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An P, Liu X, Zhang B. Safety profile of clobazam in the real world: an analysis of FAERS database and systematic review of case reports. Expert Opin Drug Saf 2024; 23:119-128. [PMID: 37070461 DOI: 10.1080/14740338.2023.2204227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Most of the safety data of clobazam came from well-designed clinical trials, while the real-world information is insufficient. RESEARCH DESIGN AND METHODS We performed a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database through OpenVigil 2 and conducted a systematic review of case reports regarding adverse drug reactions (ADR) linked to clobazam. RESULTS The analysis of FAERS identified 595 ADR signals. Nervous system disorders cantains the most positive signals among all system organ classes (SOCs). Except for seizure (n = 1696) and somnolence (n = 813), drug interactions (n = 492) were the most frequently reported positive signals. A total of 502 unique citations were initially retrieved and 31 individual cases from 28 publications were included. Skin reactions were the most reactions (n = 9), containing three types of severe reactions not alerted in the instruction. Five cases were caused by interactions between clobazam and other antiepileptic drugs, etravirine-based antiretroviral therapy, omeprazole, or meropenem. One patient died of aspiration pneumonia. CONCLUSIONS Clinicians must pay attention to severe skin reactions and monitor the signs of suspicious respiratory infections/inflammations and central sedation. Patients with skin reactions will benefit from the withdrawal of clobazam and the treatment with glucocorticoids. The drug reactions between clobazam with severe or moderate cytochrome P450 (CYP) 3A4 or CYP2C19 inhibitors or other antiepileptic drugs should also be alerted.
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Affiliation(s)
- Pengjiao An
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xin Liu
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants. Biomedicines 2023; 11:biomedicines11030940. [PMID: 36979919 PMCID: PMC10046592 DOI: 10.3390/biomedicines11030940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/22/2023] Open
Abstract
Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.
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Li X, Lai F, Jiang Z, Li M, Chen Z, Cheng J, Cui H, Wen F. Effects of inflammation on voriconazole levels: a systematic review. Br J Clin Pharmacol 2022; 88:5166-5182. [PMID: 35973037 DOI: 10.1111/bcp.15495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS This study aimed to review the studies evaluating the effect of the inflammatory state on voriconazole (VRZ) levels. METHODS The study included randomized clinical trials, cohort studies, and case-control studies that focused on the influence of the inflammatory state on VRZ levels. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, relevant articles published until 2021 were searched in several databases, including PubMed, Embase, Web of Science, and the Cochrane Library. RESULTS Twenty studies were included in this review, of which 15 described adult populations, 3 described pediatric populations, and 2 included both adult and pediatric populations. Seventeen studies used C-reactive protein (CRP) as an indicator of inflammation, 6 described a dose-response relationship for the effect of inflammation represented by CRP on VRZ concentrations, and 4 examined the effect of CRP on the metabolic rate of VRZ. CONCLUSIONS Our findings showed that the level of inflammation can significantly affect VRZ levels. However, the effect of inflammation on VRZ concentrations in children is controversial and must be analyzed along with age. Clinicians dosing VRZ should take into account the patient's inflammatory state. The impact of inflammation on genotype-based dosing decisions requires further study to explain the high pharmacokinetic variability of VRZ.
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Affiliation(s)
- Xuejuan Li
- Shenzhen Children's Hospital of China Medical University, Shenzhen, China.,Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Fangyuan Lai
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhaohui Jiang
- Department of Oncology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Meng Li
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Zebin Chen
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Junjie Cheng
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Hao Cui
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Feiqiu Wen
- Shenzhen Children's Hospital of China Medical University, Shenzhen, China
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C/MIC > 4: A Potential Instrument to Predict the Efficacy of Meropenem. Antibiotics (Basel) 2022; 11:antibiotics11050670. [PMID: 35625314 PMCID: PMC9137711 DOI: 10.3390/antibiotics11050670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/01/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
This prospective study aimed to explore the determinants of meropenem trough concentration (Ctrough) in patients with bacterial pneumonia and to investigate the association between its concentration and efficacy. From January 2019 to December 2019, patients with pulmonary infections were prospectively enrolled from the intensive care unit. Factors affecting the meropenem trough concentration were analyzed, and a multiple linear regression model was constructed. Logistic regression analyses were used to investigate the relationship between Ctrough and clinical efficacy. A total of 64 patients were enrolled, in whom 210 meropenem concentrations were measured. Of the total, 60.9% (39/64) were considered clinically successful after treatment. Ctrough may increase with increased blood urea nitrogen, albumin, and concomitant antifungal use. By contrast, concentration may decrease with increased endogenous creatinine clearance rate. Six variables, including Ctrough/minimum inhibitory concentration (MIC) > 4, were associated with the efficacy of meropenem. There was an independent correlation between Ctrough/MIC > 4 and efficacy after fully adjusting for confounding factors. Based upon renal function indexes, it is possible to predict changes in meropenem concentration and adjust the dosage precisely and individually. Ctrough/MIC > 4 is a potential instrument to predict successful treatment with meropenem.
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Luo X, Li T, Hu L, Liu S, Zhao H, Zhang J, Feng Y, Huang L. Differential effects of C-reactive protein levels on voriconazole metabolism at three age groups in allogeneic hematopoietic cell transplant recipients. J Chemother 2020; 33:95-105. [PMID: 32441568 DOI: 10.1080/1120009x.2020.1765604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate the impact of inflammation on voriconazole (VRCZ) metabolism at three age groups in the allogeneic hematopoietic cell transplant recipients of the Chinese population. The study was performed with collecting more than one VRCZ trough concentration and C-reactive protein (CRP) levels. Longitudinal analysis, correlation and comparative analysis were conducted to evaluate. A total of 104 patients with 386 VRCZ trough concentration and CRP level measured on the same day were collected. For children, CRP levels significantly associated with VRCZ pharmacokinetics in age 11-18 years but not in age 2-10 years. For adults, VRCZ concentrations were increased slightly by 0.006 mg/L when every 1 mg/L increased in CRP levels. Additionally, meropenem and inflammation might work together to cause a higher VRCZ concentration. Therefore, therapeutic drug monitoring of VRCZ should be warranted at age >10 years in allogeneic hematopoietic cell transplant recipients with elevated CRP level.
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Affiliation(s)
- Xingxian Luo
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Taifeng Li
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Lei Hu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Silu Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Haiyan Zhao
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Jiaqi Zhang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Yufei Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Lin Huang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
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Zhou PY, Lim TP, Tang SLS, Liew Y, Chua SGN, Lim LLC, Lee HLW, Tan SX, Lai OF, Tan TT, Wong GC, Kwa LHA. The utility of voriconazole therapeutic drug monitoring in a multi-racial cohort in Southeast Asia. J Glob Antimicrob Resist 2019; 21:427-433. [PMID: 31846723 DOI: 10.1016/j.jgar.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Voriconazole serum concentration, which is affected by several factors, is associated with treatment response and toxicity. There is paucity of data on voriconazole therapeutic drug monitoring (TDM) among Southeast Asians, who exhibit a higher prevalence of CYP2C19-poor metabolisers compared with Caucasians and East Asians. Hence, there are concerns for higher risk of voriconazole accumulation and toxicity. We aim to determine the utility of voriconazole TDM through establishing: (1) proportion of patients achieving therapeutic troughs without dose adjustments; (2) characterisation of patients with sub-therapeutic, therapeutic and supra-therapeutic levels; (3) appropriate dose titrations/dose required for therapeutic troughs; (4) correlation between troughs and adverse events, treatment response/fungal breakthrough. PATIENTS AND METHODS A single-centre retrospective analysis of data from adults (≥21 years old) with ≥1 voriconazole trough measured at Singapore General Hospital from 2015 to 2017 was performed. RESULTS Thirty-two patients (45.7%) among 70 patients achieved therapeutic troughs (defined as 2.0-5.5 mg/L) without dose adjustments. Eleven patients (15.7%) experienced hepatotoxicity (troughs 0.5 to >7.5 mg/L). Neurotoxicity occurred in three patients (4.3%) (troughs ≥6.7 mg/L) and all patients had symptom resolution upon dose reduction. Treatment failure of invasive fungal infection appeared less in patients with therapeutic troughs compared with sub-therapeutic troughs (11.4% vs. 14.2%). Two patients experienced treatment failure despite supra-therapeutic voriconazole troughs. CONCLUSIONS TDM should be implemented due to significant unpredictability in dose exposure. TDM can reduce unnecessary switches to alternatives due to intolerability and rule in the possibility of resistant organisms in the event of treatment failure despite therapeutic troughs, alerting clinicians to switch to alternatives promptly.
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Affiliation(s)
- Peijun Yvonne Zhou
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Tze Peng Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Si Lin Sarah Tang
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Yixin Liew
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Li Ling Cheryl Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Si Xuan Tan
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Oi Fah Lai
- Department of Clinical Translational Research, Singapore General Hospital, Singapore, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Gee Chuan Wong
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Lay Hoon Andrea Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore; Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore; Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore.
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Li Y, Chen Y, Qi X, Hu B, Du Q, Qian Y. Poor response to rivaroxaban in nephrotic syndrome with acute deep vein thrombosis: A case report. Medicine (Baltimore) 2019; 98:e16585. [PMID: 31374026 PMCID: PMC6709193 DOI: 10.1097/md.0000000000016585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Hypercoagulability can lead to thromboembolic events that are a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants are first-line treatment in the presence of demonstrated thrombosis in NS. Direct-acting oral anticoagulants (DOACs) have provided useful alternatives for the prevention and treatment of thromboembolic events. PATIENT CONCERNS A 59-year-old male developed lower limbs deep vein thrombosis (DVT) during the early course of NS but presented poor response to oral therapeutic doses of rivaroxaban. The decision was made to switch from rivaroxaban to heparin and subsequently bridged to warfarin. The patient presented significant clinical symptom improvement. DIAGNOSIS NS with Lower limbs DVT. INTERVENTIONS Rivaroxaban was discontinued and switch to heparin and subsequently bridged to warfarin. OUTCOMES Venography result of both lower limb vein showed the venous wall was smooth without obvious stenosis or obstruction. Edema of the patient's lower limbs gradually improved and disappeared. LESSONS The existing published data on the application of DOACs in NS are limited. DOACs have an immediate anticoagulant effect and have demonstrated safety and efficacy and required no routine monitoring, however, application of these agents in NS likely requires further investigation before widespread adoption.
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Affiliation(s)
- Yan Li
- Department of Pharmacy, the Second Affiliated Hospital of Chongqing Medical University
- College of Pharmacy, Chongqing Medical University
| | - Yikuan Chen
- Department of Vascular Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaotong Qi
- Department of Vascular Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bangqin Hu
- College of Pharmacy, Chongqing Medical University
| | - Qingqing Du
- Department of Pharmacy, the Second Affiliated Hospital of Chongqing Medical University
| | - Yan Qian
- Department of Pharmacy, the Second Affiliated Hospital of Chongqing Medical University
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Mahmoudi M, Brenner T, Hatiboglu G, Burhenne J, Weiss J, Weigand MA, Haefeli WE. Reply to Truffot et al. Clin Infect Dis 2018; 66:1644-1646. [DOI: 10.1093/cid/cix1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mazyar Mahmoudi
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Germany
| | | | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - Johanna Weiss
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
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