randomized placebo-controlled trial of clonidine impact on sedation of mechanically ventilated ICU patients

Clonidine has sedative and analgesic properties. Randomized studies examining these properties in mechanically ventilated ICU patients are scarce. This study was designed to assess the impact of clonidine on sedative agent use in mechanically ventilated patients. In a prospective, randomized, double blind, placebo-controlled study in a general ICU of a university medical center in Tehran, Iran, 40 patients, over 18 years on mechanical ventilation for 3 days or more randomized into 2 equal groups of clonidine and placebo. Clonidine arm received usual sedation and enteral clonidine 0.1 mg TID and escalated to 0.2 mg TID on the second day if hemodynamics remained stable. Ramsay Sedation Score was used to assess sedation. Opioids and midazolam were used in all patients. 10 patients in clonidine and 3 in placebo arms had history of drug abuse [P = 0.018]. The mean of sedatives used in the clonidine/placebo arms [mg/day] were; MED [Morphine Equivalent Dose] 91.4 +/- 97.9/112.1 +/- 98.8 P=0.39, midazolam 7.1 +/- 7.9/8.3 +/- 9.2 P=0.66 and propofol 535.8 +/- 866.7/139.1 +/- 359.9 P=0.125. After adjusting for addiction and propofol, clonidine reduced MED use by 79.6 mg/day [P=0.005] and midazolam by 5.41 mg/day [P = 0.05]. Opioids and midazolam need reduced by clonidine co-administration regardless of history of drug abuse. Acceptable side effect profile and the lower cost of clonidine could make it an attractive adjunct to sedative agents in ICU

Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder

Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery [CABG]. Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score [GSQS], and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance [ANCOVA] and independent t-test were used to compare the sleep and anxiety scores between the groups. P values

Trifluoperazine-induced cholestatic jaundice

Liver injury occurs with many drugs; therefore, a thorough work up is important for establishing the diagnosis. We report a case of trifluoperazine-induced cholestatic jaundice. A 44-year old male with schizoaffective disorder developed an increase in liver enzymes and jaundice after starting treatment with trifluoperazine .Workup for other potential etiologies was negative

Comparing the effects of clomipramine and fluoxetine on fasting blood glucose in children with obsessive-compulsive disorder

This study was conducted to compare the effects of clomipramine and fluoxetine on fasting blood glucose [FBS] in children with obsessive-compulsive disorder [OCD]. Thirty nondiabetic children with OCD entered this randomized trial. Subjects were between 7 to 17 years of age and had not received any medication that could affect blood glucose level for at least 2 weeks prior to the initiation of the study. Patients were assigned to receive 20 to 60 mg/d of fluoxetine or 75 to 200 mg/d of clompiramine for 8 weeks. The exclusion criteria were pregnancy and lactation, history of diabetes mellitus, any liver and thyroid disorder, epilepsy and major heart disease. Additionally, none of the patients should have received electroconvulsive therapy within 6 months prior to the initiation of the study. FBS levels were measured at baseline, 4 and 8 weeks after the initiation of the trial. In the fluoxetine group, FBS level was decreased from 82.93 mg/dL [baseline] to 79.73 mg/dL at week 4 [P<0.001] and to 72.53 mg/dL at week 8 [P<0.001]. On the other hand, in the clomipramine group, FBS level was increased from 84.93 mg/dL [baseline] to 87.00 mg/dL at week 4 [P<0.05] and to 95.33 mg/dL at week 8 [P<0.001]. This 8-week study demonstrated that FBS levels may decrease in children with OCD who received flouxetine, and may increase in those treated with clomipramine. Therefore, it is suggested that FBS levels should be monitored and taken into consideration when choosing between fluoxetine and clomipramine in the treatment of OCD

Fluoxetine decreased serum total cholesterol and triglyceride levels in a hypercholesterolemic patient with postpartum depression

To report the case of a 28-year old hypercholesterolemic female with postpartum depression, whose triglyceride [TG] and total cholesterol [TC] levels decreased while being treated with fluoxetine. A 28-year old female, with a diagnosis of major depressive disorder with postpartum onset based on DSM-IV criteria, was hospitalized at a mental health hospital. Her past history included another episode of depression 4 months after giving birth to her second child, which was 12 years prior to her recent episode. Her serum total cholesterol and triglyceride levels were measured prior to the initiation of medication. Then fluoxetine was initiated at a daily dose of 20 mg and had been increased to 40 mg per day at the time of discharge. The lipid profile measurements was repeated at week 4 and 8 following treatment. Total cholesterol level was reduced from 242 mg/dL at baseline to 224 mg/dL at week 4 and to 202 mg/dL at week 8; triglyceride level was decreased from 516 mg/dL to 448 mg/dL at week 4 and to 404 mg/dL at week 8. Fluoxetine may be an appropriate treatment for hyperlipidemic women with postpartum depression

[Comparing the effects of 8- week treatment with fluoxetin and imipramine on fasting blood glucose in patients with major depression disorder]

Background: this study was designed to compare the effects of fluoxetine and imipramine on fasting blood glucose [FBG] in patients with major depressive disorder

Methods: non-diabetic patients, with major depressive disorder [based on DSM-IV criteria] entered this randomized, double - blind study. Patients did not receive any medication affecting serum FBG levels at least for 2 weeks prior to the initiation of the study. Patients were assigned to receive 20 to 40 mg/day of fluoxetine or 75 to 200 mglday of imipramine for 8 weeks. Benzodiazepines were allowed when needed for anxiety, agitation or sleep. Pregnant women and patients with diabetes mellitus, and history of major heart diseases were excluded from this study. Additionally, none of the patients should have received electroconvulsive therapy [ECT] within 6 months prior to initiation of the antidepressants. FBG levels were measured at the initiation of study as well as 4 and 8 weeks after starting antidepressants

Results: nineteen patients in the fluoxetine and 24 patients in the imipramine groups completed the study. In the fluoxetine group, FBG level was decreased from 88.5 mg/dL [baseline] to 85.0 mg/dL at week 4 [P=0.73], and to 79.8mg/dL at week 8 [P<0.001]. On the other hand, in the imipramine group, FBG level was increased from 86.96 mg/dL [baseline] to 89.71 mg/dL at week 4 [P=0.079], and to 96.90 mg/dL at week 8 [P<0.001]

Conclusion: this 8-weeks study showed that FBG levels may decrease in depressive patients receiving fluoxetine and may increase in those patients treated with imipramine. Therefore, it is suggested to measure and monitor FBG before initiation and during treatment with fluoxetine and imipramine