Electropolymerization of Metallo-Octaethylporphyrins: A Study to Explore Their Sensing Capabilities.

The electropolymerization of metallo-octaethylporphyrins (OEP) containing copper, zinc or nickel metal were performed using cyclic voltammetry at three different potential ranges. The electropolymerized porphyrins were characterized by UV-Vis and Raman spectroscopies and the Soret band (393-445 nm) and Raman bands were used to assess the degree of electropolymerization obtained. The application for an analytical use of the modified electrodes to determine phenobarbital in aqueous solution was evaluated. The electropolymerized CuOEP produced at potentials ranging from 0.0 to 2.2 V was the best performer with a limit of detection (LoD) of 10 mg L-1 (43.07 µM), a linear range of 10-150 mg L-1 (43.07 to 646 µM), an average precision of 4.3% (%RSD) and an average % recovery of 101.34%. These results indicate that the CuOEP-modified electrode is suitable for the analysis of phenobarbital in human samples, as the concentration range varies from 10 to 40 mg L-1 (43.07 to 172.27 µM), typically found in antiepileptic treatments, to those at the toxic level (172-258 µM) or lethal levels (345-650 µM).

Novel Phenobarbital-Loaded Nanostructured Lipid Carriers for Epilepsy Treatment: From QbD to In Vivo Evaluation.

Pharmacological treatments of central nervous system diseases are always challenging due to the restrictions imposed by the blood-brain barrier: while some drugs can effectively cross it, many others, some antiepileptic drugs among them, display permeability issues to reach the site of action and exert their pharmacological effects. The development of last-generation therapeutic nanosystems capable of enhancing drug biodistribution has gained ground in the past few years. Lipid-based nanoparticles are promising systems aimed to improve or facilitate the passage of drugs through biological barriers, which have demonstrated their effectiveness in various therapeutic fields, without signs of associated toxicity. In the present work, nanostructured lipid carriers (NLCs) containing the antiepileptic drug phenobarbital were designed and optimized by a quality by design approach (QbD). The optimized formulation was characterized by its entrapment efficiency, particle size, polydispersity index, and Z potential. Thermal properties were analyzed by DSC and TGA, and morphology and crystal properties were analyzed by AFM, TEM, and XRD. Drug localization and possible interactions between the drug and the formulation components were evaluated using FTIR. In vitro release kinetic, cytotoxicity on non-tumoral mouse fibroblasts L929, and in vivo anticonvulsant activity in an animal model of acute seizures were studied as well. The optimized formulation resulted in spherical particles with a mean size of ca. 178 nm and 98.2% of entrapment efficiency, physically stable for more than a month. Results obtained from the physicochemical and in vitro release characterization suggested that the drug was incorporated into the lipid matrix losing its crystalline structure after the synthesis process and was then released following a slower kinetic in comparison with the conventional immediate-release formulation. The NLC was non-toxic against the selected cell line and capable of delivering the drug to the site of action in an adequate amount and time for therapeutic effects, with no appreciable neurotoxicity. Therefore, the developed system represents a promising alternative for the treatment of one of the most prevalent neurological diseases, epilepsy.

Tratamento da epilepsia idiopática canina - quadro clínico após interação medicamentosa / Treatment of canine idiopathic epilepsy - clinical picture after drug interaction

Background: The large number of diseases demand perennial development of the pharmaceutical industry. The drugtesting phase is essential to make them available safely. Awareness of pharmacological properties, adverse effects and drug interactions is required. Drug interactions are common in veterinary medicine and should be avoided. At times, epileptic seizures require polydrug therapy, predisposing patients to drug interactions. The interaction between carbamazepine and phenobarbital reported in the literature is an example. The aim of this paper is to report a clinical picture of drug interaction in the treatment of idiopathic epilepsy. Case: A 1-year-old Border Collie male dog, was admitted at the Veterinary Hospital of the Federal University of Lavras in post-ictal. The tutor reported that a year ago the animal had epileptic seizures and clusters with intervals of 21 to 25 days. Despite the continued use of previously prescribed phenobarbital (7.4 mg/kg, v.o., BID, until new recommendations) and carbamazepine (7.5 mg/kg, v.o., BID, until new recommendations), seizure control was not achieved. The physical examination indicated, tachypnea, ptialism, mydriasis, intense fatigue, and alienation from the environment. The patient did not respond to the threat-reflex test. Blood count, hepatic and renal blood chemistry, serum electrolyte (potassium, sodium, calcium and phosphorus), and phenobarbital dosages were requested. Based on the animal's history, breed characteristics, and alterations in the physical examination associated with normal results in complementary exams, idiopathic epilepsy was diagnosed. After analyzing the case, it was observed that the inefficiency in the control of seizures was possibly due to the drug interaction between phenobarbital and carbamazepine. Carbamazepine and phenobarbital reciprocally reduce their half-lives. To confirm the raised hypothesis, the serum concentration of carbamazepine was gradually reduced through weaning from its dose administered to the patient. Serial dosage of the concentration of phenobarbital in the bloodstream was performed. As a result, the serum phenobarbital, previously dosed at a concentration of 13.3 mg/dL with concomitant administration of carbamazepine, increased to 22 mg/dL 40 days after the beginning of weaning from carbamazepine (T0), and then to 36 mg/dL 100 days after T0. There was an increase in the concentration of phenobarbital in the bloodstream while the serum concentration of carbamazepine declined. The patient spaced out his seizures to every 50 to 60 days with phenobarbital monotherapy at a dose of 6 mg/kg. Discussion: Efficient control of clusters, such as the reduction of seizures by 50%, was only possible due to the meticulous perception of the possible interaction reported in medicine. Carbamazepine and phenobarbital are P450 isoenzyme inducers. The concomitant administration of both drugs potentiated the action of isoenzymes in the hepatic microsomal system, which led to an accelerated metabolic processing of the drugs. After weaning from carbamazepine, that is, reducing the action of carbamazepine on the isoenzymes of the P450 enzyme system, the concentration of phenobarbital normalized at 36 mg/ dL. Such concentration is within the reference range reported in the literature: 25 mg/dL to 35 mg/dL of serum phenobarbital for treatment efficacy. Therefore, the control of convulsive crises was achieved. The increase in the concentration of phenobarbital due only to weaning from carbamazepine, even after decreasing the daily dose of barbiturate prescribed to the animal, contributed to evidence of the interaction of these drugs. It is noted that prior knowledge of pharmacological properties, careful study of the patient's history, and the cooperation of the tutor were essential for the therapeutic success and practice of evidence-based veterinary medicine.

Pancitopenia induzida em um cão pelo uso concomitante de fármacos mielotóxicos / Pancytopenia in a dog induced by concomitant use of myelotoxic drugs

Background: The indiscriminate use of drugs is an issue in Veterinary Medicine, as it has serious consequences for theanimals. Many drugs are myelotoxic and cause a decrease in the production of blood cells, which may be irreversible insome cases. The present work reports a case of pancytopenia induced by the concomitant use of myelotoxic drugs (estrogen, metamizole and phenobarbital) in a dog and describes findings on myelotoxicity, hematological alterations andtreatment success.Case: A 7-year-old Lhasa Apso bitch was referred to the Veterinary Hospital of Federal University of Paraná, Curitibacampus, with hematuria and a history of treatment with phenobarbital [2 mg/kg twice a day (bis in die, BID)], metamizole[25 mg/kg 3 times a day (ter in die, TID)], and use of estrogen hormone (estradiol cypionate). At physical examination, theanimal was normohydrated and exhibited normal palpable lymph nodes, pale mucous membranes, galactorrhea, and a bodytemperature of 36°C. A complete blood count including reticulocyte count and a total plasma protein (TPP) exam wererequested. The results revealed pancytopenia (18% hematocrit, 1,400 total leucocytes/µL, and 22,000 reticulocytes/µL).An abdominal ultrasound exam did not detect any relevant alterations. In view of the results obtained, medullary aplasiawas suspected. A bone marrow aspiration was performed. A myelogram revealed a decrease in cellularity (erythrocyticand granulocytic hypoplasia), with presence of rare erythroid and granulocytic precursors. The diagnosis was medullaryaplasia. The animal was treated, and the evolution of the hematological alterations was monitored. The treatment consistedof administration of erythropoietin (100UI/kg subcutaneously every 48 h), prednisone (2 mg/kg BID), Leucogen (3 mg/kg BID), interferon (0.2 IU/kg BID) and Eritrós Dog Tabs [1 tablet once a day (semel in die, SID)]. After 5 days of treatment, the...(AU)

Pancitopenia induzida em um cão pelo uso concomitante de fármacos mielotóxicos / Pancytopenia in a dog induced by concomitant use of myelotoxic drugs

Background: The indiscriminate use of drugs is an issue in Veterinary Medicine, as it has serious consequences for theanimals. Many drugs are myelotoxic and cause a decrease in the production of blood cells, which may be irreversible insome cases. The present work reports a case of pancytopenia induced by the concomitant use of myelotoxic drugs (estrogen, metamizole and phenobarbital) in a dog and describes findings on myelotoxicity, hematological alterations andtreatment success.Case: A 7-year-old Lhasa Apso bitch was referred to the Veterinary Hospital of Federal University of Paraná, Curitibacampus, with hematuria and a history of treatment with phenobarbital [2 mg/kg twice a day (bis in die, BID)], metamizole[25 mg/kg 3 times a day (ter in die, TID)], and use of estrogen hormone (estradiol cypionate). At physical examination, theanimal was normohydrated and exhibited normal palpable lymph nodes, pale mucous membranes, galactorrhea, and a bodytemperature of 36°C. A complete blood count including reticulocyte count and a total plasma protein (TPP) exam wererequested. The results revealed pancytopenia (18% hematocrit, 1,400 total leucocytes/µL, and 22,000 reticulocytes/µL).An abdominal ultrasound exam did not detect any relevant alterations. In view of the results obtained, medullary aplasiawas suspected. A bone marrow aspiration was performed. A myelogram revealed a decrease in cellularity (erythrocyticand granulocytic hypoplasia), with presence of rare erythroid and granulocytic precursors. The diagnosis was medullaryaplasia. The animal was treated, and the evolution of the hematological alterations was monitored. The treatment consistedof administration of erythropoietin (100UI/kg subcutaneously every 48 h), prednisone (2 mg/kg BID), Leucogen (3 mg/kg BID), interferon (0.2 IU/kg BID) and Eritrós Dog Tabs [1 tablet once a day (semel in die, SID)]. After 5 days of treatment, the...

New nanocarried phenobarbital formulation: Maintains better control of pentylenetetrazole-Induced seizures.

This study aims to evaluate the efficacy of slow release phenobarbital in the control of convulsions triggered by pentylenetetrazole (PTZ), verifying the time of permanence in the anticonvulsant effect through behavior and electroencephalographic records. A total of 162 male Wistar rats weighing between 100 and 120 g were divided into two groups, one for behavior analysis (n = 90) and biochemistry, and another for the acquisition of electrocorticographic record (n = 72). Hepatic enzymes were measured by obtaining a blood sample from the animals studied by means of a biochemical analysis. The procedures for electrode implant and electrocorticographic recordings were performed. The intercalation of phenobarbital in layered double hydroxide (LDH) nanocarrier allowed us to evaluate a new slow release pharmaceutical formulation based on methodologies that have proven longer residence time and lower side effects. This study demonstrates that phenobarbital can be a new perspective pharmaceutical formulation.

Development and validation of a method for phenobarbital in serum: anticonvulsant pharmacotherapy monitoring

The therapeutic drug monitoring (TDM) is an important strategy for the effectiveness and safety of long-term pharmacotherapy, such as the use of phenobarbital as an anticonvulsant drug in epilepsy. In this sense, HLPC has been presented as a technique for the measurement of phenobarbital in serum. However, the ideal conditions for carrying out the method must be established for each laboratory reality. An analytical method using HPLC was developed and validated in order to identify and quantify Phenobarbital in blood. The chromatographic conditions were C-18 column (Shimpack XR-ODS 50L x 3.0), acetonitrile-water mobile phase (30:70, v v-1), 0.2 mL min-1 flow and reading wavelength of 210 nm. Linearity was established in the range of 2.5 to 80 µg mL-1, the linear correlation coefficient was 0.9981. The average of the coefficient of variation of the precision was 5.30%. The relative standard error of the accuracy was -2.17% and of the recovery coefficient was 97.83%. In all eleven patients, phenobarbital concentrations were below the therapeutic range. The tested method was selective, linear, precise, accurate and showed good recovery.(AU)

Quantitative analysis of phenobarbital in biological fluids: Analyte enrichment by an electrically-assisted microextraction technique

An electrically-assisted microextraction method called electromembrane extraction, followed by a simple high performance liquid chromatography and ultraviolet detection was developed and validated for determining phenobarbital in biological samples. The major parameters influencing the electromembrane extraction procedure including solvent composition, voltage, pH of acceptor and donor solutions, salt effect, and time of extraction were evaluated and optimized. The drug was extracted from the donor aqueous sample solution (pH 9) to the acceptor aqueous solution (pH 13). The donor and acceptor phases were separated by a hollow fiber dipped in 1-octanol as a supported liquid membrane. A voltage of 40 V during 20 minutes was applied as the driving force. The enrichment factor was obtained >51 which enhanced the sensitivity of the instrument. Limit of detection and limit of quantitation were 7.5 and 25 ng/mL, respectively. The method was linear over the range of 25-1000 ng/mL for phenobarbital (R2 >0.9998) with repeatability (%RSD) between 0.4% and 6.8% (n = 3). The proposed method was successfully applied to human plasma and urine samples with relative recovery of 70-80% and %RSD < 6.8%.

Systemic and clinical treatment of gingival hyperplasia associated with use of anticonvulsant

ABSTRACT: Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth. Preexisting gingival inflammation induced by dental plaque seems to be a favorable condition to the development and/or expression of gingival overgrowth. This study describes a case in which the use of phenytoin and phenobarbital anticonvulsant associated with the presence of dental plaque provided a large and severe extent of gingival alteration. We concluded that it was possible to achieve a good result in the patient with an intensive mechanical control of dental plaque, oral hygiene orientations and substitution of the drug for other alternative medication.

Morphine vs Methadone Treatment for Infants with Neonatal Abstinence Syndrome.

OBJECTIVE: To estimate the relationship of initial pharmacotherapy with methadone or morphine and length of stay (LOS) in infants with neonatal abstinence syndrome (NAS) admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: From the Pediatrix Clinical Data Warehouse database, we identified all infants born at ≥36 weeks of gestation between 2011 and 2015 who were diagnosed with NAS (International Classification of Diseases, Ninth Revision code 779.5) and treated with methadone or morphine in the first 7 days of life. We used multivariable Cox proportional hazards regression analysis to quantify the association between initial treatment and LOS after adjusting for maternal age, maternal race/ethnicity, maternal drug use, maternal smoking, gestational age, small for gestational age status, inborn status, and discharge year. RESULTS: We identified a total of 7667 eligible infants, including 1187 treated with methadone (15%) and 6480 treated with morphine (85%). Birth weight, gestational age, and sex were similar in the 2 groups. Methadone treatment was associated with a 22% shorter median LOS (18 days [IQR, 11-30 days] vs 23 days [IQR, 16-33]; P < .001) and a 19% shorter median NICU stay (17 days [IQR, 10-29 days] vs 21 days [IQR, 14-36 days]; P < .001). After adjustment, methadone was associated with a shorter LOS (hazard ratio for discharge, 1.24; 95% CI, 1.11-1.37; P < .001) CONCLUSION: Among infants born at ≥36 weeks of gestation with NAS, initial methadone treatment was associated with a shorter LOS compared with morphine treatment. Future prospective comparative effectiveness trials to treat infants with NAS are needed to verify this observation.

[Treatment of neonatal seizures]. / Tratamiento de las convulsiones neonatales.

Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (˜ 58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible etiologies and several treatment options. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.

Tratamiento de las convulsiones neonatales / Treatment of neonatal seizures

Las convulsiones neonatales están entre las manifestaciones más dramáticas de enfermedad neurológica y deben ser consideradas una emergencia. La incidencia es 3.5 por cada 100 nacidos a término y en prematuros asciende a 58 por cada 100 nacidos vivos. Las convulsiones neonatales son una manifestación clínica de disfunción cortical no específica que puede dar lugar a daño permanente del cerebro. La etiología es multifactorial y requiere una evaluación cuidadosa de cada escenario clínico. El diagnóstico es más complejo por el hecho de que la mayoría de convulsiones son sub-clínicas o sutiles y a veces no tienen correlación con el electroencefalograma. Aunque la identificación temprana y el tratamiento son críticos, el diagnóstico se complica por algunos factores como la variedad de presentaciones clínicas, diferentes etiologías y varias alternativas de tratamiento. De todas maneras, los estudios de investigación y la evidencia clínica disponible han demostrado que el tratamiento precoz con fármacos anticonvulsivantes puede mejorar el pronóstico.

Neonatal seizures are among the most dramatic manifestations of acute central nervous system dysfunction. The incidence is much higher in very low weight neonates than in full term infants (~58 and 3.5 per 100 live births, respectively). Neonatal seizures represent the clinical manifestation of a non-specific cortical cerebral dysfunction which can lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment for each clinical scenario. The diagnosis is further complicated by the fact that most neonatal seizures are subclinical, that is, may display very subtle or no clinical changes and the diagnosis may just be based on EEG findings. The treatment depends on the etiology, but an early and opportune intervention prevents further brain damage, thus improving prognosis. Although early identification and treatment are critical, the diagnosis of neonatal seizures is complicated by several factors such as different clinical presentations, possible etiologies and several treatment options. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.

Outpatient Pharmacotherapy for Neonatal Abstinence Syndrome.

OBJECTIVE: To determine differences in lengths of stay, length of therapy, emergency department (ED) utilization, and hospital readmissions between infants with neonatal abstinence syndrome (NAS) treated exclusively with inpatient pharmacotherapy compared with those discharged on outpatient pharmacotherapy. STUDY DESIGN: This retrospective cohort study of infants enrolled in the Tennessee Medicaid program used administrative and vital records data from 2009 to 2011. Medical record review was used to confirm cases of NAS and classify treatment type. Negative binomial regression was used to compare length of therapy and ordinal regression was used to determine frequency of ED visits and hospital readmissions. RESULTS: Among a cohort of 736 patients with confirmed NAS, 72.3% were treated with pharmacotherapy of which approximately one-half (45.5%) were discharged home on outpatient medications. For infants discharged on outpatient pharmacotherapy, initial hospital length of stay was shorter (11 vs 23 days; P < .001) and length of therapy was longer (60 vs 19 days; adjusted incidence rate ratio [aIRR] 2.84, 95%CI 2.31-3.52). After adjusting for potential confounders, infants discharged on outpatient pharmacotherapy had a greater number of ED visits within 6 months of discharge (adjusted odds ratio [aOR] 1.52, 95% CI 1.06-2.17) compared with those treated as inpatients alone. CONCLUSIONS: Outpatient pharmacotherapy for NAS was associated with higher length of therapy and higher rates of ED utilization when compared with infants treated exclusively as inpatients. Future research should focus on improving the efficiency of NAS management while minimizing postdischarge complications.

Laboratory evaluation and serum level of phenobarbital administered by different pathways in dogs / Avaliação laboratorial e nível sérico do fenobarbital administrado por diferentes vias em cão

Background: Anticonvulsants are widely used in the treatment of small animals for the remission of isolated seizures and recurrent seizures in epilepsy, including tonic-clonic seizures and in status epileticus. Phenobarbital is the drug of choice for the management of epileptic seizures, it is considered very effective, safe, low cost and with few side effects. Several routes of administration may be used, with the oral, intravenous and intramuscular routes being the most common, with rectal and nasal routes being the least common.Materials, Methods & Results: Twenty mongrel dogs were used in the present study (aged 1 to 6-year-old, males and females, weighing 6.0 to 17.0 kg). The patients were previously evaluated via physical examination, temperature, respiratory and heart rate, laboratory tests (erythrogram and leukogram), and serum biochemistry by analyzing the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (FA), and gammaglutamyltransferase (GGT). Four experimental groups were established with five animals in each group: animals receiving intramuscular injections of phenobarbital (VIM), animals receiving nasal administration of phenobarbital (VN), animals receiving rectal administration of phenobarbital (VR), and animals receiving oral administration of phenobarbital (VO). Phenobarbital was administered every 12 h for 15 days. To determine the serum level of phenobarbital, 5 mL of jugular vein blood was collected in vacuum tubes for evaluation via hemogram. The serum level was determined after 15 days of continuous administration of phenobarbital, as stable phenobarbital serum levels can only be achieved from 10 to 15 days after the first administration. For the serum biochemistry evaluation, 10 mL of blood from the jugular vein was collected using vacuum syringes for assessing ALT, AST, GGT, and FA levels.[...](AU)

Laboratory evaluation and serum level of phenobarbital administered by different pathways in dogs / Avaliação laboratorial e nível sérico do fenobarbital administrado por diferentes vias em cão

Background: Anticonvulsants are widely used in the treatment of small animals for the remission of isolated seizures and recurrent seizures in epilepsy, including tonic-clonic seizures and in status epileticus. Phenobarbital is the drug of choice for the management of epileptic seizures, it is considered very effective, safe, low cost and with few side effects. Several routes of administration may be used, with the oral, intravenous and intramuscular routes being the most common, with rectal and nasal routes being the least common.Materials, Methods & Results: Twenty mongrel dogs were used in the present study (aged 1 to 6-year-old, males and females, weighing 6.0 to 17.0 kg). The patients were previously evaluated via physical examination, temperature, respiratory and heart rate, laboratory tests (erythrogram and leukogram), and serum biochemistry by analyzing the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (FA), and gammaglutamyltransferase (GGT). Four experimental groups were established with five animals in each group: animals receiving intramuscular injections of phenobarbital (VIM), animals receiving nasal administration of phenobarbital (VN), animals receiving rectal administration of phenobarbital (VR), and animals receiving oral administration of phenobarbital (VO). Phenobarbital was administered every 12 h for 15 days. To determine the serum level of phenobarbital, 5 mL of jugular vein blood was collected in vacuum tubes for evaluation via hemogram. The serum level was determined after 15 days of continuous administration of phenobarbital, as stable phenobarbital serum levels can only be achieved from 10 to 15 days after the first administration. For the serum biochemistry evaluation, 10 mL of blood from the jugular vein was collected using vacuum syringes for assessing ALT, AST, GGT, and FA levels.[...]

Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso / Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report. / Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

Therapeutic Aspects of Dogs with Presumptive Diagnosis of Idiopathic Epilepsy

Background: Epilepsy is a chronic neurological condition characterised by recurrent epileptic seizures. Various antiepileptic drugs are used for the management of canine idiopathic epilepsy. Phenobarbital is the drug of choice for long-term treatment in dogs. Although it is well tolerated, phenobarbital can cause liver injury if administered alone or in combination with other drugs. Therefore, the main of this study was to identify dogs with presumptive diagnosis of idiopathic epilepsy and information about the antiepileptic drugs, the dose and frequency of administration, period of treatment, frequency of the seizure before and after start the treatment, complementary exams and adverse effects.Materials, Methods & Results: In this study were included 21 dogs with idiopathic epilepsy. All dogs were examined and having blood taken for blood count, biochemical tests (ALT, AST, AP, total protein, albumin, creatinine, urea, amylase, lipase, cholesterol and triglycerides), measurement of serum phenobarbital and/or potassium bromide and, some dogs, free T4 by dialysis and canine TSH. In this study, it was observed monotherapy (phenobarbital) in 76.19% (16/21), double therapy (phenobarbital and potassium bromide) in 19.05% (4/21) and triple therapy (phenobarbital, potassium bromide and gabapentin) in 4.76% (1/21) of dogs. The phenobarbital was used as monotherapy with dose between

Therapeutic Aspects of Dogs with Presumptive Diagnosis of Idiopathic Epilepsy

Background: Epilepsy is a chronic neurological condition characterised by recurrent epileptic seizures. Various antiepileptic drugs are used for the management of canine idiopathic epilepsy. Phenobarbital is the drug of choice for long-term treatment in dogs. Although it is well tolerated, phenobarbital can cause liver injury if administered alone or in combination with other drugs. Therefore, the main of this study was to identify dogs with presumptive diagnosis of idiopathic epilepsy and information about the antiepileptic drugs, the dose and frequency of administration, period of treatment, frequency of the seizure before and after start the treatment, complementary exams and adverse effects.Materials, Methods & Results: In this study were included 21 dogs with idiopathic epilepsy. All dogs were examined and having blood taken for blood count, biochemical tests (ALT, AST, AP, total protein, albumin, creatinine, urea, amylase, lipase, cholesterol and triglycerides), measurement of serum phenobarbital and/or potassium bromide and, some dogs, free T4 by dialysis and canine TSH. In this study, it was observed monotherapy (phenobarbital) in 76.19% (16/21), double therapy (phenobarbital and potassium bromide) in 19.05% (4/21) and triple therapy (phenobarbital, potassium bromide and gabapentin) in 4.76% (1/21) of dogs. The phenobarbital was used as monotherapy with dose between

Therapeutic Aspects of Dogs with Presumptive Diagnosis of Idiopathic Epilepsy

Background: Epilepsy is a chronic neurological condition characterised by recurrent epileptic seizures. Various antiepileptic drugs are used for the management of canine idiopathic epilepsy. Phenobarbital is the drug of choice for long-term treatment in dogs. Although it is well tolerated, phenobarbital can cause liver injury if administered alone or in combination with other drugs. Therefore, the main of this study was to identify dogs with presumptive diagnosis of idiopathic epilepsy and information about the antiepileptic drugs, the dose and frequency of administration, period of treatment, frequency of the seizure before and after start the treatment, complementary exams and adverse effects.Materials, Methods & Results: In this study were included 21 dogs with idiopathic epilepsy. All dogs were examined and having blood taken for blood count, biochemical tests (ALT, AST, AP, total protein, albumin, creatinine, urea, amylase, lipase, cholesterol and triglycerides), measurement of serum phenobarbital and/or potassium bromide and, some dogs, free T4 by dialysis and canine TSH. In this study, it was observed monotherapy (phenobarbital) in 76.19% (16/21), double therapy (phenobarbital and potassium bromide) in 19.05% (4/21) and triple therapy (phenobarbital, potassium bromide and gabapentin) in 4.76% (1/21) of dogs. The phenobarbital was used as monotherapy with dose between