type="ark">ark:/67375/M70-7866J15Q-5</identifier><identifier type="DOI">10.1177/00694770122244471</identifier><identifier type="ArticleID">10.1177_00694770122244471</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B">sage</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/M70-7866J15Q-5/record.json</uri></json:item></metadata><author></author><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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