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Baker T, Lorch U, Bagger Y, Holmqvist C, Jonker DM, Urban LE, Hale TW. No Measurable Transfer of Oxytocin-Receptor Agonist Merotocin Detected in Human Breast Milk. Breastfeed Med 2024; 19:451-458. [PMID: 38529915 DOI: 10.1089/bfm.2024.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Objective: The study aimed to assess the transfer of merotocin from systemic circulation to breast milk in early postpartum women and women with established lactation. Methods: This was a two-part, multicenter, open-label, parallel-group study. Merotocin was administered as a single 90-minute intravenous (iv) infusion mimicking the intranasal pharmacokinetic profile. In Part A, 12 early postpartum women received doses of either 4 μg (n = 6) or 16 μg (n = 6) of merotocin within 4 days of delivery. In Part B, six women with established lactation received 20 μg of merotocin. The total concentration of merotocin in plasma and breast milk and its metabolites excreted in breast milk were measured at various time points. Adverse events (AEs) were also assessed for both parts of the study. Results: In both early postpartum and established lactation groups (mean age, 26.3 years; 83.3% Caucasian), merotocin and its metabolites in breast milk were below the limit of quantification (25.0 pg/mL) at all time points. Sixteen treatment-emergent AEs occurred in early postpartum women only, including seven events of uterine spasm and three of breast engorgement. There was one moderate event, whereas all the other events were considered mild. Conclusion: Merotocin was undetectable in breast milk after single iv administration of up to 20 μg in early postpartum women and women with established lactation.
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Affiliation(s)
- Teresa Baker
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA
| | | | - Yu Bagger
- Ferring Pharmaceuticals, A/S, Copenhagen, Denmark
| | | | | | - Lorien E Urban
- Ferring Pharmaceuticals, Inc., Parsippany, New Jersey, USA
| | - Thomas W Hale
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA
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Puoti MG, Assa A, Benninga M, Broekaert IJ, Carpi FJM, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Tzivinikos C, Thomson M, Borrelli O. Drugs in Focus: Domperidone. J Pediatr Gastroenterol Nutr 2023; 77:e13-e22. [PMID: 37159421 DOI: 10.1097/mpg.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Domperidone is a peripheral dopamine-2 receptor antagonist with prokinetic and antiemetic properties. Its prokinetic effects are mainly manifest in the upper gastrointestinal (GI) tract. Currently its use is restricted to relief of nausea and vomiting in children older than 12 years for a short period of time. However, among (pediatric) gastroenterologists, domperidone is also used outside its authorized indication ("off label") for treatment of symptoms associated with gastro-esophageal reflux disease, dyspepsia, and gastroparesis. Little is known about its efficacy in the treatment of GI motility disorders in children and controversial data have emerged in the pediatric literature. As its use is off label, appropriate knowledge of its efficacy is helpful to support an "off label/on evidence" prescription. Based on this, the purpose of this review is to summarize all evidence on the efficacy of domperidone for the treatment of GI disorders in infants and children and to report an overview of its pharmacological properties and safety profile.
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Affiliation(s)
- Maria Giovanna Puoti
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Amit Assa
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Marc Benninga
- the Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilse Julia Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Francisco Javier Martin Carpi
- the Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Jernej Dolinsek
- the Department of Gastroenterology, Hepatology and Nutrition, University Medical Centre Maribor, Maribor, Slovenia
| | - Matjaz Homan
- the Department of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- the Service de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, F-31300 Toulouse, France, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medicine Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy
| | - Christos Tzivinikos
- the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mike Thomson
- the Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, UK
| | - Osvaldo Borrelli
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK
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Daripa B, Lucchese S. A Rare Case of Domperidone-Induced Acute Dystonia in a Young Adult Due to Consumption of Combination Drug (Proton Pump Inhibitors With Domperidone) and Its Possible Pathomechanism. Cureus 2022; 14:e23723. [PMID: 35509739 PMCID: PMC9060727 DOI: 10.7759/cureus.23723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/11/2022] Open
Abstract
Globally, a substantial number of people are tormented by dystonia. Domperidone, a D-2 receptor antagonist acts outside the blood-brain barrier in the brain stem as well as on the gastrointestinal tract. In India, domperidone is conveniently obtainable over the counter as a combination drug with proton pump inhibitors (PPIs) for dyspepsia and gastro-esophageal reflux disease. We present a rare case of domperidone-induced acute dystonia in a young adult presented within 72 hours after consuming two oral doses of this combination drug (PPIs with domperidone) for dyspepsia. Drug-induced extra pyramidal symptoms (EPS) are often misdiagnosed as some psychiatric condition and undoubtedly its expeditious diagnosis staves off unnecessary investigations and ameliorates prognosis. Our case ignites alertness amongst practitioners in India over the judicious use of PPIs with domperidone as the latter may trigger EPS. Such combination drugs can be prescribed if absolutely mandatory by the treating physician. The possible pathomechanism of this hyperkinetic motor phenomenon, perturbing the equilibrium of the cortical-subcortical circuit and resulting in an overflow of muscular activity, is attempted to be explained here, although the explicit mechanism is still blurry.
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Kim Y, Jang JH, Park N, Jeong NY, Lim E, Kim S, Choi NK, Yoon D. Machine Learning Approach for Active Vaccine Safety Monitoring. J Korean Med Sci 2021; 36:e198. [PMID: 34402232 PMCID: PMC8352788 DOI: 10.3346/jkms.2021.36.e198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vaccine safety surveillance is important because it is related to vaccine hesitancy, which affects vaccination rate. To increase confidence in vaccination, the active monitoring of vaccine adverse events is important. For effective active surveillance, we developed and verified a machine learning-based active surveillance system using national claim data. METHODS We used two databases, one from the Korea Disease Control and Prevention Agency, which contains flu vaccination records for the elderly, and another from the National Health Insurance Service, which contains the claim data of vaccinated people. We developed a case-crossover design based machine learning model to predict the health outcome of interest events (anaphylaxis and agranulocytosis) using a random forest. Feature importance values were evaluated to determine candidate associations with each outcome. We investigated the relationship of the features to each event via a literature review, comparison with the Side Effect Resource, and using the Local Interpretable Model-agnostic Explanation method. RESULTS The trained model predicted each health outcome of interest with a high accuracy (approximately 70%). We found literature supporting our results, and most of the important drug-related features were listed in the Side Effect Resource database as inducing the health outcome of interest. For anaphylaxis, flu vaccination ranked high in our feature importance analysis and had a positive association in Local Interpretable Model-Agnostic Explanation analysis. Although the feature importance of vaccination was lower for agranulocytosis, it also had a positive relationship in the Local Interpretable Model-Agnostic Explanation analysis. CONCLUSION We developed a machine learning-based active surveillance system for detecting possible factors that can induce adverse events using health claim and vaccination databases. The results of the study demonstrated a potentially useful application of two linked national health record databases. Our model can contribute to the establishment of a system for conducting active surveillance on vaccination.
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Affiliation(s)
- Yujeong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
| | - Jong Hwan Jang
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
| | - Namgi Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Na Young Jeong
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Eunsun Lim
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Soyun Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Nam Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea.
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Vaz AS, Brito N, Moura L, Fernandes A. Involuntary movements in an adolescent: what are the causes? BMJ Case Rep 2019; 12:12/12/e231398. [DOI: 10.1136/bcr-2019-231398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Involuntary movements can be a troublesome condition and represent a real challenge for emergency doctors, particularly for patients of paediatric age. We report a case of a 17-year-old boy with painful involuntary movements mostly affecting his mouth and lower limbs, but also the trunk. After reviewing the patient’s history, it was revealed that the adolescent had had acute alcohol intoxication with severe acute agitation and therefore was given a single dose of 10 mg intravenous haloperidol. The concealment of the recent event posed serious difficulties in reaching the diagnosis. When the diagnosis of haloperidol-induced acute dystonia was made, 3 mg of intravenous biperiden was promptly administered with complete clinical resolution in 15 min.
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Abstract
Domperidone is a dopamine-2 receptor (D2) antagonist. It is used as an antiemetic and has an excellent safety profile. We present a case of acute dystonia secondary to domperidone use in an 11-year-old girl. She was admitted with the diagnosis of viral gastroenteritis and received domperidone for persistent vomiting along with other supportive measures. The vomiting subsided with treatment, but she developed acute dystonia. Domperidone discontinued, and her condition improved in the next 24 hours. The patient discharged, and on a follow-up visit, she was asymptotic. A review of the literature suggests a possible association of acute dystonia with domperidone in children.
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Acute Cervical Dystonia Induced by Clebopride. Case Rep Neurol Med 2017; 2017:2834349. [PMID: 29333306 PMCID: PMC5733119 DOI: 10.1155/2017/2834349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/05/2017] [Indexed: 11/17/2022] Open
Abstract
Antidopaminergic drugs are known to induce extrapyramidal symptoms. Clebopride, a dopamine antagonist, also can produce parkinsonism, tardive dyskinesia, tardive dystonia, hemifacial dystonia, or oculogyric crisis; however, acute dystonic reaction caused by clebopride has not been reported in adults. We report two young men who experienced acute cervical dystonia within a few days of taking clebopride. The patients recovered after discontinuation of the drug. Physicians prescribing clebopride should be aware of the adverse effects of this drug.
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Abstract
PURPOSE OF REVIEW The goal of this review is to review the current status of prokinetics and to place it in historical context. Impaired motility and thus propulsion have long been thought to play important roles in the pathogenesis of a number of gastrointestinal disorders including gastroesophageal reflux disease (GERD), gastroparesis, chronic idiopathic pseudo-obstruction, and constipation. Historically, disordered motility was also thought to contribute to a number of functional gastrointestinal disorders such as functional dyspepsia (FD) and irritable bowel syndrome (IBS). RECENT FINDINGS As we learn more of the pathophysiology of FD, IBS, GERD, constipation, and gastroparesis, the limitations of a therapeutic strategy based on the stimulation of motility (i.e., the use of a prokinetic) have become apparent and the disappointments of the past explained. The development of prokinetic drugs has also been hampered by the non-selective nature of many of the agents studied to date which resulted in some unexpected side effects. There is still an unmet need for an effective and safe prokinetic, but drug development in this area must be mindful of the challenges of the area and the need for selectivity for a given target receptor.
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Affiliation(s)
- Eamonn M M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders, Houston, TX, USA.
- Division of Gastroenterology and Hepatology, The Methodist Hospital, 6550 Fannin St, SM 1201, Houston, TX, 77030, USA.
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