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1.
Diabetologia ; 49(9): 2024-9, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16865360

RESUMEN

AIMS/HYPOTHESIS: The aim of this study was to compare developments in the utilisation of antihyperglycaemic drugs (AHGDs) in ten European countries. SUBJECTS AND METHODS: Data on the yearly utilisation of insulin and oral AHGDs were collected from public registers in Denmark, Finland, Norway, Sweden, Belgium, England, Germany, Italy, Portugal and Spain, and were expressed as defined daily doses per 1,000 inhabitants per day. RESULTS: Total AGHD utilisation increased everywhere, but at different rates and levels. Insulin utilisation doubled in England and Germany, but hardly changed in Belgium, Portugal or Italy. Sulfonylurea utilisation doubled in Spain, England and Denmark but was reduced in Germany and Sweden. Metformin utilisation increased greatly everywhere. There were two- to three-fold differences in AHGD utilisation even between neighbouring countries. In Finland, there were more users of both insulin (+120%) and oral AHGDs (+80%) than in Denmark, and the daily oral AHGD doses were higher. In Denmark and Sweden, AHGD utilisation was equal in subjects aged <45 years, but in those >or=45 years of age, both insulin and oral AHGD utilisation were twice as high in Sweden. CONCLUSIONS/INTERPRETATION: The ubiquitous increase in AHGD utilisation, particularly metformin, seems logical, considering the increasing prevalence of type 2 diabetes and the results of the UK Prospective Diabetes Study. However, the large differences even between neighbouring countries are more difficult to explain, and suggest different habits and attitudes in terms of screening and management of type 2 diabetes.


Asunto(s)
Hipoglucemiantes/uso terapéutico , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Diabetes Mellitus/tratamiento farmacológico , Utilización de Medicamentos/estadística & datos numéricos , Europa (Continente) , Humanos , Hipoglucemiantes/administración & dosificación , Lactante , Recién Nacido , Insulina/administración & dosificación , Insulina/uso terapéutico , Metformina/administración & dosificación , Metformina/uso terapéutico , Persona de Mediana Edad , Compuestos de Sulfonilurea/administración & dosificación , Compuestos de Sulfonilurea/uso terapéutico
2.
Ther Drug Monit ; 28(2): 262-6, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16628141

RESUMEN

We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario in which we developed an algorithm based on a 2-compartment distribution without elimination. The GFR estimate led to plasma concentrations 3-4 times lower than those anticipated. In contrast, the estimates based on V(d) and the algorithm derived from pharmacokinetic modeling led to comparable loading dose estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated immediately postdialysis. Further observations are necessary to obtain robust long-term safety data and to optimize the monitoring schedule.


Asunto(s)
Carbonato de Litio/uso terapéutico , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Anciano , Algoritmos , Depresión/complicaciones , Depresión/prevención & control , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Carbonato de Litio/administración & dosificación , Carbonato de Litio/farmacocinética , Insuficiencia Renal Crónica/complicaciones
3.
Br J Clin Pharmacol ; 53(3): 312-7, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11874395

RESUMEN

AIMS: Activated charcoal is now being recommended for patients who have ingested potentially toxic amounts of a poison, where the ingested substance adsorbs to charcoal. Combination therapy with gastric lavage and activated charcoal is widely used, although clinical studies to date have not provided evidence of additional efficacy compared with the use of activated charcoal alone. There are also doubts regarding the efficacy of activated charcoal, when administered more than 1 h after the overdose. The aim of this study was to examine if there was a difference in the effect of the two interventions 1 h post ingestion, and to determine if activated charcoal was effective in reducing the systemic absorption of a drug, when administered 2 h post ingestion. METHODS: We performed a four-limbed randomized cross-over study in 12 volunteers, who 1 h after a standard meal ingested paracetamol 50 mg kg(-1) in 125 mg tablets to mimic real-life, where several factors, such as food, interfere with gastric emptying and thus treatment. The interventions were activated charcoal after 1 h, combination therapy of gastric lavage followed by activated charcoal after 1 h, or activated charcoal after 2 h. Serum paracetamol concentrations were determined by h.p.l.c. Percentage reductions in the area under the curve (AUC) were used to estimate the efficacy of each intervention (paired observations). RESULTS: There was a significant (P<0.005) reduction in the paracetamol AUC with activated charcoal at 1 h (median reduction 66%, 95% confidence intervals 49, 76) compared with controls, and a significant (P<0.01) reduction for gastric lavage followed by activated charcoal at 1 h (median reduction 48.2%, 95% confidence interval 32.4, 63.7) compared with controls. There was no significant difference between the two interventions (95% confidence interval for the difference -3.8, 34.0). Furthermore, we found a significant (P<0.01) reduction in the paracetamol AUC when activated charcoal was administered 2 h after tablet ingestion when compared with controls (median 22.7%, 95% confidence intervals 13.6--34.4). CONCLUSIONS: These results suggest that combination treatment may be no better than activated charcoal alone in patients presenting early after large overdoses. The effect of activated charcoal given 2 h post ingestion is substantially less than at 1 h, emphasizing the importance of early intervention.


Asunto(s)
Acetaminofén/envenenamiento , Analgésicos no Narcóticos/envenenamiento , Carbón Orgánico/administración & dosificación , Lavado Gástrico , Acetaminofén/sangre , Acetaminofén/farmacocinética , Adulto , Analgésicos no Narcóticos/sangre , Analgésicos no Narcóticos/farmacocinética , Área Bajo la Curva , Cromatografía Líquida de Alta Presión , Terapia Combinada , Estudios Cruzados , Sobredosis de Droga/terapia , Femenino , Alimentos , Humanos , Masculino , Factores de Tiempo
4.
Cerebrovasc Dis ; 13(3): 204-9, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-11914539

RESUMEN

This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. BP declined with increasing time from stroke onset with a total of 8/4 mm Hg. Independent factors related to diastolic BP were ischemic heart disease (-3.9 mm Hg), male gender (2.2 mm Hg), known hypertension prior to stroke (8.6 mm Hg), and primary hemorrhage (9.7 mm Hg). Independent factors related to systolic BP were age (3.6 mm Hg/10-year increase), atrial fibrillation (-7.2 mm Hg), ischemic heart disease (-6.0 mm Hg), intracerebral hemorrhage (13.3 mm Hg), and known hypertension prior to stroke (16.3 mm Hg). No independent relations were seen between BP and diabetes, claudication, previous stroke, smoking, daily alcohol consumption, initial stroke severity and lesion size. The increase in BP in the acute phase of stroke is a uniform response to the ischemic event per se. BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.


Asunto(s)
Presión Sanguínea/fisiología , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Medicina Comunitaria , Dinamarca/epidemiología , Femenino , Humanos , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/fisiopatología , Admisión del Paciente , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Estadística como Asunto , Accidente Cerebrovascular/complicaciones , Factores de Tiempo
6.
Acta Anaesthesiol Scand ; 45(6): 734-40, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11421832

RESUMEN

Gentamicin is used worldwide in the treatment of serious infections in critically ill patients. The therapeutic efficacy of gentamicin is correlated to the peak serum concentration and the adverse effects to the trough concentrations. Information concerning the pharmacodynamics in critically ill patients is scarce, but pharmacokinetic data are available. A once-daily dosage regimen has replaced multiple dosing of gentamicin in most intensive care units. No studies evaluating the superiority of either of these dosage recommendations in critically ill patients have ever been conducted. Based on 8 meta-analyses performed addressing this issue on a wide range of patients and theoretical considerations, we consider a once-daily dosage regimen feasible in critically ill patients. In septic patients the volume of distribution is significantly increased compared to normal patients, implying that the initial dose should be increased in this patient population. Additionally a general trend towards using higher loading doses (5-7 mg/kg) has been observed in USA, and the appropriateness of this dosing strategy is based on a large descriptive American study. We recommend that the initial dosage of gentamicin in critically ill hyperdynamic septic patients should be 7 mg/kg. Optimal and appropriate monitoring of the treatment with gentamicin in the critically ill patient is still an issue for further investigation. The treatment period with gentamicin should be short (3-5 days), bearing the pharmacological properties of aminoglycosides (small volume of distribution and poor tissue penetration) in mind. In patients with reduced renal function the initial dose of gentamicin should also be increased and maintenance dose reduced preferentially by prolonging the dosing intervals. However, the use of aminoglycosides in a high dose regimen in oliguric or anuric patients or patients who present with a rapidly decreasing renal function needs further consideration.


Asunto(s)
Antibacterianos/administración & dosificación , Enfermedad Crítica , Gentamicinas/administración & dosificación , Antibacterianos/farmacocinética , Antibacterianos/uso terapéutico , Gentamicinas/farmacocinética , Gentamicinas/uso terapéutico , Humanos
7.
Acta Anaesthesiol Scand ; 44(10): 1169-90, 2000 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11065197

RESUMEN

In September 1997, an international consensus conference on standardization of studies of neuromuscular blocking agents was held in Copenhagen, Denmark. Based on the conference, a set of guidelines for good clinical research practice (GCRP) in pharmacokinetic studies of neuromuscular blocking agents is presented. Guidelines include: design of the study; relevant patient groups to investigate; test drug administration, sampling and analysis; pharmacokinetic analysis; pharmacokinetic/pharmacodynamic modeling; population pharmacokinetics; statistics; and presentation of pharmacokinetic data. The guidelines are intended to aid those working in this research area; it is hoped that they will assist researchers, editors of scientific papers, and pharmaceutical companies in improving the quality of pharmacokinetic studies.


Asunto(s)
Bloqueantes Neuromusculares/farmacocinética , Temperatura Corporal , Calibración , Enfermedad Crítica , Humanos , Modelos Biológicos
8.
Pharmacol Toxicol ; 86(4): 178-82, 2000 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10815751

RESUMEN

Isradipine is a calcium channel-blocking agent of the dihydropyridine type, used in the treatment of hypertension. A terminal half-life of 8-9 hr has been reported, in several pharmacokinetic studies after oral administration of isradipine. In a yet unpublished study a much shorter half-life was observed, and the present trial was therefore conducted in order to estimate the half-life after intravenous administration of isradipine. The bioavailability was estimated as well. In a randomised cross-over design ten healthy young volunteers were given either isradipine orally or an intravenous infusion. The two study periods were separated by at least 3 days. Blood samples for measurement of isradipine concentration were collected for 10-12 hr after administration and half-life and bioavailability were estimated. Mean terminal half-life after intravenous administration was calculated to be 2.8 hr, and the bioavailability to be 0.28. None of the 10 subjects suffered from side effects. In the present intravenous study the half-life of isradipine seems to be of much shorter than demonstrated in previous oral studies.


Asunto(s)
Bloqueadores de los Canales de Calcio/farmacocinética , Isradipino/farmacocinética , Administración Oral , Adulto , Área Bajo la Curva , Disponibilidad Biológica , Estudios Cruzados , Femenino , Semivida , Humanos , Infusiones Intravenosas , Isradipino/sangre , Masculino , Tasa de Depuración Metabólica
9.
Respir Med ; 93(10): 715-8, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10581660

RESUMEN

The aim of this study was evaluate the predictive value of a 2 week course of prednisolone on the effect of 6 months treatment with inhaled budesonide in patients with stable chronic obstructive pulmonary disease (COPD). Forty patients with stable COPD entered the study, and received prednisolone (37.5 mg o.d.) for 2 weeks. They were subsequently divided into steroid-irreversible and steroid-irreversible, using 15% of baseline as a dividing point. In each group patients were randomized to receive budesonide 400 micrograms b.i.d. or placebo for 6 months. During treatment with prednisolone, three patients dropped out because of side effects. Of the remaining 37, only two patients (5%) were reversible with prednisolone forced expiratory volume in 1s [(FEV1) > 15% of baseline], and among the steroid-irreversible, 26 patients were evaluated after 6 months treatment with either placebo or budesonide. No significant differences in spirometry values, symptoms, or number of exacerbations were found between these two groups. Reversibility with prednisolone is rarely seen in COPD. In outpatients with stable COPD and no signs of asthma or atopy, 2 weeks treatment with prednisolone seems to be of no value in choosing subsequent long-term therapy.


Asunto(s)
Glucocorticoides/uso terapéutico , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Selección de Paciente , Prednisolona/uso terapéutico , Adolescente , Adulto , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Budesonida/administración & dosificación , Budesonida/uso terapéutico , Método Doble Ciego , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiopatología , Enfermedades Pulmonares Obstructivas/fisiopatología , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Valor Predictivo de las Pruebas , Resultado del Tratamiento
11.
Ugeskr Laeger ; 160(27): 4055-8, 1998 Jun 29.
Artículo en Danés | MEDLINE | ID: mdl-9659834

RESUMEN

This study was performed to investigate the possible differences between prescribed medicine, as entered in the hospital record, and the medicine dispensed to the patients according to the nurse's dispensing records (NDR's) in two clinical departments at a Copenhagen University Hospital. Discrepancies were defined as either dosage differences or drugs only present in one file, and were divided into major and minor discrepancies, according to clinical significance. In the first department, discrepancies were found in 61.4% of the records, and major discrepancies were found in 35.1%. In the second department, discrepancies were found in 70.5% of the cases, and major discrepancies in 42.5%. No correlation was found between the number of drugs per patient and the number of discrepancies. A significant difference exists between what is prescribed, and what is dispensed. This can have clinical as well as legal consequences.


Asunto(s)
Registros Médicos , Errores de Medicación , Dinamarca , Formas de Dosificación , Vías de Administración de Medicamentos , Prescripciones de Medicamentos , Departamentos de Hospitales , Humanos , Sistemas de Medicación en Hospital
12.
Am J Hypertens ; 10(5 Pt 1): 483-91, 1997 May.
Artículo en Inglés | MEDLINE | ID: mdl-9160757

RESUMEN

This study shows the association between smoking and both office and ambulatory blood pressure. By means of stratification, a uniform number of subjects of both sexes and spanning 6 decades (aged 20 to 79 years) were recruited randomly from the local community register. A total of 352 subjects participated, including 161 smokers. Smokers (both sexes and all age groups summed), as compared with nonsmokers had statistically significant lower office blood pressure as follows (mean systolic +/- SED/mean diastolic +/- SED): (systolic and diastolic, -6.8 +/- 2.1/-3.9 +/- 1.3); day ambulatory blood pressure (diastolic, /-2.8 +/- 1.0); and night ambulatory blood pressure (systolic and diastolic, -4.2 +/- 1.8/-3.9 +/- 1.1). The intraperson variability of the day ambulatory blood pressure (as measured every 15 min) was identical for the smokers and the nonsmokers. Smokers were found to have a diminished "white coat" effect; this diminished white coat effect has not previously been described. The major white coat effect was seen in the older nonsmokers, whereas the diminished white coat effect was most pronounced in the older male smokers and in the younger female smokers. Smokers seem to have a diminished white coat effect, as well as a lower ambulatory blood pressure throughout the day (diastolic) and at night (systolic and diastolic). The similar intraperson variability found in the smokers' and nonsmokers' blood pressure further speaks for a consistently lower blood pressure in smokers as compared with nonsmokers.


Asunto(s)
Presión Sanguínea/fisiología , Frecuencia Cardíaca/fisiología , Fumar , Adulto , Anciano , Monitoreo Ambulatorio de la Presión Arterial , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Estrés Psicológico/fisiopatología
13.
Support Care Cancer ; 5(1): 38-43, 1997 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9010988

RESUMEN

A few studies indicate a dose-response effect of the antiemetic metopimazine. The aim of this study was therefore to investigate the tolerability of increasing doses of metopimazine given orally every 4 h for eleven doses. The dose levels 20 mg, 30 mg, 40 mg, 50 mg and 60 mg were studied in 36 patients completing 46 cycles of chemotherapy. Serum concentrations of metopimazine and the acid metabolite AMPZ were measured by HPLC in 13 patients (15 cycles). The dose-limiting toxicity was moderate to severe dizziness caused by orthostatic hypotension as seen in 0, 0, 17%, 42% and 50% of patients at the respective dose levels. Other side effects were few and mild, and only a single possible extrapyramidal adverse event was observed in a patient at the 60-mg dose. High serum concentrations were not predictive for toxicity, as found on comparison of patients with and without symptoms, but in individual patients symptoms were seen at the time of Cmax. We found that metopimazine was safe with a dosage of 30 mg x 6. This dose is four times higher than that previously recommended for antiemetic use.


Asunto(s)
Antieméticos/administración & dosificación , Ácidos Isonipecóticos/administración & dosificación , Administración Oral , Adulto , Factores de Edad , Anciano , Antieméticos/efectos adversos , Antieméticos/sangre , Antieméticos/metabolismo , Antieméticos/farmacocinética , Antineoplásicos/efectos adversos , Enfermedades de los Ganglios Basales/inducido químicamente , Presión Sanguínea/efectos de los fármacos , Mareo/inducido químicamente , Relación Dosis-Respuesta a Droga , Femenino , Predicción , Cefalea/inducido químicamente , Humanos , Hipotensión Ortostática/inducido químicamente , Ácidos Isonipecóticos/efectos adversos , Ácidos Isonipecóticos/sangre , Ácidos Isonipecóticos/metabolismo , Ácidos Isonipecóticos/farmacocinética , Masculino , Persona de Mediana Edad , Fases del Sueño/efectos de los fármacos , Xerostomía/inducido químicamente
14.
Ugeskr Laeger ; 158(49): 7084-91, 1996 Dec 02.
Artículo en Danés | MEDLINE | ID: mdl-8999617

RESUMEN

The aim of this study was to establish reference values for 24-hour ambulatory blood pressure in a Danish population stratified for gender and age in the decades from 20 to 79 years of age. A sample of 352 persons, 179 men and 173 women randomly selected from the local community register, age 20-79 years underwent 24-h ambulatory blood pressure monitoring. For men age < 50 daytime ambulatory blood pressure (median) was 125/79 mmHg and night time was 106/65 mmHg, for women the respective pressures were 113/77 mmHg and 97/64 mmHg. For men age > or = 50 daytime ambulatory blood pressure was 133/83 mmHg and night time was 124/86 mmHg, for women the respective pressures were 122/83 mmHg and 105/65 mmHg. Presently, we can only relate cardiovascular risk to clinic blood pressure. Therefore we have calculated corresponding ambulatory blood pressure values to WHO's upper limit 160/90 mmHg for normal blood pressure in the clinic and found 154/87 mmHg for daytime and 134/74 mmHg at night. For a clinic pressure of 95 mmHg the corresponding daytime value was 91 mmHg, for 100 mmHg it was 95 mmHg.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Adulto , Anciano , Estudios Cruzados , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia
16.
Am J Hypertens ; 8(10 Pt 1): 978-86, 1995 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8845079

RESUMEN

UNLABELLED: The study was conducted to determine age and sex stratified normal values for 24-h ambulatory blood pressure. A sample of 352 healthy subjects (all white) were randomly selected from the community register and stratified by sex and age groups in decades from 20 to 79 years of age. Persons with a history of hypertension, cerebral apoplexy, diabetes, myocardial or renal disease, and who were taking blood pressure-influencing medication were excluded. Ambulatory blood pressure was recorded over 24 h, with measurements taken every 15 min from 07:00 to 22:59, and every 30 min from 23:00 to 6:59. Systolic blood pressure increased only slightly with age and was significantly higher in men than in women. The diastolic blood pressure increased only slightly with age in both sexes until the 50 to 59 years age group and declined thereafter. The diastolic blood pressure was not different for the two sexes. Both systolic and diastolic blood pressure were approximately 15% lower during the night regardless of age or sex. Ambulatory blood pressure during the daytime was on an average of 5 mm Hg lower than office blood pressure, but the mean difference between the two measurements increased with age. The variability of the difference also increased with age. IN CONCLUSION: Normal values for ambulatory blood pressure are presented in a randomly selected age- and gender-stratified population. Differences between office blood pressure and ambulatory blood pressure increased with age suggesting that the previously observed higher blood pressure seen in the elderly partly might be explained by a greater impact of white coat hypertension in older people.


Asunto(s)
Envejecimiento/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Ritmo Circadiano , Caracteres Sexuales , Adulto , Anciano , Determinación de la Presión Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Valores de Referencia
18.
Eur J Clin Pharmacol ; 48(1): 39-43, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7621846

RESUMEN

A number of randomised studies indicate that a single high dose of aminoglycoside every 24 h may be more efficient and less toxic than the same dose divided into multiple daily doses. In the meta-analysis of 16 studies described here, which included more than 1200 patients, the relative chance (i.e. the relative risk, RR) of cure of the single-dose regime compared with the multiple-dose regime was 1.027, indicating that the single daily dose regime had a 2.7% higher cure rate (NS). The RR of avoiding nephrotoxicity was 1.001 (NS) and the RR of avoiding ototoxicity was 1.001 (NS). It is concluded that there is no difference concerning efficacy and safety between single-dose and multiple-dose regimes for administration of aminoglycosides.


Asunto(s)
Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Aminoglicósidos , Antibacterianos/administración & dosificación , Trastornos de la Audición/inducido químicamente , Humanos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/patología , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
Acta Anaesthesiol Scand ; 38(1): 15-29, 1994 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-8140867

RESUMEN

Relatively few clinically significant drug interactions with anaesthetics have been documented in the literature. The following should be stressed since these interactions are not readily predictable or are potentially fatal. Pethidine should never be administered to patients who have received monamine oxidase inhibiting drugs within the last fortnight, since a fatal hyperpyrexia and/or hypertension may result. Thiopentone induction seems to make the heart more susceptible to arrhythmias caused by adrenergic drugs, and may cause severe arterial hypotension in patients treated with diazoxide. Midazolam orally should possibly be avoided as premedication in patients treated with erythromycin since anaesthetic concentrations of midazolam may result. Patients for whom bupivacaine analgesia is planned could preferentially be premedicated with other drugs than diazepam, which causes the serum level of bupivacaine to increase. Bradycardia and hypotension not attributable to sympathetic blockade have been reported following bupivacaine extradurally in verapamil-treated patients. Sulfonamides and the ester group of local anaesthetics, such as prilocaine in combination, may result in severe methaemoglobinaemia in infants. Epinephrine added to local anaesthetics may cause local vasodilation if administered to patients concurrently being treated with cyclic antidepressants, and the combination imposes the risk of severe hypertension and arrhythmias.


Asunto(s)
Anestesia Intravenosa , Anestésicos Locales , Interacciones Farmacológicas , Barbitúricos , Benzodiazepinas , Humanos , Narcóticos
20.
Pharmacol Toxicol ; 73(5): 279-84, 1993 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-8115311

RESUMEN

The pharmacokinetic variables and antihypertensive effect of the calcium antagonist isradipine, were investigated in 30 hypertensive patients. Isradipine was given orally in parallel group design in plain and slow release formulations in doses of 2.5 mg twice daily and 5.0 mg once daily, respectively. Isradipine concentration in serum was measured by a sensitive RIA method after the first dose and after 6 weeks of treatment. The pharmacokinetics and concentration/effect relationship after the first dose and after 6 weeks of treatment were compared. No differences in pharmacokinetics were observed between single and multiple dosing. Data were in accordance with results from studies in healthy volunteers. Rate, but not extent of bioavailability differs between the two isradipine formulations. Antihypertensive efficacy of the two formulations was similar (16/11 and 19/15 mmHg), and a significant time dependent increase in Emax from 10/3 mmHg to 23/14 mmHg after 6 weeks of treatment was observed.


Asunto(s)
Hipertensión/tratamiento farmacológico , Isradipino/administración & dosificación , Isradipino/farmacocinética , Presión Sanguínea/efectos de los fármacos , Preparaciones de Acción Retardada , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Isradipino/sangre , Isradipino/uso terapéutico , Masculino , Modelos Biológicos
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