Fulminant neuroleptic malignant syndrome after perioperative withdrawal of antiParkinsonian medication.

Neuroleptic malignant syndrome is a rare complication when using neuroleptic drugs. We report the case of a patient with severe Parkinson's disease who developed neuroleptic malignant syndrome after withdrawal of his antiParkinsonian medication for elective coronary artery bypass grafting. Sodium dantrolene may be a therapeutic option in severe cases.

Influence of propiverine on hepatic microsomal cytochrome p450 enzymes in male rats.

The bladder spasmolytics propiverine was shown to induce hepatic cytochrome P450 (P450) and aminopyrine and aniline oxidation in rats. To characterize the type of enzyme induction and its dose dependence, activities of seven hepatic microsomal P450-dependent monooxygenases were measured in 72 male LEW1A albino rats (body weight 236-295 g) after oral treatment with 0.5, 2, 6, and 60 mg/kg of propiverine hydrochloride for 5 days and compared with the effects of 40 mg/kg beta-naphthoflavone, 10 mg/kg phenobarbital, and 20 mg/kg dexamethasone (each group, n = 8). CYP2B expression was measured by Western blotting. Furthermore, the inhibitory potency of propiverine on P450 enzymes was evaluated in competition assays with three most specific monooxygenases. Results show that Propiverine induced several monooxygenases and CYP2B expression dose dependently. The effects were well comparable with a phenobarbital-type inducer with 60 mg/kg being equipotent to 10 mg/kg phenobarbital. Furthermore, propiverine in low concentrations inhibited pentylresorufin O-dealkylase (for CYP2B) in vitro. In conclusion, propiverine is a phenobarbital-type inducer on hepatic P450 enzymes in rats in doses about 100-times above the therapeutic doses in man.

High-performance liquid chromatographic determination of propiverine and its N-oxide in human serum.

A high-performance liquid chromatographic method has been developed for the determination of propiverine hydrochloride (P4) and its main metabolite, propiverine N-oxide (P4NO) in human serum. P4 has been shown to be efficacious in those patients who have either idiopathic bladder instability, or neurogenic bladder (detrusor hyperflexia) resulting from spinal cord injuries. In the present method, the analytes were extracted from serum (1 ml, pH 8) into methyl tert.-butyl ether. The separation was performed on a reversed-phase C8 (RP-select B) column using phosphate buffer-acetonitrile (30:70, v/v). UV absorption was used for measuring the analytes, with a limit of quantitation of about 10 ng/ml, which is appropriate for pharmacokinetic studies.

Pharmacokinetics and safety of propiverine in patients with fatty liver disease.

OBJECTIVE: The present study was designed to assess the pharmacokinetics of propiverine after single and multiple dosing in patients with and without fatty liver disease. METHODS: The serum concentration-time curves of propiverine and its main metabolite propiverine-N-oxide were investigated in 12 patients with mild to moderate impairment of liver function (mean antipyrine clearance 26.0 ml x min(-1)) and in 12 controls (antipyrine clearance 42.8 ml x min(-1)). Subjects were treated orally with propiverine hydrochloride (Mictonorm) for 5 days (15 mg t. i. d.) to reach steady state. RESULTS: No significant differences were observed for propiverine and its main metabolite with regard to peak serum concentration (Cmax), area under the serum concentration-time curve (AUC) and elimination half-life (t1/2). Adverse events were reported by 12 patients. Five patients with fatty liver disease and seven patients with normal liver function complained of dry mouth and/or blurred vision. All adverse events reported were transient and mild. CONCLUSION: No pharmacokinetic differences relevant for safety were observed, comparing patients with and without fatty liver disease following repeated oral administration of propiverine. Thus there seems to be no need to adjust the dose in patients with mild to moderate impairment of liver function.

Relative bioavailability of DL-oxyfedrine HCl after single-dose oral administration of tablets as compared to equimolar solutions.

The pharmacokinetics and comparative bioavailability of oxyfedrine after single-dose oral administration of oxyfedrine*HCl tablets in comparison to an equimolar aqueous solution of oxyfedrine*HCl were investigated in 12 healthy male subjects. Six of them received 96 mg DL-oxyfedrine*HCl as tablets and solution and the remaining 6 subjects received 16 mg DL-oxyfedrine*HCl as tablets and solution in a randomized cross-over design. For evaluation of the relative bioavailability of the tablet formulation, the main metabolite norephedrine (expressed as hydrochloride) was analyzed in plasma for all 12 subjects. Furthermore, for determination of the parent drug, samples of whole blood were analyzed for DL-oxyfedrine*HCl. Relevant concentrations of the parent drug were found only in the high dosage group. There was no evidence of dose-linearity referring to AUC and Cmax of norephedrine between 16-mg and 96-mg doses of DL-oxyfedrine*HCl. The relative bioavailability of the tablet formulation after administration of 16 mg DL-oxyfedrine*HCl, based on the metabolite norephedrine*HCl was for AUC: 85.37% within a 90% confidence interval of 69.29-105.17% and for Cmax: 78.79% within a 90% confidence interval of 59.19-104.90%. The figures for the 96 mg dose strength were: AUC: 107.85% (90.06-129.15%) and for Cmax: 74.74% (62.48-89.42%).

[Behavior of biochemical stress reactions in real professional performance of teachers in relation to age and occupational ability]. / Verhalten biochemischer Beanspruchungsreaktionen in der realen Arbeitstätigkeit von Pädagogen in Abhängigkeit vom Alter und der beruflichen Leistungsfähigkeit.

In order to investigate the strain of teachers as persons with chiefly psychic load several hormonal parameters (ACTH, HGH, cortisol, catecholamines) and trace elements (zinc, copper) were measured at a teaching day as well as at a teaching-free day. The different influences of age and reduced professional performance on the concentrations of the biochemical parameters were shown. It seems that the variation of release of catecholamines is the most important parameter for the diagnostic of strain in such professional load.

[Stress in the occupational role of teachers with disabilities and physical disorders]. / Beanspruchung in der beruflichen Tätigkeit von Pädagogen mit Leistungseinschränkungen und Gesundheitsstörungen.

We investigated 18 female polytechnical school-teachers with reduced work fitness compared to a group of female teachers without fitness-reduction with the aim to measure the strain of dominant psychologic work in school. We used blood pressure, heart-rate, voice function and subjective feeling according the Nitsch-scale during teaching and a day without teaching. The results indicate differences in subjective feeling scores whereas somatic parameters did not show higher strain. Because of the high interindividual differences in strain in the group with reduced work fitness further investigations should be realized.