Reporting sexual function disorders caused by antipsychotic drugs: is there a role for the community pharmacy?

Sexual function disorders are frequent adverse effects of antipsychotic use. These effects can lead to non-compliance to medication, which dramatically worsen the outcome of the psychotic disease. Detecting sexual dysfunction by the carers may be difficult, since feelings of embarrassment may occur in both care-taker as in patient. In order to prevent underreporting, strategies to recognise sexual dysfunction should be developed, based upon collaboration between care providers of the psychotic patient. Community pharmacies in many countries can detect non-compliance to medication in prescription data and report this to psychiatric services of the patient. Exchanging information by cross-sectoral networks may optimise the disease management of the psychotic patient.

[Reversible tooth discoloration during oral use of antibiotics]. / Reversibele tandverkleuring tijdens oraal gebruik van antibiotica.

From January 1991 until June 1995. 25 cases were reported to the Netherlands Pharmacovigilance Foundation LAREB of yellow to brown tooth discoloration following the oral use of medication; 21 cases (84%) involved antibiotics, of which 14 were amoxicillin. 17/21 patients were children, with ages ranging from 1 to 10 years. All children used liquid formulations (suspension or solutabs). Discoloration was reversible in all cases, but had a protracted course in some. Presumably a pigment precipitated on (and not in) the teeth, but the nature of the pigment was uncertain.

[Potentiation of digoxin by itraconazole]. / Potentiëring van digoxine door itraconazol.

The case is reported of a 71-year-old woman with clinical signs of digoxin intoxication, presumably developing as a result of the simultaneous use of digoxin for cardiac abnormalities and itraconazole for infection with Candida albicans. Five similar experiences have previously been reported in the literature. Itraconazole may induce a decreased elimination of digoxin, but the mechanism of interaction is still unknown. Comedication and renal function may perhaps contribute to the degree of interaction. When itraconazole is needed in a patient also using digoxin the blood level of the latter drug should be monitored; the daily dose of digoxin may have to be decreased to only one-quarter of the original. Nausea and anorexia may be mistaken for side effects of itraconazole and be overlooked as early signs of digoxin intoxication.

[Tendinitis of the Achilles tendon caused by pefloxacin and other fluoroquinolone derivatives]. / Achillespeestendinitis door pefloxacine en andere fluorochinolon-derivaten.

Four cases were reported to the Netherlands Pharmacovigilance Foundation LAREB of Achilles tendinitis, as a suspected adverse reaction to pefloxacin; the patients were two men of 64 years old, one of 33 and one of 76 years old. More than twenty cases of tendinitis have previously been described in the literature in association with pefloxacin and various other fluoroquinolone derivatives; tendon rupture was a frequent complication. In the data base of the WHO Collaborating Centre for International Drug Monitoring tendon disorders are a very rare reaction, with the exception of fluoroquinolone derivatives. More information is needed with regard to the frequency of tendinopathy during the use of pefloxacin and the other drugs in this group. Achilles tendon rupture is an serious condition, often requiring surgical treatment. Patients using a fluoroquinolone derivative should be informed of the risk of developing tendinitis and tendon rupture.