Potential for drug-drug interactions in treating cancer-related nausea and distress.

PURPOSE: To determine the extent and severity of drug-drug interactions between anti-emetics and antipsychotics or antidepressants. SUMMARY: Oncology patients are often required to deal with chemotherapy-induced nausea and vomiting at the same time as psychosocial distress. A review of primary literature, as well as several drug interaction databases, was performed with anti-emetics used in The NCCN® 1.2010 Anti-emesis Guidelines (n = 11) and all currently US-marketed antidepressants or antipsychotics (n = 40).(1) The results from these databases were compiled into a single easy-to-use chart that portrays the severity of the interaction and brief recommendation.(2,3,4) In total, 197 drug-drug interactions out of a total of 440 possible combinations (44.8%) were discovered during the analysis. CONCLUSIONS: Although most anti-emetics had several serious interactions with antidepressants or antipsychotics, palonosetron, and granisetron were found to have no significant interactions. The results can be used to avoid or limit drug interactions in the prescribing of new medications for the oncology patient.(1,2,3,4).

Effect of intravenous magnesium sulphate in reducing irritability and restlessness in pure and polysubstance opiate detoxification.

The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of intravenous magnesium sulphate (MgSO(4)) on the need for chlormethiazole in pure or polysubstance opiate detoxification. Forty-one inpatients suffering from pure and polysubstance opiate dependence were treated with morphine sulphate pentahydrate in a gradual detoxification program. Morphine reduction took about 11 days. Additionally, 5% MgSO(4) was administered intravenously to the intervention group (Mg group, n=22) over 24 h by perfusor (150-200 mg MgSO(4)/h; plasma level of 2.36+/-0.29 mmol/l), whereas NaCl 0.9% was intravenously administered in the placebo group (n=19). In case of withdrawal symptoms (irritability, restlessness, and insomnia), patients received chlormethiazole p.o. Our hypothesis that the need for chlormethiazole would be decreased by adjunctive administration of Mg was not confirmed in our study population (2180 mg/day in the Mg group vs. 2360 mg/day in the placebo group). There was neither a difference in the quantity of chlormethiazole required nor a difference in the severity of withdrawal symptoms measured with the Wang scale between the two comparison groups. We observed that calcium plasma levels decreased and phosphate plasma levels increased significantly during intravenous therapy with Mg. Despite promising pilot studies, the administration of Mg did not enable a dose reduction of tranquilizing medication (chlormethiazole) in pure and polysubstance opiate detoxification.

[Magnesium, acute myocardial infarction and reperfusion injury].

Coronary artery disease (CAD) ranks top with respect to morbidity and mortality in humans. Development of high-tech diagnostic and therapeutic strategies has greatly improved the prognosis of CAD and acute myocardial infarction (AMI) over the past decade. Data from experimental and clinical research have provided important information on the role of magnesium in CAD and AMI. In relation to duration and severity of CAD, an adrenaline induced systemic stress arises, which provokes enhanced magnesium requirements, because magnesium is the co-factor in ATP dependent myocardial metabolism. The success of pharmacological or mechanical intervention in AMI can be compromised by reperfusion injury, which is probably caused by myocardial calcium accumulation. Since magnesium blocks myocardial calcium influx, reperfusion injury might be diminished or even prevented by magnesium application. Thus, the common procedure of invasive cardiac intervention and intravenous magnesium administration before reperfusion could become the gold standard in treatment of AMI.

Intravenous magnesium sulphate in acute myocardial infarction--is the answer "MAGIC"?

The role of magnesium in coronary artery disease has been evaluated extensively during the last three decades. The intravenous application of magnesium in acute myocardial infarction is of major importance, the beneficial effects have been underlined in several studies. Magnesium is of significance in the pathomechanisms of reperfusion injury and reduction of malign arrhythmias in the critical acute phase of myocardial infarction, if applied intravenously. However, the promising results of LIMIT-2 could not be confirmed by the data of ISIS-4. The timing of magnesium therapy is probably the most important key factor. Similar to the guidelines of thrombolytic intervention, magnesium has to be administered as early as possible, at the latest before myocardial reperfusion has started. Nevertheless, because of conflicting results of prior trials doubts on the efficacy of intravenous magnesium in myocardial infarction still remain. The multinational, multicenter trial MAGIC has been set up to evaluate the optimal patient cohort as well as the ideal dose regimen for the application of intravenous magnesium sulphate in patients with acute myocardial infarction. The answer on the open questions on intravenous magnesium sulphate in myocardial infarction could be "MAGIC".