Golf-inhibiting gynecomastia associated with atorvastatin therapy.

Gynecomastia can have a significant emotional and social impact on men. Although numerous drug therapies may cause this condition, we found no documented cases of gynecomastia associated with atorvastatin. We describe the development of breast enlargement and tenderness in a 52-year-old Caucasian man 6 months after his simvastatin therapy had been switched to atorvastatin. His symptoms ultimately interfered with his ability to play golf and participate in other activities. These problems resolved after atorvastatin discontinuation and did not recur despite resumption of simvastatin therapy. The gynecomastia in this patient represented a possible adverse effect of atorvastatin according to the Naranjo adverse drug reaction probability scale. The mechanism may be atorvastatin's theoretical suppression of adrenal or gonadal steroid production through effects on cholesterol synthesis. Based on this and other case reports, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) should be considered as a potential cause when evaluating otherwise unexplainable cases of gynecomastia in patients taking these drugs.

Potentially inappropriate prescribing for geriatric inpatients: an acute care of the elderly unit compared to a general medicine service.

OBJECTIVE: To compare potentially inappropriate medication prescribing, as defined by the updated Beers criteria, in an acute care of the elderly (ACE) unit and a general medicine service. DESIGN: Non-concurrent cohort study of admitting and discharge summaries from an electronic medical record system. SETTING: A general medicine service and ACE unit at an 880-bed, tertiary care, teaching hospital. PARTICIPANTS: 176 patients from the ACE unit and 173 from the general medicine service who were 65 years of age or older, admitted after October 1, 1999, and discharged before February 29, 2000. MAIN OUTCOME MEASURE(S): Numbers of high- and low-severity potentially inappropriate medications (PIMs) and total medications on admission and discharge. RESULTS: The average number of all medications added on discharge was lower for the ACE unit versus general medicine service, 0.13 versus 0.75, respectively (P = .027). In the ACE unit, 11% of patients were prescribed PIMs with high-severity outcomes on discharge, either independent or dependent of diagnosis, compared with 12.7% in the general medicine service. The mean change in potentially inappropriate diagnoses independent medications upon discharge was - 0.09 in the ACE unit versus + 0.09 in the general medicine service (P = .011). CONCLUSION: Although detected differences were small, PIMs were less likely to be prescribed and more likely to be discontinued in the ACE unit. No differences were found in the majority of comparisons between groups.

Reversible thrombocytopenia associated with eptifibatide.

OBJECTIVE: To report a patient who experienced severe, reversible thrombocytopenia after receiving eptifibatide for acute coronary syndrome. CASE SUMMARY: A 61-year-old white man with a past medical history of coronary artery disease, peripheral vascular disease, insulin-dependent diabetes, hypertension, and dyslipidemia was treated with eptifibatide as an adjunct to standard antiischemic therapy for acute coronary syndrome. On administration of eptifibatide, the patient experienced chills accompanied by sharp pains that radiated throughout his body. The infusion was immediately stopped and the symptoms resolved. A platelet count obtained 11 hours later showed a decrease from a baseline of 230 to 3 x 10(3)/mm(3) (normal 160-360). Multiple platelet analyses confirmed profound thrombocytopenia. Over the course of the hospitalization, the patient's platelet count returned to normal; he experienced no other adverse hematologic sequelae. DISCUSSION: All of the glycoprotein IIb/IIIa receptor antagonists are associated with thrombocytopenia. However, the risk of thrombocytopenia has been observed to be less with eptifibatide. Because of the temporal relationship between eptifibatide administration and the patient's symptoms and laboratory analysis, we believe that the thrombocytopenia was the result of an adverse reaction. CONCLUSIONS: The temporal relationship to administration and the resolution of the adverse reaction on discontinuation of the drug support the likelihood that the severe, reversible thrombocytopenia was associated with eptifibatide.