RESUMO
OBJECTIVE: To determine the frequency of concurrent use of cisapride, astemizole and terfenadine with macrolides and azole antimitotics, drug combinations that have been reported in the literature as producing a pharmacological interaction associated with potentially fatal ventricular arrhythmias. MATERIAL AND METHODS: A retrospective analysis of a total of 72,444 prescriptions generated by 611 physicians during a 6 months period for ambulatory patients, was performed. The database included a register of automatic alerts produced every time a predetermined drug combination was detected. RESULTS: 145 potentially risk situations were detected, with an incidence rate to 2.1 cases per 1,000 prescriptions, which increases to 6.2% when prescriptions for terfenadine, astemizole, and cisapride were included, with 12, 9 y 5%, respectively. Only 36 physicians (6%) wrote prescriptions producing alerts, and about half (45%) were pediatricians. The same physician prescribed both drugs in 31% of the cases. CONCLUSION: The use of drug combinations associated with a high risk of potentially fatal ventricular arrhythmias is relatively high in Mexico. An electronic online detecting system showed to be useful in preventing this kind of potential pharmacological interactions.
Assuntos
Antibacterianos/efeitos adversos , Antifúngicos/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Astemizol/efeitos adversos , Cisaprida/efeitos adversos , Serviços de Informação sobre Medicamentos/organização & administração , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Programas de Assistência Gerenciada/organização & administração , Sistemas On-Line , Assistência Farmacêutica/organização & administração , Terfenadina/efeitos adversos , Triazóis/efeitos adversos , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Antifúngicos/farmacologia , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/prevenção & controle , Astemizol/farmacologia , Criança , Pré-Escolar , Cisaprida/farmacologia , Grupos Diagnósticos Relacionados , Interações Medicamentosas , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Antagonistas dos Receptores Histamínicos H1/farmacologia , Humanos , Incidência , Lactente , Macrolídeos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Risco , Terfenadina/farmacologia , Triazóis/farmacologiaRESUMO
BACKGROUND: Adverse cardiac effects have been related to the use of H1-receptor antagonists terfenadine and astemizole. OBJECTIVE: We have investigated the cardiac effects of the H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, used in recommended doses, concomitantly or not with the antibiotic erythromycin. METHODS: A group of 80 children aged 5 to 12 years was studied. All children had been diagnosed with perennial allergic rhinitis based on symptoms, clinical signs and a positive immediate skin test to Dermatophagoides pteronyssinus. The children had no personal history of cardiac disease or hepatic dysfunction, and they had a normal electrocardiogram (ECG) at the beginning of the study. Forty children had allergic rhinitis and sinusitis, and were assigned to subgroups of ten children who received terfenadine, astemizole, loratadine, or cetirizine, concomitantly with erythromycin, for 14 days. Erythromycin was started to treat presumed bacterial infection in children with complete radiologic opacification of the maxillary sinus(es). The remaining 40 children had no sinusitis, and were assigned to subgroups of 10 children who received terfenadine, astemizole, loratadine, or cetirizine for 14 days. RESULTS: No significant changes in the QT interval and QTc (QT corrected by Bazzett's equation) were observed among children who received astemizole, loratadine or cetirizine, with or without erythromycin. Children who have received terfenadine and erythromycin showed significantly prolonged QT interval (mean pretreatment and posttreatment values 0.32s and 0.34s, respectively). Analysis of the QTc interval, however, showed no significant differences in the group treated with terfenadine and erythromycin (mean values 0.39s and 0.39s, respectively). CONCLUSIONS: Our results show that H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, administered with or without erythromycin, to atopic children in recommended doses, do not induce adverse cardiac effects. Although the association between terfenadine and erythromycin has caused a statistically significant increase in QT interval measurements, the magnitude of these changes was below levels considered cardiotoxic or clinically relevant.
Assuntos
Antialérgicos/efeitos adversos , Antibacterianos/uso terapêutico , Astemizol/efeitos adversos , Cetirizina/efeitos adversos , Eritromicina/uso terapêutico , Coração/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Hipersensibilidade Imediata/fisiopatologia , Loratadina/efeitos adversos , Terfenadina/efeitos adversos , Criança , Pré-Escolar , Interações Medicamentosas , Eletrocardiografia/efeitos dos fármacos , Feminino , Coração/fisiopatologia , Humanos , Hipersensibilidade Imediata/etiologia , MasculinoRESUMO
They were studied 48 children of 3 to 8 years old, of two sex (30 male and 18 female), that attended the external service of otolaryngology of the Hospital of the ISSSTE of Nuevo Laredo, Tamaulipas (Mexico) and the private practice of the Allergy Clinic and Otolaringol in Nuevo Laredo, Tamaulipas, of the month of November of 1995 to April of 1996. Some of the side effects observed in the patients treated in the group A (carbinoxamine-P) were: mild sedation and in some instances hyperexcitability and irritability. However, it was not necessary to discontinue the medication or to modify the dose. In the group B (astemizole-P) was observed only excitement and irritability in some instances by hypersensitivity to the pseudoephedrine. It is very important to consider that the adequate and timely treatment in a patient with otitis serous media will permit to avoid sequels that they can cause, in the long run, a meaningful impact in the language and intellectual development of the child.
Assuntos
Astemizol/uso terapêutico , Efedrina/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Descongestionantes Nasais/uso terapêutico , Otite Média com Derrame/tratamento farmacológico , Piridinas/uso terapêutico , Astemizol/administração & dosagem , Astemizol/efeitos adversos , Criança , Pré-Escolar , Quimioterapia Combinada , Efedrina/administração & dosagem , Efedrina/efeitos adversos , Feminino , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Humanos , Hipercinese/induzido quimicamente , Masculino , Descongestionantes Nasais/administração & dosagem , Descongestionantes Nasais/efeitos adversos , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Fases do Sono , Resultado do TratamentoRESUMO
O desenvolvimento dos anti-histamínicos "nao-clásicos" tem sido considerado um significante avanço no tratamento dos pacientes alérgicos. Além de proporcionarem reduçao dos sintomas, sao medicamentos de uso oral que nao causam sedaçao ou prejuízo à atividade psicomotora do paciente. Entretanto, alguns relatos de casos com efeitos cardíacos adversos atribuídos à terfenadina e ao astemizol, administrados em altas doses e/ou associados ao cetoconazol ou a antibióticos macrolídeos, têm causado muita discussao. Neste trabalho revemos tais eventos, bem como suas possíveis explicaçoes.
Assuntos
Humanos , Astemizol/efeitos adversos , Cetirizina/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Loratadina/efeitos adversos , Terfenadina/efeitos adversos , Fatores de RiscoRESUMO
El aumento de la prevalencia mundial de las patologías respiratorias alérgicas conlleva un aumento simultáneo en la prescripción de antihistamínicos orales. Los efectos adversos que dichos medicamentos provocan en el sistema nervioso central son muy frecuentes(1), por lo que se presenta una revisión actualizada de los antihistamínicos sistémicos bajo el clásico adagio de la Medicina: "Primum non nocere" ("antes que nada no dañar"). En esta revisión se describe las generalidades de la acción de la histamina en el organismo. Los efectos terapéuticos y secundarios de los antihistamínicos de primera y segunda generación y finalmente se presenta una descripción acabada del nuevo antialérgico epinastina