RESUMO
WHAT IS KNOW AND OBJECTIVE: Teriflunomide is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis. CASE SUMMARY: We present a rare intoxication with a high dose (672 mg) of teriflunomide. According to its product label, the only known treatment is the administration of colestyramine and activated carbon (charcoal). No serious adverse events occurred during the time the patient was admitted (<24 h). No long-term overdose-related symptoms or complaints were reported. WHAT IS NEW AND CONCLUSION: The fact that after the acute overdose both adverse events and laboratory parameters were acceptable, prescribing colestyramine and activated carbon, as well as monitoring of laboratory parameters such as full blood count, liver and kidney values and QTc, seems sufficient during the early stage (<24 h after intake) of teriflunomide overdose.
Assuntos
Anti-Inflamatórios não Esteroides/toxicidade , Crotonatos/toxicidade , Overdose de Drogas/fisiopatologia , Hidroxibutiratos/toxicidade , Nitrilas/toxicidade , Toluidinas/toxicidade , Adulto , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Resina de Colestiramina/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Humanos , MasculinoRESUMO
Evidence-based guidelines describe the optimal implementation order of different classes of anti-diabetic drugs in patients with type 2 diabetes mellitus (DM2). Renal impairment affects 20-40% of the DM2 patients. Guidelines do not provide information about the applicability of individual anti-diabetic drugs in patients with DM2 and impaired renal function. Renal impairment not only affects the pharmacokinetics of anti-diabetic drugs but glucose metabolism as well. Pharmacokinetic properties, as well as clinical experience with individual anti-diabetic drugs, should be used to evaluate the applicability of anti-diabetic drugs. In patients with DM2 and a creatinine clearance ≥ 60 ml/min/1.73 m2 all anti-diabetic drugs can be used at standard doses. In patients with DM2 and a creatinine clearance < 60 ml/min/1.73 m2 certain anti-diabetic drugs are contraindicated, while others should be dose-adjusted. A limited number of anti-diabetic drugs can be dosed independent of renal function.