1.
Ergotism and factitious hypotension associated with interaction of ergotamine with CYP3A4 inhibitors.
Srisuma, S, Lavonas, EJ, Wananukul, W
Clinical toxicology (Philadelphia, Pa.). 2014;(7):674-7
Abstract
BACKGROUND Although uncommon, severe ergotism continues to occur. The purpose of this study is to describe causes and clinical effects of ergotism in recent years. METHODS This is an observational case series with data obtained retrospectively from all patients with ergotism referred to Ramathibodi Poison Center in Bangkok, Thailand from January 2006 to August 2013. RESULT Twelve cases of ergotism were identified. All cases involved ergotamine 1 mg/caffeine 100 mg combination tablets. Nine cases (75%) were precipitated by drug-drug interactions with CYP3A4 inhibitors. The other cases involved suicidal attempt (2 cases) and pediatric unsupervised ingestion (1 case). Ten patients (83%) had signs of peripheral vascular insufficiency. Five of these patients initially had factitiously low or unmeasurable blood pressure using non-invasive technique and had paradoxical increase following intravenous vasodilator administration. Two patients required partial foot amputations due to gangrene. Two patients, including a 15-month-old boy with an unsupervised ingestion, died. DISCUSSION In this series, most cases of severe ergotism were associated with interaction with CYP3A4 inhibitors, which increase ergotamine bioavailability. Factitious low blood pressure in these cases was likely caused by severe vasospasm. CONCLUSION Critical ergotism continues to occur in Thailand, most commonly associated with the drug-drug interactions.
2.
Suppression of non-sustained ventricular tachycardia with ranolazine: a case report.
Kaliebe, JW, Murdock, DK
WMJ : official publication of the State Medical Society of Wisconsin. 2009;(7):373-5
Abstract
BACKGROUND Ranolazine is a new anti-anginal agent that inhibits abnormal late sodium currents, indirectly causing a decrease in diastolic cardiomyocyte calcium levels. This produces an energy-sparing effect and stabilizes cardiac membranes. Ranolazine has been shown to be a potent inhibitor of triggered activity in the experimental setting. METHODS This case report describes the dramatic antiarrhythmic effects of ranolazine in a patient with highly symptomatic complex ventricular ectopy, including non-sustained ventricular tachycardia (NSVT). Cardiac ischemia and left ventricular systolic dysfunction were ruled out by cardiac catheterization. After failing standard treatment, we initiated ranolazine therapy. RESULTS Ranolazine was effective in suppressing ectopic ventricular activity and completely suppressed NSVT. CONCLUSIONS Further research on the anti-arrhythmic properties of ranolazine in the clinical setting is needed.
3.
Anaphylaxis to proton pump inhibitors.
González, P, Soriano, V, López, P, Niveiro, E
Allergologia et immunopathologia. 2002;(6):342-3
Abstract
Proton pump inhibitors (PPI) are widely used for the treatment of peptic ulcer, but cases of anaphylactic reactions have rarely been described. We present a patient who experienced an episode of urticaria 30 minutes after oral intake of an omeprazole capsule. Skin prick tests to omeprazole, pantoprazole and lansoprazole were positive. Challenge test with lansoprazole was carried out and within 45 minutes the patient developed urticaria, facial edema, vomiting, and hypotension. Oral challenge with other imidazole derivatives (ketoconazole, cimetidine, metronidazole) were carried out with good tolerance. Serum tryptase levels determined 3 hours after the adverse reaction to lansoprazole were elevated. Specific IgE to PPI were not detected by an enzyme-linked immunosorbent assay technique. The clinical findings, positive skin prick test to PPI and elevated serum tryptase levels suggest that an IgE-mediated mechanism was implicated in the reactions to both omeprazole and lansoprazole. Skin prick tests may be a useful tool for detecting patients sensitized to PPI. An experimental protocol was used to detect specific IgE antibodies against PPI, which may explain RAST negativity. The previous findings suggest that cross-reactivity between PPI exists, but not with other imidazoles.