A comparative study of intranasal budesonide and oral terfenadine in perennial allergic rhinitics: effect on the symptom score and nasal secretion eosinophils / 천식및알레르기

BACKGROUND: Eosinophilia in the nasal secretion and mucosal tissues is the characteristic finding of allergic rhinitis. We compared the effects of nasal budesonide dipropionate and oral terfenadine on the symptom score and nasal secretion eosinophils in perennial allergic rhinitics. MATERIALS AND METHOD: Study subjects consisted of 81 patients with perennial allergic rhinitis and nasal eosinophilia. Fifty-seven patients were treated with nasal budesonide and 24 patients were treated with oral terfenadine for two weeks respectively. Nasal secretion eosinophils were measured as the percentage of total leukocytes under microscope. Symptom scores for sneezing, rhinorrhea, obstruction and itching were graded from 0 (no symptom) to 3 (severe symptom). RESULTS: In budesonide treatment group, symptom score reduction (total symptom score before treatment-total symptom score after treatment) was 5.1, while it was 2.3 in the terfenadine treatment group, which revealed a statistically significant difference (p<0.01). Reduction of eosinophils was 50% in the budesonide treatment group and 28% in terfenadine treatment group (p=0.045). There was statistically significant correlation between total symptom score and % eosinophils (r= 0.668 , p<0.01 ) CONCLUSION: Although both the nasal budesonide and oral terfenadine substantially reduced the proportion of eosinophils in the nasal secretion as well as symptoms in allergic rhinitics with eosinophilia, budesonide was superior to terfendine. Nasal eosinophils correlated with reduction of allergic symptoms in a statisticaly significant manner.

Arritmia ventricular maligna tras empleo simultáneo de terfenadina y ketoconazol

Se reportó el caso de una paciente joven que presentó arritmia ventricular maligna tras empleo simultáneo de terfenadina y ketoconazol, con el objetivo de ratificar lo contraproducente de determinadas asociaciones farmacológicas. El cuadro clínico estuvo matizado por las manifestaciones cardiovasculares y las severas alteraciones electrocardiográficas. Se empleó pidolato magnésico por vía oral y monitorización electrocardiográfica continua. No fueron necesarias otras medidas para el tratamiento de la arritmia. La paciente se recuperó en un tiempo relativamente breve de estrecha observación en la Unidad de Cuidados Intensivos, fue dada de alta con una evolución satisfactoria.

The case of a young patient who presented malignant ventricular arrhytmia after having used terfenadine and ketoconazole simultenously was reported aimed at ratifying that certain pharmacological associations may not produce the desired effect. The clinical picture was characterized by cardiovascular manifestations and severe electrocardiographic alterations. Magnesic pidolate was orally administered and the continual electrocardiographic monotiring was used. No other measures were necessary for the treatment of arrhytmia. The patient recovered in a relatively short time of close observation at the Intensive Care Unit. She was discharged after a satisfactory evolution.

A Case of Torsade de Pointes after Treatment with Terfenadine and Ketoconazole

Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although it occurs in many clinical settings, torsade de pointes is most commonly caused by drugs. The second generation antihistamines, including terfenadine and astemizole, have little sedation or other adverse effects on the CNS. They have been used widely to treat various allergic diseases, but it has been reported that overdoses or combinations with antifungal agents or macrolide antibiotics may lead to TdP. We report a case of TdP that occured during com-bination therapy of terfenadine and ketoconazole.

A Case of Torsade de Pointes after Combined Use of Terfenadine and Itraconazole

Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.

Torsades de Pointes After Combined Treatment of Terfenadine and Ketoconazole / 대한내과학회지

Terfenadine is widely used because of nonsedating effect. But It could rarely provoke a potentially lethal ventricular tachyarrhythmia. Recently, we experienced two cases of torsades de pointes(TDP) of occurred after combined use of terfenadine and ketoconazole in usual dose. In one case, 31-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. On attack, ECG showed a polymorphic ventricular tachycardia, and after attack, showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred. In the other case, 32-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. ECG showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred.

Dissolution of imported and locally-made terfenadine tablet.

Terfenadine, an effective histamine H1- antagonist, is a popular in Thailand. Both imported and locally-made brands are available in the market. This study was performed to prove the general characteristics and the dissolution profile of one imported terfenadine tablet and five locally-made brands. The tablet from each brand were uniform in weight, thickness and diameter. The dissolution profile of the other three locally-made products do not reach the standard dissolution profile.