Drugs & Therapy Perspectives

Correction to: Midazolam oral solution (Ozalin ® ): a profile of its use for procedural sedation or premedication before anaesthesia in children The article Midazolam oral solution (Ozalin®): a profile of its use for procedural sedation or premedication before anaesthesia in children, written by Katherine A. Lyseng-Williamson, was originally published Online First without open access. After publication in volume 35, issue 6, pages 255-262, Primex Pharmaceuticals AG requested that the article be Open Choice to make the article an open access publication. Post-publication open access was funded by Primex Pharmaceuticals AG. The article is forthwith distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

First reports of adverse drug reactions

No difference in relevant potential allergens in SPF-containing facial moisturizers: implications in frontal fibrosing alopecia Abstract Background Although controversial, it has been proposed that the use of leave-on facial skin care products, namely daily facial moisturizers with sun protection factor (SPF), is associated with frontal fibrosing alopecia (FFA). In accordance, several authors have previously reported on patch testing results in cross-sectional studies of patients with FFA. Aims The aim was to survey the top-selling facial moisturizers for the prevalence of potential allergens identified in FFA patient patch testing and to then distinguish if those moisturizers containing SPF were statistically more likely to have relevant potential allergens than moisturizers without SPF. Methods Three online retailers were surveyed for the best-selling facial moisturizers, and ingredient lists were reviewed for allergens found in FFA-patient patch testing and fragrance and botanical cross-reactors. Results Out of 100 unique facial moisturizers, 87 contained at least one potential allergen identified in previous patch testing results of FFA patients. There was no significant difference in the prevalence of indicated allergens in facial moisturizers with SPF in comparison to those without SPF. Conclusion It does not appear that the presence of additional identified allergens in facial moisturizers with SPF explains the reported association with FFA. Further prospective, comparative studies are necessary to understand the potential role of personal cosmetic products in the development of FFA.

Assessment of anticoagulation management in outpatients attending a warfarin clinic in Windhoek, Namibia Abstract Background Warfarin, an anticoagulant with a low therapeutic index, requires frequent international normalized ratio (INR) monitoring to ensure efficacy and safety. Little is known about anticoagulation management in Namibia. Objective The purpose of this study was to investigate the level of anticoagulation control among outpatients requiring maintenance warfarin therapy. Setting Clinical records of patients attending the warfarin anticoagulation clinic at Windhoek Central Hospital (Windhoek, Namibia) during a 1-year period were reviewed. Methods Of the 294 outpatients who visited the warfarin anticoagulation monitoring clinic in 2017, 215 patients were included in the data analysis. The following information was available and used for data analysis: age and sex of the patient, indication for warfarin use, number of visits, warfarin dose and INR values. The individual's time in therapeutic range (iTTR) was the primary outcome, which was calculated both using the Rosendaal method and as the percentage of the reported INR values in the therapeutic range. Results The patients' mean iTTR was 29.4%, well below the 65% target, when estimated by the Rosendaal method and 25.2% when calculated as the percentage of INR values within the therapeutic range. Only 22 of the 215 patients (10%) had an iTTR ≥ 65%. Conclusions Anticoagulation control at this outpatient clinic was low relative to the target iTTR of 65%. Consequently, patients were at risk for further embolic events or bleeding events based on the high numbers of sub- and supratherapeutic INRs during the time period studied.

K-haler ® breath-triggered inhaler: a profile of the properties of the device Abstract The k-haler® device is a new breath-triggered pressurized metered-dose inhaler (BTI). Its breath-triggered mechanism employs unique 'kinked-hose valve' technology (k-valve™) and is easy to actuate. In vitro, the k-haler device required less respiratory power, which is affected by the resistance of the device, for dose release than a dry powder inhaler (DPI), potentially making it suitable for a wider range of patients, including those with a low inspiratory flow rate. It has a lower, more consistent plume force than conventional press-and-breathe pressurized metered-dose inhalers (pMDIs), has high fine-particle fraction and pulmonary deposition rates, and, in contrast to conventional pMDIs (but like other BTIs and DPIs), does not require actuation-inhalation coordination. The k-haler device is compact, has an easy-to-read dose counter, a connected mouthpiece and is simple to use, with limited data indicating that more patients are satisfied with the device than they are with some DPIs and that many patients prefer it over some commonly used inhalers. To facilitate correct use, the packaging of the k-haler contains simple how-to-use instructions and diagrams, as well as a patient information leaflet. A number of inhaled products may be suitable for administration via the k-haler device.

Minimize exposure to antidopaminergic drugs whenever possible to reduce the risk of drug-induced parkinsonism and tardive dyskinesia Abstract Drug-induced parkinsonism (DIP) and tardive dyskinesia (TD) are iatrogenic consequences of antidopaminergic drugs, and are most common in the elderly. To reduce the risk of DIP and TD, exposure to antidopaminergic drugs should be minimized, with the lowest effective dosage possible being used for the shortest treatment duration. Prevention and early detection of DIP and TD are essential, as evidence supporting the use of available treatment options is limited.

Take a multifaceted approach when treating onychomycosis Abstract Onychomycosis is difficult to treat, particularly due to factors at the patient, organism, treatment and environmental levels that increase disease susceptibility or impact treatment. Along with taking these into consideration and addressing them as required, performing diagnostic tests is necessary when selecting the appropriate treatment and administration route, thereby maximizing the chances of successful treatment. Because onychomycosis has a high recurrence rate, preventive measures are recommended even after achieving a cure.

Effect of GSTP1 polymorphism on efficacy and safety of cyclophosphamide aggressive therapy in lupus nephropathy patients Abstract Background Lupus nephritis (LN) occurs in up to 60% of adults with systemic lupus erythematosus (SLE) and is a predictor of poor survival. Cyclophosphamide (CYC) is regarded as the most effective immunosuppressive medication to improve survival for patients with LN. Objective This prospective hospital-based study was conducted to identify the effect of glutathione S transferase Pi-1 (GSTP1) genotypes on the efficacy and safety of CYC aggressive therapy. Methods We enrolled SLE nephropathy patients admitted to the Department of Rheumatology of the 500-bed Yangon Specialty Hospital (YSH), Yangon, Myanmar, who received CYC aggressive therapy for 6 months according to treatment guidelines for SLE patients with renal involvement. The frequencies of I/I, I/V and V/V GSTP1 genotypes were determined using the polymerase chain reaction-restriction fragment length polymorphism method. The efficacy of CYC aggressive therapy between LN patients with wild GSTP1 (I/I) and those with polymorphic GSTP1 (I/V or V/V) genotypes was evaluated by comparing 24-h urinary protein levels and assessing the remission rates at 3 and 6 months after initiation of CYC. CYC-related myelotoxicity was assessed by reviewing complete blood picture results on the 10th day after CYC treatment. Results In total, 95 eligible patients were recruited. The frequencies of I/I, I/V and V/V GSTP1 genotypes were 54.7, 41.1 and 4.2%, respectively. At 3 and 6 months after CYC treatment, mean 24-h urinary protein had significantly decreased from baseline in both wild and polymorphic genotype groups (p < 0.001). No significant differences were seen between the wild and polymorphic genotype groups with regard to changes in 24-h urinary protein levels, remission at 3 and 6 months or myelotoxicity. Conclusion CYC aggressive therapy had similar efficacy and caused no significant differences in myelotoxicity in wild GSTP1 (I/I) and polymorphic GSTP1 (I/V or V/V) genotypes in patients treated according to YSH guidelines for SLE patients with renal involvement.

Omadacycline in community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections: a profile of its use Abstract Omadacycline (Nuzyra™) is an orally bioavailable, first-in-class, semisynthetic aminomethylcycline antibacterial. A derivative of minocycline, omadacycline has a novel structure that overcomes common mechanisms of tetracycline resistance. In vitro, omadacycline had broad-spectrum activity against Gram-positive, Gram-negative, and atypical bacteria that can cause community-acquired bacterial pneumonia (CABP), and acute bacterial skin and skin structure infections (ABSSSI). In clinical trials, omadacycline was noninferior to moxifloxacin and linezolid in terms of early clinical response rates in patients with CABP and ABSSSI, respectively. Omadacycline was generally well tolerated, with most treatment-emergent adverse events being mild to moderate in severity.

High-dose hydroxocobalamin in end-stage liver disease and liver transplantation Abstract Distributive shock is a serious complication in patients with chronic or end-stage liver disease, and can be exacerbated by vasoplegia in this patient population. Vasoplegic syndrome (VS) is a state of shock refractory to catecholamines and vasopressin that is often multifactorial in liver failure patients, and can occur in any phase of liver transplantation (LT) [i.e., pre-transplantation, intraoperative, and post-transplantation]. Methylene blue (MB) has been a well-established pharmacologic therapy for VS. However, it has been known to cause dose-related toxicity. Hydroxocobalamin (HXC) is not currently FDA approved for the management of VS, but studies have demonstrated its ability to cause an increase in systolic blood pressure by hypothesized mechanisms with only minimal side effects. To date, only three other reports have demonstrated the use of HXC in LT patients, which highlighted its use both intraoperatively and post-transplantation. Our report illustrates the utility of HXC in four LT patients with VS. Two of these cases illustrate the usefulness of HXC in the pre-transplantation period, which has never been previously reported. HXC is a useful pharmaceutical agent in the management of VS, especially if contraindications to MB exist or in cases of MB-resistant vasoplegia. Further studies with large sample sizes are necessary to ascertain the optimal dosage of HXC in LT patients.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com