Biomedical subjects
S G Bryant
Publications and source records attributed to S G Bryant.
Treatment of status epilepticus: a review.
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Neuroleptic-induced catatonia after abrupt withdrawal of amantadine during neuroleptic therapy.
Catatonic reactions to high-potency neuroleptic drugs have been described in the literature. Our patient developed neuroleptic-induced catatonia (NIC) after abrupt withdrawal of amantadine, a dopaminergic agent that has been implicated in neuroleptic malignant syndrome (NMS) on its discontinuation. This case report adds support to the hypothesis that NIC and NMS are 2 syndromes on a continuum of dopamine blockade, each of which may be treated with or uncovered by amantadine therapy.
Determinants of compliance in epileptic outpatients.
The authors have investigated reasons for medication compliance in a population of epileptic patients. The hypothesis that the health care belief model would be predictive of medication-taking behavior was validated. A pilot study was constructed which investigated the comparative responses of compliant and noncompliant epileptic outpatients to questions regarding demographic, clinical history, and attitudinal characteristics. Noncompliant patients were characterized as having a longer duration of epilepsy, more complicated dosage regimens, and more changes in medication. In addition, noncompliant patients both demonstrated more confusion over medication directions and less insight into the need for anticonvulsants and feared addiction to their medication. They had a lower level of satisfaction with their health care and were more frequently subject to the social complications of epilepsy. The authors suggest that a more holistic approach be taken when attempting to reverse noncompliant behavior.
Postmarketing surveillance of adverse drug reactions: patient self-monitoring.
BACKGROUND: This report summarizes our experience with a new approach to postmarketing drug surveillance using a pharmacy-based patient self-monitoring strategy, developed in collaboration with Eckerd Drug Company, the American Association of Retired Persons Pharmacy Service, and other pharmacies nationwide. METHODS: Patients presenting prescriptions to collaborating pharmacies for a targeted drug or a standard drug used as a control received an entry form asking them to register and then call a toll-free telephone number to report possible drug reactions. When contacted by patients, study staff conducted a standardized, computer-driven interview. Two brief mail questionnaires were also employed. RESULTS: Original validation data gathered from 1984 through 1986 indicated that the most commonly expected adverse drug reactions caused by antibiotic and tricyclic antidepressants reported by 162 self-monitoring patients closely matched those elicited from a comparable control sample of 1109 patients who were independently interviewed by our staff. Results from subsequent studies are also described. CONCLUSIONS: We believe this method has great promise for providing not only a cost-effective, complementary, early alerting mechanism for detecting adverse drug reactions, but also the additional possibility for discovering unsuspected therapeutic benefits of newly marketed drugs.
Review of bupropion.
The chemistry, pharmacokinetics, pharmacology, clinical efficacy, adverse effects, and dosage of bupropion hydrochloride, an aminoketone antidepressant, are reviewed. Bupropion is rapidly absorbed after oral administration and demonstrates a first-order absorptive phase. Bupropion has biphasic elimination with a redistribution half-life of about one hour and an elimination half-life of 11-14 hours. Bupropion is widely distributed to tissues and extensively metabolized by oxidation and reduction to at least six metabolites, some of which may be active. Bupropion does not inhibit monoamine oxidase, exerts no effect on serotonin uptake, and minimally alters the reuptake of norepinephrine at presynaptic sites. It does not appear to exert action leading to postsynaptic beta-adrenergic down-regulation, and it has minimal inhibitory effects on presynaptic dopamine uptake. Bupropion has been shown to be as effective as tricyclic antidepressants (TCAs), with particularly well-documented efficacy in depressed patients with manic-depressive illness in several controlled clinical trials. Bupropion causes fewer anticholinergic, orthostatic, and cardiac conductive side effects than TCAs. Elderly patients may be given full adult doses of bupropion, and preliminary experience with overdoses suggests that it is a relatively safe drug for patients with suicidal ideation. The usual adult daily dose of bupropion hydrochloride is 300-750 mg, depending on the severity of the depression. In all cases, bupropion should be given in three doses daily. Bupropion is an effective antidepressant with a good side-effect profile; it is a useful alternative for patients unresponsive to or intolerant of therapeutic doses of TCAs.
Antidepressant properties of trazodone.
The chemistry, pharmacokinetics, biochemistry and pharmacology, clinical trials, adverse effects, FDA-approved indications, and availability and cost of trazodone hydrochloride, a triazolopyridine antidepressant, are reviewed. Trazodone is nearly completely absorbed after oral administration; although food delays absorption and reduces peak serum concentration, total area under the plasma concentration-time curve is not altered. Trazodone has biphasic elimination, with a redistribution half-life of about one hour and an elimination half-life of 10-12 hours. Trazodone is nearly completely metabolized hepatically by hydroxylation and oxidation to metabolites that are probably inactive. Trazodone is less potent but more selective than conventional tricyclic antidepressants; at low doses, trazodone acts as a serotonin antagonist, while at high doses it acts as a serotonin agonist. Trazodone has been compared with imipramine, amitriptyline, desipramine, and placebo in controlled clinical trials and found to be an effective antidepressant. Trazodone causes significantly fewer anticholinergic side effects than does imipramine. Trazodone has few cardiovascular side effects. In patients ingesting toxic amounts of trazodone, no deaths have been reported unless other drugs were present or ingested concomitantly. The usual adult daily dose of trazodone hydrochloride is 150-400 mg given in two divided doses. Trazodone is an effective antidepressant with a low incidence of serious adverse effects. It may be particularly useful in certain depressed patients who are intolerant of anticholinergic effects of other antidepressants, have cardiac conduction disturbances, or who do not respond to treatment with tricyclic antidepressants and in whom electroshock therapy is contraindicted.
Patient drug attributions and postmarketing surveillance.
Although studies have shown that patients can distinguish probable adverse drug reactions (ADRs) from adverse clinical events (ACEs) caused by other factors, it is not known whether these attribution judgments add any independent validity to other accepted methods of identifying ADRs, such as physician assessments or epidemiologic data. Data from 2487 patients receiving fluoxetine and 815 receiving trazodone were used to see whether such information was redundant when added to standard statistical analysis directed toward detecting ADRs. Relative risk values for 14 trazodone or fluoxetine ADRs were selected because each was significantly identified by an innovative postmarketing surveillance system. In one analysis, all patient reports were used to compute relative risk; in the other, only reports attributed by patients to the study drug were included. Results indicate that taking into account patient attribution judgments results in a consistent, albeit modest, increase in the discriminatory power of this monitoring method.