Paroxetine level in breast milk.
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Biomedical subjects
Publications and source records attributed to O Spigset.
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Choosing the "right" trade name for a drug is important for the manufacturer, both because the name identifies the product and because it can create an image which helps the marketing and thus increases the sale of the drug. A name registered as a trade mark is the company's property and cannot be used by others. Choosing a good name from scratch is not easy, but several ground rules exist: Get as close as possible to the non-proprietary (generic) name, the name of the company, the properties of the drug, or a combination of these. Try to have the first letter of the name near the beginning (or the end) of the alphabet. Keep the name short and avoid names that could be difficult to pronounce or may have a bizarre meaning in other languages. In this article, examples of "good" and "bad" drug names are presented. Various aspects of the non-proprietary and chemical names of drugs are also discussed, as well as the risk of confusing different drugs that have names that look alike or sound alike.
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OBJECTIVES: Although fluvoxamine inhibits the biotransformation of drugs known to be metabolized by CYP1A2, there are no data available with regard to the importance of CYP1A2 for the metabolism of fluvoxamine itself. Because smoking induces the metabolism of drugs catalyzed by CYP1A2, this study investigated the pharmacokinetics of fluvoxamine in smokers and nonsmokers. METHODS: The serum concentration of fluvoxamine was determined by high-performance liquid chromatography for 48 hours after oral administration of a single dose of 50 mg fluvoxamine to 12 smokers (> or = 10 cigarettes per day) and 12 nonsmokers. RESULTS: The smokers had significantly lower areas under the serum concentration-time curve and significantly lower maximal serum concentrations than the nonsmokers (mean +/- SD, 771 +/- 346 versus 1110 +/- 511 nmol.hr.L-1 [p = 0.012] and 39.1 +/- 17.3 versus 57.7 +/- 21.5 nmol.L-1 [p = 0.012], respectively). The terminal elimination half-life did not differ significantly between smokers and nonsmokers (10.1 +/- 1.9 and 10.7 +/- 2.3 hours, respectively). The oral clearance was high among both smokers (4.1 +/- 1.9 L.min-1) and nonsmokers (3.3 +/- 2.7 L.min-1; difference not significant). CONCLUSION: Smokers had lower serum concentrations of fluvoxamine than nonsmokers after a single oral dose of fluvoxamine. This finding is consistent with a possible role of CYP1A2 in fluvoxamine metabolism.
The use of psychotropic drugs has been associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a number of case reports. SIADH is characterised by the sustained release of antidiuretic hormone (ADH) from the posterior pituitary. The patients have a reduced ability to excrete diluted urine, ingested fluid is retained, and the extracellular fluid expands and becomes hypo-osmolar. The cardinal signs are hyponatraemia, serum hypoosmolality and a less than maximally diluted urine. Common symptoms include weakness, lethargy, headache, anorexia and weight gain. These symptoms may be followed by confusion, convulsions, coma and death. The early symptoms are vague and nonspecific, and they may even mimic the symptoms of the psychiatric disorder itself. For antidepressants, the risk of SIADH seems to be highest during the first weeks of treatment. For antipsychotics, the risk seems to be more spread out in time. The causative role of the drug may sometimes be difficult to estimate, as even drug-free psychiatric patients, mostly those with schizophrenia, develop SIADH on the basis of psychogenic polydipsia. Smoking is another factor associated with the development of SIADH, and the risk may also increase with age. The acute treatment of SIADH induced by a psychotropic drug includes discontinuation of the drug as well as restriction of fluid intake. In cases with significant clinical symptoms, infusion of sodium chloride is recommended. After the acute management, it is useful to evaluate the causative role of the drug by performing a water loading test and/or drug rechallenge. If continued treatment with an antidepressant or antipsychotic is indicated, a drug with a different pharmacological profile should be chosen, and the serum sodium levels should be monitored closely. If treatment with the drug that caused SIADH must be continued, concomitant treatment with demeclocycline may reduce the tendency of hyponatraemia.
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Coenzyme Q10 is an endogenous substance which has a well established role as electron carrier in the mitochondrial synthesis of adenosine triphosphate (ATP). In addition, coenzyme Q10 also has antioxidant and membrane stabilizing properties. Based on biopsy samples from patients undergoing cardiac surgery and blood samples from patients with congestive heart failure, the existence of a relative Q10 deficiency in patients with cardiac failure has been suggested. A total number of eight double blind, placebo controlled studies in patients with heart failure have been published. Most of these studies include a small number of patients, and various methodological problems have been attributed to these. The results, judged as improvement in ejection fraction or work capacity, are inconsistent. In one large study, coenzyme Q10 was found to have a positive effect on morbidity, and in another on quality of life. However, although some of the results appear to be promising, more studies are needed, including studies designed with mortality as a primary end point, before the effect of the substance in patients with heart failure can be established.
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This review is an update on anesthetic agents and their excretion into breast milk; it presents the reported effects on suckling infants, and discusses the precautions which should be considered. For most anaesthetic agents, there is very sparse information about breast milk excretion and even less published knowledge about the possible effects on the suckling infant. Generally, when an anaesthetic agent is given on a single-dose basis, there is no evidence that it is excreted in breast milk in clinically significant amounts, even if there are detectable concentrations of the drug in the milk. Most anaesthetics are rapidly cleared from the mother, and, consequently, it should be possible to allow suckling as soon as practically feasible after surgery. However, repeated administration of certain opiates and benzodiazepines has been reported to cause adverse effects in neonates, with premature neonates apparently being more susceptible. Thus, in long-term treatment with these drugs, the importance of uninterrupted breast feeding should be assessed against possible adverse drug effects in the neonate.
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An antinociceptive effect of calcitonin has been reported in numerous studies on both animals and humans. In the present article, we review the controlled clinical studies in which calcitonin has been used to relieve skeletal pain (cancer metastases, osteoporotic fractures) as well as extraskeletal pain (phantom limb pain, neurogenic claudication, reflex sympathetic dystrophy, migraine). To date, a positive effect of calcitonin is well documented against placebo in short-term treatment of skeletal pain. However, for long-term treatment of skeletal pain, and for the treatment of extraskeletal pain, the present documentation is insufficient. No controlled trials against conventional analgesic treatment is published. Thus, further studies are required before the place of calcitonin in pain therapy can be established.
Persons who contacted the Anorexia/Bulimia Association of Norway for information and stated that they had an eating disorder were asked to participate in this questionnaire study. The answers from the 32 women who fulfilled the DSM-III-R criteria for bulimia nervosa are presented. Usually the women's eating problems had started in the teens after a period of voluntary dieting. The mean duration of bulimia nervosa was six years. 31% had a history of anorexia nervosa. At the time of the study almost all had normal body weight, but nevertheless felt overweight. 78% practised self-induced vomiting, 22% used laxatives and 16% used diuretics to reduce weight. Depressive and anxiety symptoms were common in connection with the overeating episodes, but also more generally, which interfered with everyday life. Somatic symptoms (abdominal pain, diarrhoea, constipation, dyspepsia, headache, dry mouth and eyes, parotid gland swelling, muscular symptoms, fatigue, and oligomenorrhoea) were also common.
The past decade has seen important progress in understanding the localization, pharmacology, and function of serotonin (5-HT) receptor subtypes. At least seven subclasses have been shown to exist, and evidence is emerging to suggest further subclassification. Serotonin is involved in numerous physiological processes (e.g. feeding, sleep, pain, sexual behavior, temperature regulation) and pathophysiological ones. Serotonin reuptake blockers have been found effective in the alleviation of depression and attacks of panic, and are at varying stages of clinical evaluation in the treatment of obsessive compulsive disorder, chronic pain, and bulimia nervosa. Selective potent serotonin receptor agonists and antagonists show promise in the treatment of migraine, nausea and vomiting, schizophrenia, anxiety, hypertension, and Raynaud's disease.