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Prentice D, Dharsono F, Martinet P. Pathological Laughter: The First Manifestation of Intracerebral Haemorrhage Linked to Phenylephrine Overuse. Cureus 2024; 16:e63461. [PMID: 39077269 PMCID: PMC11285287 DOI: 10.7759/cureus.63461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/31/2024] Open
Abstract
A 42-year-old woman presented to the emergency department with sudden-onset uncontrollable laughter, 'fou rire prodromique' (prodrome of crazy laughter), and left leg weakness. Imaging revealed a right cerebral haemorrhage of the premotor cortex corresponding to the leg cortical representation. A history of excess phenylephrine use for sinusitis and migraine was subsequently obtained. The patient's neurological recovery was good, enabling a return to her pre-stroke employment. The neurological causes of pathological laughter and the brain networks involved are discussed in this report. The role of sympathomimetics in the causation of cerebral haemorrhage potentially via the initiation of a reversible cerebral vasoconstriction syndrome is highlighted. The use of over-the-counter substances should be part of medication history in such cases.
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Affiliation(s)
- David Prentice
- Neurosciences, Perron Institute for Neurological and Translational Science, Nedlands, AUS
| | - Ferry Dharsono
- Neuroradiology, Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, AUS
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Idris IM, Burnett AL, DeBaun MR. Epidemiology and treatment of priapism in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:450-458. [PMID: 36485155 PMCID: PMC9820196 DOI: 10.1182/hematology.2022000380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the prepubertal period and tends to be recurrent with increasing age. Significantly, priapism is associated with an unrecognized high burden of mental duress and sexual dysfunctions. The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. Only 3 randomized clinical trials (stilbesterol, ephedrine or etilefrine, and sildenafil) have been conducted for secondary priapism prevention in SCD. All 3 trials were limited with small sample sizes, selection biases, and inconclusive results after completion. The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. We posit an increase in NO levels will restore the normal homeostatic relationship between voluntary erection and detumescence. Currently, 2 randomized phase 2 trials (1 double-blind, placebo-controlled trial and 1 open-label, single-arm intervention) are being conducted for secondary priapism prevention in men at high risk for recurrent priapism (NCT03938454 and NCT05142254). We review the epidemiology and pathobiology of priapism, along with mechanistic therapeutic approaches for secondary prevention of priapism in SCD.
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Affiliation(s)
- Ibrahim M. Idris
- Department of Haematology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | | | - Michael R. DeBaun
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, TN
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3
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He H, Sha J, Wan Y, Sun R, Jiang G, Li Y, Li T, Ren B. Solid-liquid phase equilibrium of naphazoline hydrochloride in eleven neat solvents: Determination, solvent effect, molecular simulation and thermodynamic analysis. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2020.114748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grimaldi-Bensouda L, Begaud B, Benichou J, Nordon C, Dialla O, Morisot N, Hamon Y, Cottin Y, Serrano E, Abenhaim L, Touzé E. Decongestant use and the risk of myocardial infarction and stroke: a case-crossover study. Sci Rep 2021; 11:4160. [PMID: 33603081 PMCID: PMC7893034 DOI: 10.1038/s41598-021-83718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Pharmacovigilance reports of cerebral and cardiovascular events in those who use decongestants have triggered alerts related to their use. We aimed to assess the risk of stroke and myocardial infarction (MI) associated with the use of decongestants. We conducted a nested case-crossover study of patients with incident stroke and MI identified in France between 2013 and 2016 in two systematic disease registries. Decongestant use in the three weeks preceding the event was assessed using a structured telephone interview. Conditional logistic multivariable models were used to estimate the odds of incident MI and stroke, also accounting for transient risk factors and comparing week 1 (index at-risk time window, immediately preceding the event) to week 3 (reference). Time-invariant risk factors were controlled by design. In total, 1394 patients with MI and 1403 patients with stroke, mainly 70 years old or younger, were interviewed, including 3.2% who used decongestants during the three weeks prior to the event (1.0% definite exposure in the index at-risk time window, 1.1% in the referent time window; adjusted odds ratio (aOR), 0.78; 95%CI, 0.43-1.42). Secondary analysis yielded similar results for individual events (MI/stroke). We observed no increased risk of MI or stroke for patients 70 years of age and younger without previous MI or stroke who used decongestants.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- The PGRx Study Group, Paris, France.
- Service de Pharmacologie, Hôpital Raymond Poincaré, Groupe Hospitalier Paris-Ile de France Ouest, Assistance Publique- Hôpitaux de Paris, Paris, France.
- UFR des Sciences de La Santé, Université Paris-Saclay, Paris, France.
| | - Bernard Begaud
- Département de Pharmacologie Médicale, Equipe "Pharmaco-Epidémiologie et Impact des Médicaments sur Les Populations", Bordeaux Population Health Research Center INSERM U1219, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Jacques Benichou
- Hôpital Universitaire de Rouen, Rouen, France
- INSERM U1219, Bordeaux, France
| | - Clementine Nordon
- The PGRx Study Group, Paris, France
- GHU Paris Psychiatrie Et Neurosciences, Paris, France
- Laser Core Paris, Paris, France
| | | | | | | | - Yves Cottin
- Departement de Cardiologie, Centre Hospitalo-Universitaire de Dijon, Dijon, France
| | - Elie Serrano
- ORL Et Chirurgie Cervico-Faciale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Lucien Abenhaim
- The PGRx Study Group, London, UK
- London School of Hygiene and Tropical Medicine and Laser Core UK, London, UK
| | - Emmanuel Touzé
- Normandie Université, Université Caen Normandie, CHU Caen Normandie, Inserm U1237, Caen, France
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Omar NB, Chagoya G, Elsayed GA, Litovsky SH, Hackney JR, Fisher WS. Cerebellar talcosis following posterior reversible encephalopathy syndrome in an intravenous methamphetamine abuser. Surg Neurol Int 2021; 12:2. [PMID: 33500817 PMCID: PMC7827572 DOI: 10.25259/sni_616_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Background Intravenous (IV) methamphetamine abuse is associated with a variety of short- and long-term effects on the nervous system, some of which have yet to be fully elucidated. One known systemic complication that has not been described in nervous system tissues is the deposition of substrate crystals contained in injectable drugs. Case Description An unusual case is presented of a 35-year-old active IV methamphetamine abuser with posterior reversible encephalopathy syndrome (PRES) who subsequently developed multifocal bilateral cerebellar enhancing lesions and leptomeningeal enhancement due to biopsy-proven crystalline deposits. Conclusion Although large crystalline substances will not normally penetrate the blood-brain barrier (BBB), during a state of BBB compromise such as with PRES, talc deposition may occur in the central nervous system.
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Affiliation(s)
- Nidal Bassam Omar
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Gustavo Chagoya
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Galal A Elsayed
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Silvio H Litovsky
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James R Hackney
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Winfield S Fisher
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, United States
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Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev 2018; 38:1332-1403. [PMID: 29315692 PMCID: PMC6033155 DOI: 10.1002/med.21476] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta-blockers, calcium channel blockers, female hormones, nonsteroidal anti-inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.
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Affiliation(s)
- Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Lenka Applová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Jiří Patočka
- Department of Radiology and Toxicology, Faculty of Health and Social StudiesUniversity of South BohemiaČeské BudějoviceCzech Republic
- Biomedical Research CentreUniversity HospitalHradec KraloveCzech Republic
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Fernando Remiao
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Jana Pourová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Aleš Mladěnka
- Oncogynaecologic Center, Department of Gynecology and ObstetricsUniversity HospitalOstravaCzech Republic
| | - Jana Karlíčková
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Luděk Jahodář
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Marie Vopršalová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Kurt J. Varner
- Department of PharmacologyLouisiana State University Health Sciences CenterNew OrleansLAUSA
| | - Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
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Dakay K, McTaggart RA, Jayaraman MV, Yaghi S, Wendell LC. Reversible cerebral vasoconstriction syndrome presenting as an isolated primary intraventricular hemorrhage. Chin Neurosurg J 2018; 4:11. [PMID: 32922872 PMCID: PMC7398312 DOI: 10.1186/s41016-018-0118-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background Primary intraventricular hemorrhage is an uncommon cause of stroke and is often associated with longstanding, uncontrolled hypertension. Reversible cerebral vasoconstriction is also an uncommon condition characterized by reversible constriction of intracerebral vessels, which can lead to ischemic or hemorrhagic strokes. Case presentation We describe a case of isolated primary intraventricular hemorrhage secondary to reversible cerebral vasoconstriction syndrome triggered by pseudoephedrine. Conclusions Reversible cerebral vasoconstriction syndrome is a rare cause of primary intraventricular hemorrhage and should be considered in the differential in angiography-negative IVH when there is a history of vasoactive substance use.
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Affiliation(s)
- Katarina Dakay
- Department of Neurology, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Ryan A McTaggart
- Departments of Radiology, Neurology, and Neurosurgery, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Mahesh V Jayaraman
- Departments of Radiology, Neurology, and Neurosurgery, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Linda C Wendell
- Department of Neurology, Neurosurgery and Medical Education, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, 593 Eddy St APC 712, Providence, RI 02903 USA
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Streijger F, So K, Manouchehri N, Gheorghe A, Okon EB, Chan RM, Ng B, Shortt K, Sekhon MS, Griesdale DE, Kwon BK. A Direct Comparison between Norepinephrine and Phenylephrine for Augmenting Spinal Cord Perfusion in a Porcine Model of Spinal Cord Injury. J Neurotrauma 2018; 35:1345-1357. [PMID: 29338544 DOI: 10.1089/neu.2017.5285] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current clinical guidelines recommend elevating the mean arterial blood pressure (MAP) to increase spinal cord perfusion in patients with acute spinal cord injury (SCI). This is typically achieved with vasopressors such as norepinephrine (NE) and phenylephrine (PE). These drugs differ in their pharmacological properties and potentially have different effects on spinal cord blood flow (SCBF), oxygenation (PO2), and downstream metabolism after injury. Using a porcine model of thoracic SCI, we evaluated how these vasopressors influenced intraparenchymal SCBF, PO2, hydrostatic pressure, and metabolism within the spinal cord adjacent to the injury site. Yorkshire pigs underwent a contusion/compression SCI at T10 and were randomized to receive either NE or PE for MAP elevation of 20 mm Hg, or no MAP augmentation. Prior to injury, a combined SCBF/PO2 sensor, a pressure sensor, and a microdialysis probe were inserted into the spinal cord adjacent to T10 at two locations: a "proximal" site and a "distal" site, 2 mm and 22 mm from the SCI, respectively. At the proximal site, NE and PE resulted in little improvement in SCBF during cord compression. Following decompression, NE resulted in increased SCBF and PO2, whereas decreased levels were observed for PE. However, both NE and PE were associated with a gradual decrease in the lactate to pyruvate (L/P) ratio after decompression. PE was associated with greater hemorrhage through the injury site than that in control animals. Combined, our results suggest that NE promotes better restoration of blood flow and oxygenation than PE in the traumatically injured spinal cord, thus providing a physiological rationale for selecting NE over PE in the hemodynamic management of acute SCI.
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Affiliation(s)
- Femke Streijger
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Kitty So
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Neda Manouchehri
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Ana Gheorghe
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Elena B Okon
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Ryan M Chan
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Benjamin Ng
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Katelyn Shortt
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Mypinder S Sekhon
- 2 Vancouver General Hospital, Division of Critical Care Medicine, Department of Medicine, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Donald E Griesdale
- 3 Department of Anesthesiology, University of British Columbia (UBC) , Vancouver, British Columbia, Canada
| | - Brian K Kwon
- 1 International Collaboration on Repair Discoveries, University of British Columbia (UBC) , Vancouver, British Columbia, Canada .,4 Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
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Kupferman JC, Zafeiriou DI, Lande MB, Kirkham FJ, Pavlakis SG. Stroke and Hypertension in Children and Adolescents. J Child Neurol 2017; 32:408-417. [PMID: 28019129 DOI: 10.1177/0883073816685240] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertension is the single most important modifiable risk factor for adult stroke. Stroke mortality has significantly decreased over the last 5 decades; this decline has been mainly associated to improved blood pressure control. Though much less prevalent than in adults, stroke is an increasingly recognized cause of morbidity and mortality in children. Although hypertension has not been strongly identified as a risk factor in childhood stroke yet, there is preliminary evidence that suggests that elevated blood pressure may be associated with stroke in children. This review summarizes the literature that may link elevated blood pressure to the development of childhood ischemic and hemorrhagic stroke. The authors suggest that elevated blood pressure may be a significant risk factor that, alone or in combination with other multiple risk factors, leads to the development of stroke in childhood. It is therefore recommend that blood pressure be measured and assessed carefully in every child presenting with acute stroke.
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Affiliation(s)
- Juan C Kupferman
- 1 Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dimitrios I Zafeiriou
- 2 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marc B Lande
- 3 Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Fenella J Kirkham
- 4 Developmental Neuroscience, UCL Institute of Child Health, London, United Kingdom
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Potential cardiovascular adverse events when phenylephrine is combined with paracetamol: simulation and narrative review. Eur J Clin Pharmacol 2015; 71:931-8. [PMID: 26022219 PMCID: PMC4500855 DOI: 10.1007/s00228-015-1876-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/20/2015] [Indexed: 11/23/2022]
Abstract
Background Increased bioavailability of phenylephrine is reported when combined with paracetamol in over-the-counter formulations for the symptomatic treatment of the common cold and influenza. Such formulations could increase phenylephrine-related cardiovascular adverse events particularly in susceptible individuals. Quantification of the effect of phenylephrine concentration on blood pressure allows simulation of potential adverse combination therapy effects. Methods MEDLINE and EMBASE databases were searched for papers discussing or describing any adverse effect, hypersensitivity or safety concerns related to phenylephrine alone or in combination with other drugs. The pharmacodynamic relationship between plasma phenylephrine concentration and mean arterial blood pressure was characterized using published observations of blood pressure changes after ophthalmic eye drops. The resulting pharmacokinetic and pharmacodynamic parameters were then used to predict mean arterial blood pressure (MAP) changes in that population if given an oral combination of phenylephrine and paracetamol. Results There were 1172 papers identified for examination. Forty-seven reports fulfilled the inclusion criteria. Increases in blood pressure and decreases in heart rate have been reported with doses over 15 mg. It has been estimated that a 20-mmHg increase in systolic blood pressure would occur with an oral dose of 45 mg phenylephrine in normotensive healthy people. Those taking monoamine oxidase inhibitors report increased systolic blood pressure of greater than 60 mmHg. Blood pressure and heart rate changes are potentiated in patients with underlying hypertension. Simulation showed a modest increase in MAP when phenylephrine 10 mg was co-administered with paracetamol 1 g (4.2 vs 12.3 mmHg). Conclusions Combination paracetamol phenylephrine oral therapy has potential to increase blood pressure more than phenylephrine alone in those with cardiovascular compromise. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1876-1) contains supplementary material, which is available to authorized users.
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Liguori C, Garaci F, Romigi A, Mercuri NB, Marciani MG, Placidi F. Bilateral thalamic stroke due to nasal ephedrine and naphazoline use. Neurol Sci 2014; 36:1285-6. [PMID: 25527367 DOI: 10.1007/s10072-014-2030-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/04/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Claudio Liguori
- Neurophysiopathology Unit, Department of Systems Medicine, Sleep Medicine Centre, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy,
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