Hepatitis B

Two types of hepatitis B vaccine are commercially available plasma-derived hepatitis B vaccine and yeast recombinant hepatitis B virus vaccine. The two vaccines are equally immunogenic, protective, and safe. However, in most countries the recombinant vaccine is considered the vaccine of choice. Plasma-derived hepatitis B virus vaccine Plasma-derived hepatitis B virus vaccine is prepared from the plasma of chronic HBsAg carriers, and consists of purified, inactivated 20-nm HBsAg particles...

Respiratory

Gold-induced lung toxicity is an infrequent adverse effect in patients with rheumatoid arthritis and psoriatic arthritis. There are three types interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and bronchiolitis obliterans the first is the most frequent. There have been two reports of gold-induced lung toxicity in psoriatic arthritis (16). A 54-year-old woman with psoriatic polyarthritis was treated with aurothiomalate 50 mg week. When the cumulative dose reached 250...

Can Iron Infusion Cause Arthritis To Flare Up

The possible sarcoma-inducing potential of intramuscular iron was fully discussed 15 years ago (SED-9, 375) (33) and no new information on the topic has come to light. The conclusion at that time was that the evidance linking intramuscular iron to sarcomatous change was scanty. Saccharated ferric oxide, an intravenous formulation of iron that is used when oral iron is not effective in anemia, can cause osteomalacia during long-term use. The underlying mechanism of nephropathy leading to bone...

General Information

Penicillamine is dimethylcysteine or 2-amino-3-mercapto-3-methylbutyric acid, a sulfur-containing amino acid. It has three functional groups an alpha-amine, a carboxyl, and a sulfhydryl, which largely determine its pharmacological effects. Because the levorotatory isomer, l-penicillamine, is a pyridoxine antagonist and toxic, the racemic mixture has been replaced for medicinal purposes by purified d-penicil-lamine. Here penicillamine refers to the d-isomer unless otherwise specified....

References

Molecular therapeutics. Methotrexate and its mechanism of action. Arthritis Rheum 1996 39(12) 1951-60. 2. Alarcon GS, Tracy IC, Strand GM, Singh K, Macaluso M. Survival and drug discontinuation analyses in a large cohort of methotrexate treated rheumatoid arthritis patients. Ann Rheum Dis 1995 54(9) 708-12. 3. Bologna C, Viu P, Picot MC, Jorgensen C, Sany J. Long-term follow-up of 453 rheumatoid arthritis patients treated with methotrexate an open, retrospective, observational...

Organs and Systems Cardiovascular

Compared with azathioprine, hypertension has been considered one of the main long-term risks in patients taking ciclosporin, with major concerns about the post-transplantion increase in cardiovascular morbidity and mortality. However, there are many susceptibility factors for cardiovascular disease in transplant patients (6), and it is difficult to take into account their complex interplay. Ciclosporin-associated hypertension appears to be dose-related, and higher whole-blood ciclosporin...

Drug Administration Drug additives

Thiomersal (see the monograph on Mercury and mercurial salts) has been used as an additive to biologics and vaccinessince the 1930s because it is very effective in killing bacteria used in several vaccines and in preventing bacterial contamination, particularly in opened multidose containers. Some but not all vaccines contain thiomersal. Billions of children and adults have been immunized worldwide and there is no scientific data that thiomer-sal-containing products have caused problems of...

Prostaglandins in liver disease

Liver failure and transplant dysfunction Prostaglandins of the E series (both intravenous and oral formulations) have been used to treat fulminant hepatic failure, primary non-function following orthotopic liver transplantation, and recurrent hepatitis B infection after orthotopic liver transplantation in open trials (48-50). Adverse effects are almost universal. They include gastrointestinal symptoms (abdominal pain and cramping, watery diarrhea), which affect SS-100 and are more common with...

Drug studies

The postoperative analgesic effects of intravenous keta-mine 10 mg and oxycodone 2 mg have been compared in a randomized, double-blind study in 40 tonsillectomized men (1). There were no significant differences between the two analgesics. The patients found ketamine more acceptable than oxycodone. Oxycodone was associated with more skin problems, especially pruritus. Oxycodone also caused a significantly lower respiratory rate with lower oxygen saturation throughout the recovery period and...

Drug Administration Drug overdose

In a retrospective review of 243 patients who had taken an overdose of metamizole, median age 17 years (range 4 months to 83 years), median amount 5 g (250 mg to 45 g), and median time to consultation 2 hours (5 minutes to 48 hours), there were toxic effects in 39 (16 ) 57 of these were gastrointestinal and all were mild (14). The time to consultation was longer in the symptomatic patients (4 versus 1.5 hours) and in children (8 versus 3.5 hours in adults). There were no cases of...

Musculoskeletal

Acute arthritis arthralgia due to rubella vaccine occurs more often and tends to be more severe in susceptible women than in children, usually involving the small peripheral joints. Joint symptoms generally begin 3-25 days after immunization, persist for 1-11 days and rarely recur. Incidence rates are estimated to average 13-25 (118) among adult women after RA 27 3 immunization with much lower rates among children, adolescents, and adult men. The incidence of acute joint symptoms increases with...

Gastrointestinal

Prostaglandins have a protective effect on the gastrointestinal mucosa. All NSAIDs that non-selectively inhibit prostaglandin synthesis cause gastrointestinal mucosal damage. Direct NSAID-mediated acid damage has been identified as a mechanism of gastrointestinal toxicity (56). Several in vitro and animal studies have provided evidence of early vascular changes and have highlighted the role of leukocyte adhesion to the endothelium in NSAID-induced gastropathy. The pathogenesis of...

Immunologic

The questions of whether early childhood immunization affects the development of atopy and whether it causes allergic reactions have been reviewed (81). The authors concluded that immunization programs do not explain the increasing incidence of allergic diseases, but that individual children may uncommonly develop an allergic reaction to a vaccine. Non-sterile injection equipment can transmit HIV and other infectious agents, including hepatitis viruses. There is also a possibility of needle...

Tripterygium wilfordii

Extracts from the root of Tripterygium wilfordii (Lei gong teng) are used in China for the treatment of various disorders, such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and glomerulonephritis. The potential benefits in such serious diseases should be carefully weighed against a substantial risk of adverse reactions, including gastrointestinal disturbances, skin rashes, amenorrhea, leukopenia, and thrombocytopenia (35). A previously healthy young man...

Use in healthy volunteers

The G-CSF is sometimes used in healthy volunteers to mobilize blood progenitor cells or granulocytes before infusion into neutropenic patients (11). The safety of filgrastim in healthy donors has been evaluated in a large prospective multicenter study (12). The interim results, obtained from the first 150 enrolled donors aged 18-64 years who received either 10 or 16 micrograms kg day, have shown that 99 patients had at least one adverse effect graded as mild (grade I) in 35 of cases, moderate...

Romazarit

See also Non-steroidal anti-inflammatory drugs General Information Romazarit, a slow-acting drug for use in rheumatoid arthritis, was well tolerated in pharmacokinetic studies. It is structurally similar to clobuzarit, which was withdrawn because of four possible cases of StevensJohnson syndrome (SEDA-17,114). In a double-blind placebo-controlled study in 224 patients with rheumatoid arthritis romazarit 200 mg or 450 mg bd for up to 24 weeks reduced the rate of progress of the disease. Adverse...

Podophyllum emodi Indian podophyllum

Proresid (mitopodozide), a mixture of more than 20 derivatives of Podophyllum emodi, has been used for many years in some countries as a disease-modifying agent in rheumatoid arthritis. A microtubulin antagonist, it is comparable with colchicine and griseofulvin. Its use has been limited because treatment is often complicated by severe diarrhea, abdominal pain, nausea, and vomiting. Leukopenia and thrombocytopenia have been reported (3,4). Etoposide and teniposide are semisynthetic derivatives...

Nervous system

The use of deferoxamine to reduce aluminium overload in hemodialysis patients can exacerbate aluminium encephalopathy and precipitate dialysis dementia (3034). Confusion, disorientation, agitation, aggression, abnormal behavior, speech arrest, myoclonus, hallucinations, and seizures can occur. Some patients are very sensitive to this effect, and a test dose of deferoxamine is advisable in order to ascertain whether aluminium is excessively mobilized (35). Deferoxamine can modify the...

Parenteral iron

Like oral iron, parenteral iron is used too widely. When iron is truly needed, oral administration is generally preferable (9). Intractable gastrointestinal intolerance to oral formulations, hyperemesis in pregnancy, very severe blood loss, and possibly ulcerative colitis are some of the few valid indications for parenteral iron. A low iron-binding capacity (for example due to prior saturating iron therapy or malnutrition), folic acid deficiency, and an allergic constitution predispose the...

Methotrexate

Methotrexate is an antagonist of folic acid and is used for treating neoplastic diseases and non-neoplastic diseases such as rheumatoid arthritis and psoriasis. As methotrexate reduces the activity of dihydrofolate reductase, supplementation with folic acid and especially with folinic acid could reduce the beneficial effects of methotrexate. This assumption has been supported by the results of an intervention study (40). Patients with rheumatoid arthritis treated with methotrexate (15 g week)...

Shark products

Shark cartilage powder, prepared from cartilage from the fins of hammerhead sharks (Sphyrna lewini) or spiny dogfish (Squalus acanthias), is promoted as a treatment for arthritis and cancer (43), based on antiangiogenic properties, but crude extracts are ineffective (44), presumably because the active constituents, such as sphyrnastatins are not absorbed. A 38-year-old white man worked in a factory that ground shark cartilage (45). After 10 months of exposure, he reported chest symptoms at work...

Therapeutic uses of BCG

In addition to its use in preventing tuberculosis, BCG has been used as an immunostimulant or immunomodulator. The degree of safety of this procedure differs with the technique and the purpose for which it is used. In most areas, the use of BCG to counter cancer has proved disappointing, although it is still used to some extent, generally as an adjunct to other forms of treatment (1-7). More encouraging is the use of intravesical instillation of BCG for recurrent superficial transitional cell...

See also Individual agents General Information

Non-steroidal anti-inflammatory drugs (NSAIDs) form a heterogeneous group of organic acids (Table 1) that have analgesic, antipyretic, anti-inflammatory, and platelet inhibitory actions. Antrafenine Etofenamate Floctafenine Flufenamic acid Glafenine Meclofenamate Mefenamic acid Niflumic acid Talinflumate Tolfenamic acid Celecoxib Parecoxib Rofecoxib Valdecoxib More than 100 NSAIDs are marketed or at an advanced stage of development worldwide. Their use is constantly expanding and the search for...

Handphone Vivo

The effect of 13 antimicrobial agents on the elimination phase of phagocytosis in human polymorphonuclear leukocytes. In Eickenberg HU, Hahn A, Opferkuch W, editors. The Influence of Antibiotics on the Host-Parasite Relationship. Berlin Springer Verlag 1982 118-28. 2. Golub LM, Ramamurthy N, McNamara TF, Gomes B, Wolff M, Casino A, Kapoor A, Zambon J, Ciancio S, Schneir M, et al. Tetracyclines inhibit tissue collagenase activity. A new mechanism in the treatment...

Organs and Systems Nervous system

Benign intracranial hypertension pseudotumor cerebri mainly affects babies, especially during the first 3 months of life. Occasionally even older children can be affected, especially when inordinately high doses are used 5 . Very rarely, it occurs in adults with renal insufficiency. In infancy, impaired nalidixic acid elimination due to underdeveloped glucuronidation , overdosage, or prolonged treatment may be responsible. Metabolic acidosis is usually important in adults 6 . The syndrome...

Organs and Systems

Suspicions were expressed in the Mealey Publication's Drug and Medical Device Report that the Lyme disease vaccine LYMErix could cause an incurable form of autoimmune arthritis. It was hypothesized that blood concentrations of OspA after three doses of vaccine place vaccinees classified by genetic type HLA-DR4 at risk of developing treatment-resistant Lyme arthritis. The premarket trials for the vaccine were assessed by an independent advisory committee, which found no link between Lyme disease...

Immunologics For Arthritis Side Effects

Sulfa allergy refers to a specific hypersensitivity response to a group of chemicals containing a sulfonamide moiety covalently bound to a benzene ring drugs structurally similar to sulfonamides may cross-react, for example sul-fonylureas, thiazides, and furosemide 167 . Sulfa allergy is most consistent with an immune-mediated reaction with delayed onset, 7-14 days after the start of therapy, characterized by fever, rash, and eosinophilia. IgG antibodies may be present and directed against...

Second Generation Effects

Whereas the benefits of penicillamine outweigh the risk in patients with Wilson's disease and probably cysteinuria, there have been a few reports of congenital injury attributed to the use of penicillamine, notably congenital cutis hyperelastica with a fatal course in three infants. Penicillamine should be withdrawn during pregnancy in patients with rheumatoid arthritis 383-385 . It should be added, however, that in Wilson's disease it is also worth considering if it is possible to control...

Phenylbutazone

See also Non-steroidal anti-inflammatory drugs General Information Phenylbutazone was originally a solubilizing agent for ami-nopyrine and was first used to treat rheumatoid arthritis and allied disorders in 1949. Phenylbutazone and its related compounds were used worldwide until the early 1980s when, following growing concern about their safety, Ciba-Geigy published its own international assessment on phenyl-butazone Butazolidine and oxyphenbutazone Tanderil , which summarized reports on 1182...