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Kikuchi K, Tsukamoto K, Kikuchi H, Saito T, Mori F. Tizanidine-Induced Bradycardia Without Concomitant Medications: A Case Report. Cureus 2024; 16:e60581. [PMID: 38894773 PMCID: PMC11184462 DOI: 10.7759/cureus.60581] [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: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
A 37-year-old woman was admitted to our hospital due to a loss of consciousness. She had been taking 2 mg of tizanidine for two months to manage shoulder muscle pain at night. On admission, an electrocardiogram showed sinus bradycardia with a heart rate of 30 bpm and QT prolongation (QTc 495 msec). She had a temporary pacemaker inserted in the catheterization room, after which an improvement in her level of consciousness was observed. There were no apparent endocrine disorders or structural heart diseases. The administration was discontinued after admission, and 12 hours after admission, her heart rate normalized to a sinus rhythm of 70-100 bpm, and QTc improved to 431 msec. Therefore, she was diagnosed with tizanidine-induced bradycardia. Although reports of tizanidine-induced bradycardia are rare, tizanidine's central α2 agonistic effects can cause bradycardia, necessitating caution.
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Affiliation(s)
| | | | | | | | - Fumiaki Mori
- Cardiology, Yokohama Medical Center, Yokohama, JPN
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2
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Ezekekwu E, Johnson C, Karimi S, Antimisiaris D, Lorenz D. Examining the relationship between long working hours and the use of prescription sedatives among U.S. workers. Sleep Med 2023; 109:226-239. [PMID: 37478659 DOI: 10.1016/j.sleep.2023.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/11/2023] [Accepted: 06/27/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES The prevalence of long working hours has been accompanied by a corresponding rise in sleep disorders. Sedative-hypnotic agents (SHAs), have been reported as the second most commonly misused drug class in the U.S. The key objective of this study was to examine the relationship between working hours on the use of sleep aids and medications with sedative properties. METHODS The 2010-2019 Medical Expenditure Panel Survey data was utilized. SHAs and medications with sedative related properties (MSRPs) were identified. Furthermore, we employed different regression models ranging from multivariable linear regression, Tobit regression, Heckman regression, and multivariable logistic regression, to ensure consistency, robustness, and reliability of associations. RESULTS Overall, a sample of 81,518 observations of full-time workers was analyzed. Working 56hours or more per week was significantly associated (p < 0.05) with an increased odds of using SHAs and MSRPs by 13% (Adjusted Odds Ratio, aOR =1.13, 95% Confidence Interval, CI=1.01:1.26) and 9% (aOR=1.09, 95% CI=1.03:1.16), respectively more than that among those who worked fewer hours. Females in our study had a higher likelihood (aOR=1.11, 95% CI=1.05:1.19) of using SHAs when compared to males. Also, professional services had the highest likelihood (aOR=1.31, 95% CI=1.14:1.50) of using SHAs. CONCLUSION We found that long working hours were significantly associated with an elevated use of SHAs and MSRPs among U.S. workers. Specifically, female workers and individuals working in professional services had the highest likelihood of using sleep medications.
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Affiliation(s)
- Emmanuel Ezekekwu
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Christopher Johnson
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Seyed Karimi
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Demetra Antimisiaris
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray Street, Louisville, KY 40202, USA.
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Ahn HJ, Jeong WJ, Kim KJ, Kim SC, Kim DW, Chang HJ, Kang CS, Oh SK, Cho SU, Min JH, Cho YC, Park JS, Ryu S, You YH, Lee JW, Kim MS. Serial plasma and urine measurements of a patient with acute intoxication of zolpidem and flunitrazepam resulting in QT prolongation and ventricular tachycardia. Clin Toxicol (Phila) 2020; 58:501-503. [DOI: 10.1080/15563650.2019.1663206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kwan Jae Kim
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sun Cheun Kim
- Forensic Toxicology Division, Daejeon Institute, National Forensic Service, Daejeon, South Korea
| | - Dong Woo Kim
- Forensic Toxicology Division, Daejeon Institute, National Forensic Service, Daejeon, South Korea
| | - Hye Jin Chang
- Forensic Toxicology Division, Daejeon Institute, National Forensic Service, Daejeon, South Korea
| | - Chang Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jing Woong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Min Su Kim
- Department of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
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Woo J, Lee CJ. Sleep-enhancing Effects of Phytoncide Via Behavioral, Electrophysiological, and Molecular Modeling Approaches. Exp Neurobiol 2020; 29:120-129. [PMID: 32408402 PMCID: PMC7237266 DOI: 10.5607/en20013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022] Open
Abstract
Sleep is indispensable for living animals to live and maintain a normal life. Due to the growing number of people suffering from sleep disorders such as insomnia, there have been increasing interests in environmentally friendly therapeutic approaches for sleep disorders to avoid any side effects of pharmacological treatment using synthetic hypnotics. It has been widely accepted that the various beneficial effects of forest, such as relieving stress and anxiety and enhancing immune system function, are caused by plant-derived products, also known as phytoncide. Recently, it has been reported that the sleep-enhancing effects of phytoncide are derived from pine trees such as (-)-α-pinene and 3-carene. These are the major constituents of pine tree that potentiate the inhibitory synaptic responses by acting as a positive modulator for GABAA-BZD receptor. In this review, we discuss the effects of phytoncide on sleep and review the latest approaches of sleep-related behavioral assay, electrophysiological recording, and molecular modeling technique.
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Affiliation(s)
- Junsung Woo
- Center for Cell and Gene Th erapy, Baylor College of Medicine, Houston, TX 77030, USA
| | - C Justin Lee
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon 34126, Korea
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Groot JAN, Ten Bokum L, van den Oever HLA. Late presentation of Torsades de Pointes related to fluoxetine following a multiple drug overdose. J Intensive Care 2018; 6:59. [PMID: 30214811 PMCID: PMC6131849 DOI: 10.1186/s40560-018-0329-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023] Open
Abstract
Background Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used in the treatment of depression. While most intoxications with SSRI’s have favorable outcomes and do not require interventions other than strict observation of vital signs and heart rhythm, clinicians should be aware of the life-threatening complications that may occur. Case presentation A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l. Conclusion Most intoxications with selective serotonin reuptake inhibitors (SSRI) have favorable outcomes and do not require medical interventions other than strict cardiopulmonary observation. However, higher doses have been associated with QTc interval prolongation, TdP, serotonin syndrome, and death. This case illustrates that life-threatening complications may occur late in the course of hospital admission. Even though overdoses with SSRI’s generally result in few fatalities, clinicians should be aware of the life-threatening clinical manifestations that may occur. Despite being an imperfect predictor of imminent TdP, continuous monitoring of cardiac rhythm is strongly recommended when either cardiac or non-cardiac symptoms are present.
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Affiliation(s)
| | - Leonore Ten Bokum
- 2Department of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, Deventer, 7416 SE The Netherlands
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Kim YH, Kim HB, Kim DH, Kim JY, Shin HY. Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies. Korean J Intern Med 2018; 33:727-736. [PMID: 28844123 PMCID: PMC6030407 DOI: 10.3904/kjim.2016.282] [Citation(s) in RCA: 7] [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] [Received: 08/31/2016] [Accepted: 02/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Some observational epidemiologic studies have reported conflicting results on the relationship between hypnotics use and the risk of developing and/or dying from heart disease. We investigated these associations using a meta-analysis of available literatures. METHODS We searched the databases PubMed and EMBASE, along with the bibliographies of relevant articles to find additional publications in February 2016. RESULTS Of 495 articles satisfying our initial criteria, two case-control studies and six cohort studies met our inclusion criteria and were included in the final analyses. Compared with never having used any kind of hypnotics, the odds ratio for overall use was 0.84 for risk of or mortality from heart disease (95% confidence interval, 0.79 to 0.89) in a random-effects meta-analysis of all eight studies. With respect to the geographical region, use of hypnotics was associated with a decreased risk or mortality of heart disease in Asia but not in Western countries. Among various types of sleep medications, zolpidem showed a decreased risk (-29%) of developing or dying from heart disease, but benzodiazepines were related with an increased risk (80%) of or mortality from heart disease. CONCLUSIONS The current meta-analysis of observational epidemiological studies suggested an evidence of association between hypnotics use and a decreased risk of heart disease.
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Affiliation(s)
- Young-Hyo Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Hong-Bae Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
- Department of Family Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea
- Correspondence to Hong-Bae Kim, M.D. Department of Family Medicine, Myongji Hospital, 55 Hwasu-ro 14beon-gil, Deokyang-gu, Goyang 10475, Korea Tel: +82-31-810-5420 Fax: +82-31-969-0500 E-mail:
| | - Do-Hyoung Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Ja-Young Kim
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
- Department of Family Medicine, Yonsei University Graduate School of Medicine, Seoul, Korea
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JoonWoo Han, Young-Jin Ko, Byung-Joo Park, Seonji Kim. Signal Detection of Adverse Drug Reaction of Zolpidem Using the Korea Adverse Event Reporting System Database. ACTA ACUST UNITED AC 2018. [DOI: 10.34161/johta.2018.6.1.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Beauchamp P, Moritz W, Kelm JM, Ullrich ND, Agarkova I, Anson BD, Suter TM, Zuppinger C. Development and Characterization of a Scaffold-Free 3D Spheroid Model of Induced Pluripotent Stem Cell-Derived Human Cardiomyocytes. Tissue Eng Part C Methods 2015; 21:852-61. [PMID: 25654582 DOI: 10.1089/ten.tec.2014.0376] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiomyocytes (CMs) are terminally differentiated cells in the adult heart, and ischemia and cardiotoxic compounds can lead to cell death and irreversible decline of cardiac function. As testing platforms, isolated organs and primary cells from rodents have been the standard in research and toxicology, but there is a need for better models that more faithfully recapitulate native human biology. Hence, a new in vitro model comprising the advantages of 3D cell culture and the availability of induced pluripotent stem cells (iPSCs) of human origin was developed and characterized. Human CMs derived from iPSCs were studied in standard 2D culture and as cardiac microtissues (MTs) formed in hanging drops. Two-dimensional cultures were examined using immunofluorescence microscopy and western blotting, while the cardiac MTs were subjected to immunofluorescence, contractility, and pharmacological investigations. iPSC-derived CMs in 2D culture showed well-formed myofibrils, cell-cell contacts positive for connexin-43, and other typical cardiac proteins. The cells reacted to prohypertrophic growth factors with a substantial increase in myofibrils and sarcomeric proteins. In hanging drop cultures, iPSC-derived CMs formed spheroidal MTs within 4 days, showing a homogeneous tissue structure with well-developed myofibrils extending throughout the whole spheroid without a necrotic core. MTs showed spontaneous contractions for more than 4 weeks that were recorded by optical motion tracking, sensitive to temperature and responsive to electrical pacing. Contractile pharmacology was tested with several agents known to modulate cardiac rate and viability. Calcium transients underlay the contractile activity and were also responsive to electrical stimulation, caffeine-induced Ca(2+) release, and extracellular calcium levels. A three-dimensional culture using iPSC-derived human CMs provides an organoid human-based cellular platform that is free of necrosis and recapitulates vital cardiac functionality, thereby providing a new and promising relevant model for the evaluation and development of new therapies and detection of cardiotoxicity.
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Affiliation(s)
- Philippe Beauchamp
- 1 Department of Clinical Research, Cardiology, Bern University Hospital , Bern, Switzerland
| | | | | | - Nina D Ullrich
- 3 Department of Physiology, Bern University , Bühlplatz, Bern, Switzerland .,4 Department of Physiology and Pathophysiology, Heidelberg University , Heidelberg, Germany
| | | | - Blake D Anson
- 5 Cellular Dynamics International , Madison, Wisconsin
| | - Thomas M Suter
- 1 Department of Clinical Research, Cardiology, Bern University Hospital , Bern, Switzerland
| | - Christian Zuppinger
- 1 Department of Clinical Research, Cardiology, Bern University Hospital , Bern, Switzerland
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Abstract
Advances in the understanding and treatment of cardiac disorders have been thwarted by the inability to study beating human cardiac cells in vitro. Induced pluripotent stem cells (iPSCs) bypass this hurdle by enabling the creation of patient-specific iPSC-derived cardiomyocytes (iPSC-CMs). These cells provide a unique platform to study cardiac diseases in vitro, especially hereditary cardiac conditions. To date, iPSC-CMs have been used to successfully model arrhythmic disorders, showing excellent recapitulation of cardiac channel function and electrophysiologic features of long QT syndrome types 1, 2, 3, and 8, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Similarly, iPSC-CM models of dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) have shown robust correlation of predicted morphologic, contractile, and electrical phenotypes. In addition, iPSC-CMs have shown some features of the respective phenotypes for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), LEOPARD syndrome, Pompe's disease, and Friedriech's ataxia. In this review, we examine the progress of utilizing iPSC-CMs as a model for cardiac conditions and analyze the potential for the platform in furthering the biology and treatment of cardiac disorders.
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HERG K+ channel-dependent apoptosis and cell cycle arrest in human glioblastoma cells. PLoS One 2014; 9:e88164. [PMID: 24516604 PMCID: PMC3916397 DOI: 10.1371/journal.pone.0088164] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
Glioblastoma (GB) is associated with poor patient survival owing to uncontrolled tumor proliferation and resistance to apoptosis. Human ether-a-go-go-related gene K+ channels (hERG; Kv11.1, KCNH2) are expressed in multiple cancer cells including GB and control cell proliferation and death. We hypothesized that pharmacological targeting of hERG protein would inhibit tumor growth by inducing apoptosis of GB cells. The small molecule hERG ligand doxazosin induced concentration-dependent apoptosis of human LNT-229 (EC50 = 35 µM) and U87MG (EC50 = 29 µM) GB cells, accompanied by cell cycle arrest in the G0/G1 phase. Apoptosis was associated with 64% reduction of hERG protein. HERG suppression via siRNA-mediated knock down mimicked pro-apoptotic effects of doxazosin. Antagonism of doxazosin binding by the non-apoptotic hERG ligand terazosin resulted in rescue of protein expression and in increased survival of GB cells. At the molecular level doxazosin-dependent apoptosis was characterized by activation of pro-apoptotic factors (phospho-erythropoietin-producing human hepatocellular carcinoma receptor tyrosine kinase A2, phospho-p38 mitogen-activated protein kinase, growth arrest and DNA damage inducible gene 153, cleaved caspases 9, 7, and 3), and by inactivation of anti-apoptotic poly-ADP-ribose-polymerase, respectively. In summary, this work identifies doxazosin as small molecule compound that promotes apoptosis and exerts anti-proliferative effects in human GB cells. Suppression of hERG protein is a crucial molecular event in GB cell apoptosis. Doxazosin and future derivatives are proposed as novel options for more effective GB treatment.
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Sirenko O, Hesley J, Rusyn I, Cromwell EF. High-content assays for hepatotoxicity using induced pluripotent stem cell-derived cells. Assay Drug Dev Technol 2013; 12:43-54. [PMID: 24229356 DOI: 10.1089/adt.2013.520] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Development of predictive in vitro assays for early toxicity evaluation is extremely important for improving the drug development process and reducing drug attrition rates during clinical development. High-content imaging-based in vitro toxicity assays are emerging as efficient tools for safety and efficacy testing to improve drug development efficiency. In this report we have used an induced pluripotent stem cell (iPSC)-derived hepatocyte cell model having a primary tissue-like phenotype, unlimited availability, and the potential to compare cells from different individuals. We examined a number of assays and phenotypic markers and developed automated screening methods for assessing multiparameter readouts of general and mechanism-specific hepatotoxicity. Endpoints assessed were cell viability, nuclear shape, average and integrated cell area, mitochondrial membrane potential, phospholipid accumulation, cytoskeleton integrity, and apoptosis. We assayed compounds with known mechanisms of toxicity and also evaluated a diverse hepatotoxicity library of 240 compounds. We conclude that high-content automated screening assays using iPSC-derived hepatocytes are feasible, provide information about mechanisms of toxicity, and can facilitate the safety assessment of drugs and chemicals.
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