Frequency of Serious Adverse Skin Reactions Caused by Continuous Subcutaneous Administration of Psychotropic Drugs

Continuous subcutaneous injections of medication are effective in controlling symptoms of the terminal stage of cancer. Chlorpromazine and levomepromazine occasionally cause skin irritation. We examined all patients who underwent continuous subcutaneous administration of psychotropic drugs (chlorpromazine, levomepromazine, midazolam) at the palliative care unit of our hospital from April 2010 to March 2013, the frequency of adverse skin reactions of Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade 3 or above. Of the 603 hospitalized patients, 389 (64.5%) underwent continuous subcutaneous administration of one of the three drugs. The frequency of grade 3 or above (ulceration or necrosis) adverse skin reactions was 4 out of 345 chlorpromazine cases (1.2%; 95% CI: 0.0-2.3%), 2 out of 90 levomepromazine cases (2.2%; 95% CI: −0.8-5.2%), and 0 out of 210 midazolam cases (0.0%; 95% CI: 0.0-0.0%). The frequency of serious adverse skin reactions caused by continuous subcutaneous administration of psychotropic drugs was low, suggesting that this treatment is relatively safe for the skin.

Cardiovascular effects of midazolam in levomepromazine premedicated dogs / Efeitos do midazolam sobre o sistema cardiovascular em cães pré-medicados com levomepromazina

Experiments were performed on ten mongrel dogs with 10-18 kg body weight. They received levomepromazine 1.0 mg/kg body weight, I.V. as premedication, and 15 minutes later, midazolam was given in dosage of 2.0 mg/kg body weight intravenously. The result showed moderat increase on respiratory rate and decrease heart rate after 15 minutes and increase heart rate after 30 minutes. Mean and sistolic arterial pressure decreased significantly (p 0.05) but without clinical importance, remained in the physiologic range. Hipnosis duration was less than 20 minutes and at 30 minutes the dogs awaked and they tried to walk.

Foram utilizados 10 cães adultos, de ambos os sexos, sem raça definida, com peso corpóreo entre 10 e 18 kg. Os animais foram pré-medicados com 1,0 mg/kg de levomepromazina e 15 minutos após receberam 2,0 mg/kg de midazolam, ambos por via intravenosa. A freqüência respiratória mostrou um aumento moderado e a freqüência cardíaca redução aos 15 minutos e elevação aos 30 minutos. Houve redução da pressão arterial média e da pressão sistólica com significado estatístico e não clínico. Houve tendência de redução da pressão arterial diastólica. A hipnose durou aproximadamente 20 minutos e aos 30 minutos os cães estavam acordados e em tentativa de deambulação.