Interactions with Entry & Integrase Inhibitors

Total Page:16

File Type:pdf, Size:1020Kb

Interactions with Entry & Integrase Inhibitors www.hiv-druginteractions.org Interactions with Entry & Integrase Inhibitors Charts revised July 2018. Full information available at www.hiv-druginteractions.org Page 1 of 4 Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. BIC/ E/C/F/ E/C/F/ BIC/ E/C/F/ E/C/F/ F/TAF DTG TAF TDF MVC RAL F/TAF DTG TAF TDF MVC RAL Anaesthetics & Muscle Relaxants Antibacterials (continued) Alcuronium Ertapenem Bupivacaine Erythromycin Cisatracurium Ethambutol Desflurane Ethionamide Dexmedetomidine Flucloxacillin Enflurane Gentamicin Ephedrine Imipenem/Cilastatin Halothane Isoniazid Isoflurane Kanamycin Levofloxacin Ketamine Linezolid Nitrous oxide Meropenem Propofol Metronidazole Rocuronium Moxifloxacin Sevoflurane Nitrofurantoin Sufentanil Ofloxacin Suxamethonium (succinylcholine) Para-aminosalicylic acid Tetracaine Penicillins Thiopental Pyrazinamide Tizanidine Rifabutin Vecuronium Rifampicin Analgesics Rifapentine Alfentanil Rifaximin Aspirin Spectinomycin Buprenorphine Streptomycin Celecoxib Sulfadiazine Telithromycin Codeine Tetracyclines Dextropropoxyphene Trimethoprim/Sulfamethoxazole Diamorphine (diacetylmorphine) Vancomycin Diclofenac Dihydrocodeine Anti-coagulant, Anti-platelet and Fibrinolytic Fentanyl Acenocoumarol Hydrocodone Apixaban Aspirin (anti-platelet) Hydromorphone Clopidogrel Ibuprofen Dabigatran Mefenamic acid Dalteparin Methadone Dipyridamole Morphine Edoxaban Naproxen Eltrombopag istribution. For personal use only. Not for distribution. for only. Not use For personal istribution. Nimesulide Enoxaparin Oxycodone Fondaparinux Paracetamol (Acetaminophen) Heparin Pethidine (Meperidine) Phenprocoumon Piroxicam Prasugrel Tramadol Rivaroxaban Streptokinase Anthelmintics Albendazole Ticagrelor Diethylcarbamazine Warfarin Ivermectin Anticonvulsants Levamisole (Ergamisol) Carbamazepine Mebendazole Clonazepam Niclosamide Ethosuximide Oxamniquine Gabapentin Lacosamide Praziquantel for d Not only. use For personal Lamotrigine Pyrantel Suramin sodium Levetiracetam Oxcarbazepine Triclabendazole Phenobarbital (Phenobarbitone) Antiarrhythmics Phenytoin Amiodarone Pregabalin Bepridil Topiramate Disopyramide Valproate (Divalproex) Dofetilide Vigabatrin Flecainide Zonisamide Lidocaine (Lignocaine) Antidepressants Mexiletine Agomelatine Propafenone Amitriptyline Quinidine Bupropion Antibacterials Citalopram Amikacin Clomipramine Amoxicillin Desipramine Ampicillin Doxepin Azithromycin Duloxetine Bedaquiline Escitalopram Capreomycin Fluoxetine Fluvoxamine Cefalexin for distribution. only. Not use For personal Imipramine Cefazolin Lithium Cefixime Maprotiline Cefotaxime Mianserin Ceftazidime Milnacipran Ceftriaxone Mirtazapine Chloramphenicol Nefazodone Ciprofloxacin Nortriptyline Clarithromycin Paroxetine Clavulanic acid Phenelzine Clindamycin Reboxetine Clofazimine Sertraline Cloxacillin Tranylcypromine Cycloserine Trazodone Dapsone Trimipramine Doxycycline Venlafaxine Key to abbreviations Key to symbols Where advice differs between countries, and/or between boosted and Bictegravir + Emtricitabine + These drugs should not be coadministered BIC/F/TAF Tenofovir alafenamide (Biktarvy®) unboosted regimens, the charts reflect the more cautious option. ® Potential interaction – may require close monitoring, DTG Dolutegravir (Tivicay ) alteration of drug dosage or timing of administration © Liverpool Drug Interactions Group, University of Liverpool Elvitegravir + Cobicistat + Emtricitabine + Potential interaction likely to be of weak intensity. Pharmacology Research Labs, 1st Floor Block H, 70 Pembroke Place, LIVERPOOL, L69 3GF E/C/F/TAF Tenofovir alafenamide (Genvoya®) Additional action/monitoring or dosage adjustment is We aim to ensure that information is accurate and consistent with current knowledge Elvitegravir + Cobicistat + Emtricitabine + unlikely to be required and practice. However, the University of Liverpool and its servants or agents shall not E/C/F/TDF Tenofovir disoproxil fumarate (Strilbild®) No clinically significant interaction expected be responsible or in any way liable for the continued currency of information in this ® ® publication whether arising from negligence or otherwise howsoever or for any MVC Maraviroc (Celsentri , Selzentry ) There are no clear data, actual or theoretical, to indicate ® consequences arising therefrom. The University of Liverpool expressly exclude RAL Raltegravir (Isentress ) whether an interaction will occur liability for errors, omissions or inaccuracies to the fullest extent permitted by law. www.hiv-druginteractions.org Interactions with Entry & Integrase Inhibitors Charts revised July 2018. Full information available at www.hiv-druginteractions.org Page 2 of 4 Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. BIC/ E/C/F/ E/C/F/ BIC/ E/C/F/ E/C/F/ F/TAF DTG TAF TDF MVC RAL F/TAF DTG TAF TDF MVC RAL Anti-diabetics Antipsychotics/Neuroleptics (continued) Acarbose Paliperidone Empagliflozin Perazine Exanatide Periciazine Glibenclamide (Glyburide) Perphenazine Gliclazide Pimozide Glimepiride Pipotiazine Glipizide Quetiapine Risperidone Insulin Sulpiride Linagliptin Thioridazine Liraglutide Tiapride Metformin Ziprasidone Nateglinide Zotepine Pioglitazone Zuclopenthixol Repaglinide Antivirals Rosiglitazone Aciclovir Saxagliptin Adefovir Sitagliptin Amantadine Tolbutamide Boceprevir Vildagliptin Cidofovir Antifungals Daclatasvir Amphotericin B Elbasvir/Grazoprevir Anidulafungin Entecavir Caspofungin Famciclovir Fluconazole Foscarnet Flucytosine Ganciclovir Griseofulvin Glecaprevir/Pibrentasvir Itraconazole Ledipasvir/Sofosbuvir Ketoconazole Ombitasvir/Paritaprevir/r Miconazole Ombitasvir/Paritaprevir/r + Dasabuvir Nystatin Oseltamivir Posaconazole Ribavirin Terbinafine Rimantadine Simeprevir Voriconazole Sofosbuvir Antihistamines Sofosbuvir/Velpatasvir Astemizole Sofosbuvir/Velpatasvir/Voxilaprevir istribution. For personal use only. Not for distribution. for only. Not use For personal istribution. Cetirizine Telaprevir Chlorphenamine Telbivudine Diphenhydramine Valaciclovir Fexofenadine Zanamivir Levocetirizine Anxiolytics/Hypnotics/ Sedatives Loratadine Alprazolam Promethazine Bromazepam Terfenadine Buspirone Antimigraine Agents Chlordiazepoxide Clorazepate Almotriptan Diazepam Dihydroergotamine Estazolam Ergotamine Flunitrazepam Rizatriptan Flurazepam Sumatriptan for d Not only. use For personal Hydroxyzine Antiprotozoals Lorazepam Lormetazepam Amodiaquine Midazolam (oral) Artemisinin Midazolam (parenteral) Atovaquone Oxazepam Benznidazole Temazepam Chloroquine Triazolam Diloxanide Zaleplon Eflornithine Zolpidem Halofantrine Zopiclone Lumefantrine Beta Blockers Mefloquine Atenolol Meglumine antimoniate Bisoprolol Melarsoprol Carvedilol Miltefosine Metoprolol Nifurtimox Nebivolol Paromomycin Oxprenolol Pentamidine Pindolol Primaquine Propranolol Proguanil Timolol For personal use only. Not for distribution. for distribution. only. Not use For personal Pyrimethamine Bronchodilators Quinine Aclidinium bromide Sodium stibogluconate Aminophylline Sulfadoxine Formoterol Antipsychotics/Neuroleptics Glycopyrronium bromide Indacaterol Amisulpride Ipratropium bromide Aripiprazole Montelukast Asenapine Olodaterol Chlorpromazine Roflumilast Clozapine Salbutamol Fluphenazine Salmeterol Haloperidol Theophylline Iloperidone Tiotropium bromide Levomepromazine Umeclidinium bromide Olanzapine Vilanterol Key to abbreviations Key to symbols Where advice differs between countries, and/or between boosted and Bictegravir + Emtricitabine
Recommended publications
  • 2020 Prior Authorization Criteria
    2020 PRIOR AUTHORIZATION CRITERIA TABLE OF CONTENTS abiraterone tablet ...................................................................................................................... 217 ABRAXANE .............................................................................................................................. 131 ACTIMMUNE .............................................................................................................................. 14 ADASUVE ................................................................................................................................... 27 ADEMPAS ................................................................................................................................ 197 AFINITOR ................................................................................................................................. 217 AFINITOR DISPERZ ................................................................................................................. 217 AIMOVIG ..................................................................................................................................... 15 ALECENSA ............................................................................................................................... 217 ALIMTA ..................................................................................................................................... 131 ALIQOPA .................................................................................................................................
    [Show full text]
  • Full Text in Pdf Format
    DISEASES OF AQUATIC ORGANISMS Published July 30 Dis Aquat Org Oral pharmacological treatments for parasitic diseases of rainbow trout Oncorhynchus mykiss. 11: Gyrodactylus sp. J. L. Tojo*, M. T. Santamarina Department of Microbiology and Parasitology, Laboratory of Parasitology, Faculty of Pharmacy, Universidad de Santiago de Compostela, E-15706 Santiago de Compostela, Spain ABSTRACT: A total of 24 drugs were evaluated as regards their efficacy for oral treatment of gyro- dactylosis in rainbow trout Oncorhj~nchusmykiss. In preliminary trials, all drugs were supplied to infected fish at 40 g per kg of feed for 10 d. Twenty-two of the drugs tested (aminosidine, amprolium, benznidazole, b~thionol,chloroquine, diethylcarbamazine, flubendazole, levamisole, mebendazole, n~etronidazole,mclosamide, nitroxynil, oxibendazole, parbendazole, piperazine, praziquantel, roni- dazole, secnidazole, tetramisole, thiophanate, toltrazuril and trichlorfon) were ineffective Triclabenda- zole and nitroscanate completely eliminated the infection. Triclabendazole was effective only at the screening dosage (40 g per kg of feed for 10 d), while nitroscanate was effective at dosages as low as 0.6 g per kg of feed for 1 d. KEY WORDS: Gyrodactylosis . Rainbow trout Treatment. Drugs INTRODUCTION to the hooks of the opisthohaptor or to ulceration as a result of feeding by the parasite. The latter is the most The monogenean genus Gyrodactylus is widespread, serious. though some individual species have a restricted distri- Transmission takes place largely as a result of direct bution. Gyrodactyloses affect numerous freshwater contact between live fishes, though other pathways species including salmonids, cyprinids and ornamen- (contact between a live fish and a dead fish, or with tal fishes, as well as marine fishes including gadids, free-living parasites present in the substrate, or with pleuronectids and gobiids.
    [Show full text]
  • Blockade of Muscarinic Acetylcholine Receptors Facilitates Motivated Behaviour and Rescues a Model of Antipsychotic- Induced Amotivation
    www.nature.com/npp ARTICLE Blockade of muscarinic acetylcholine receptors facilitates motivated behaviour and rescues a model of antipsychotic- induced amotivation Jonathan M. Hailwood 1, Christopher J. Heath2, Benjamin U. Phillips1, Trevor W. Robbins1, Lisa M. Saksida3,4 and Timothy J. Bussey1,3,4 Disruptions to motivated behaviour are a highly prevalent and severe symptom in a number of neuropsychiatric and neurodegenerative disorders. Current treatment options for these disorders have little or no effect upon motivational impairments. We assessed the contribution of muscarinic acetylcholine receptors to motivated behaviour in mice, as a novel pharmacological target for motivational impairments. Touchscreen progressive ratio (PR) performance was facilitated by the nonselective muscarinic receptor antagonist scopolamine as well as the more subtype-selective antagonists biperiden (M1) and tropicamide (M4). However, scopolamine and tropicamide also produced increases in non-specific activity levels, whereas biperiden did not. A series of control tests suggests the effects of the mAChR antagonists were sensitive to changes in reward value and not driven by changes in satiety, motor fatigue, appetite or perseveration. Subsequently, a sub-effective dose of biperiden was able to facilitate the effects of amphetamine upon PR performance, suggesting an ability to enhance dopaminergic function. Both biperiden and scopolamine were also able to reverse a haloperidol-induced deficit in PR performance, however only biperiden was able to rescue the deficit in effort-related choice (ERC) performance. Taken together, these data suggest that the M1 mAChR may be a novel target for the pharmacological enhancement of effort exertion and consequent rescue of motivational impairments. Conversely, M4 receptors may inadvertently modulate effort exertion through regulation of general locomotor activity levels.
    [Show full text]
  • Drug Class Review Beta Adrenergic Blockers
    Drug Class Review Beta Adrenergic Blockers Final Report Update 4 July 2009 Update 3: September 2007 Update 2: May 2005 Update 1: September 2004 Original Report: September 2003 The literature on this topic is scanned periodically. The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Mark Helfand, MD, MPH Kim Peterson, MS Vivian Christensen, PhD Tracy Dana, MLS Sujata Thakurta, MPA:HA Drug Effectiveness Review Project Marian McDonagh, PharmD, Principal Investigator Oregon Evidence-based Practice Center Mark Helfand, MD, MPH, Director Oregon Health & Science University Copyright © 2009 by Oregon Health & Science University Portland, Oregon 97239. All rights reserved. Final Report Update 4 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 6 Purpose and Limitations of Evidence Reports........................................................................................ 8 Scope and Key Questions .................................................................................................................... 10 METHODS.................................................................................................................................
    [Show full text]
  • Appendix A: Potentially Inappropriate Prescriptions (Pips) for Older People (Modified from ‘STOPP/START 2’ O’Mahony Et Al 2014)
    Appendix A: Potentially Inappropriate Prescriptions (PIPs) for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014) Consider holding (or deprescribing - consult with patient): 1. Any drug prescribed without an evidence-based clinical indication 2. Any drug prescribed beyond the recommended duration, where well-defined 3. Any duplicate drug class (optimise monotherapy) Avoid hazardous combinations e.g.: 1. The Triple Whammy: NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015) 2. Sick Day Rules drugs: Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015) 3. Anticholinergic Burden (ACB): Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB: Amantadine Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine Baclofen Carbamazepine Disopyramide Loperamide Oxcarbazepine Pethidine
    [Show full text]
  • Product List March 2019 - Page 1 of 53
    Wessex has been sourcing and supplying active substances to medicine manufacturers since its incorporation in 1994. We supply from known, trusted partners working to full cGMP and with full regulatory support. Please contact us for details of the following products. Product CAS No. ( R)-2-Methyl-CBS-oxazaborolidine 112022-83-0 (-) (1R) Menthyl Chloroformate 14602-86-9 (+)-Sotalol Hydrochloride 959-24-0 (2R)-2-[(4-Ethyl-2, 3-dioxopiperazinyl) carbonylamino]-2-phenylacetic 63422-71-9 acid (2R)-2-[(4-Ethyl-2-3-dioxopiperazinyl) carbonylamino]-2-(4- 62893-24-7 hydroxyphenyl) acetic acid (r)-(+)-α-Lipoic Acid 1200-22-2 (S)-1-(2-Chloroacetyl) pyrrolidine-2-carbonitrile 207557-35-5 1,1'-Carbonyl diimidazole 530-62-1 1,3-Cyclohexanedione 504-02-9 1-[2-amino-1-(4-methoxyphenyl) ethyl] cyclohexanol acetate 839705-03-2 1-[2-Amino-1-(4-methoxyphenyl) ethyl] cyclohexanol Hydrochloride 130198-05-9 1-[Cyano-(4-methoxyphenyl) methyl] cyclohexanol 93413-76-4 1-Chloroethyl-4-nitrophenyl carbonate 101623-69-2 2-(2-Aminothiazol-4-yl) acetic acid Hydrochloride 66659-20-9 2-(4-Nitrophenyl)ethanamine Hydrochloride 29968-78-3 2,4 Dichlorobenzyl Alcohol (2,4 DCBA) 1777-82-8 2,6-Dichlorophenol 87-65-0 2.6 Diamino Pyridine 136-40-3 2-Aminoheptane Sulfate 6411-75-2 2-Ethylhexanoyl Chloride 760-67-8 2-Ethylhexyl Chloroformate 24468-13-1 2-Isopropyl-4-(N-methylaminomethyl) thiazole Hydrochloride 908591-25-3 4,4,4-Trifluoro-1-(4-methylphenyl)-1,3-butane dione 720-94-5 4,5,6,7-Tetrahydrothieno[3,2,c] pyridine Hydrochloride 28783-41-7 4-Chloro-N-methyl-piperidine 5570-77-4
    [Show full text]
  • FDA Warns About an Increased Risk of Serious Pancreatitis with Irritable Bowel Drug Viberzi (Eluxadoline) in Patients Without a Gallbladder
    FDA warns about an increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder Safety Announcement [03-15-2017] The U.S. Food and Drug Administration (FDA) is warning that Viberzi (eluxadoline), a medicine used to treat irritable bowel syndrome with diarrhea (IBS-D), should not be used in patients who do not have a gallbladder. An FDA review found these patients have an increased risk of developing serious pancreatitis that could result in hospitalization or death. Pancreatitis may be caused by spasm of a certain digestive system muscle in the small intestine. As a result, we are working with the Viberzi manufacturer, Allergan, to address these safety concerns. Patients should talk to your health care professional about how to control your symptoms of irritable bowel syndrome with diarrhea (IBS-D), particularly if you do not have a gallbladder. The gallbladder is an organ that stores bile, one of the body’s digestive juices that helps in the digestion of fat. Stop taking Viberzi right away and get emergency medical care if you develop new or worsening stomach-area or abdomen pain, or pain in the upper right side of your stomach-area or abdomen that may move to your back or shoulder. This pain may occur with nausea and vomiting. These may be symptoms of pancreatitis, an inflammation of the pancreas, an organ important in digestion; or spasm of the sphincter of Oddi, a muscular valve in the small intestine that controls the flow of digestive juices to the gut. Health care professionals should not prescribe Viberzi in patients who do not have a gallbladder and should consider alternative treatment options in these patients.
    [Show full text]
  • Advice for Primary Care Regarding Beta Blockers in Heart Failure and Qof
    Advice for Primary Care Regarding Beta-Blockers in Heart Failure and QOF ADVICE FOR PRIMARY CARE REGARDING BETA BLOCKERS IN HEART FAILURE AND QOF Author(s): Trudi Phillips, Lead Nurse, SEWCN / Heart Failure Specialist Nurse, Cwm Taf HB Date: 20 th May 2010 Version: 4: Status Final Pathway: Heart Failure Intended Audience: Cardiac Network, GPs and Primary Care Staff Purpose and Summary of Document: To advise GPs and primary care on the initiation of Beta Blockers for patients with heart failure and changing Beta Blocker medication. Publication / Distribution: • Cardiac Network primary care distribution list • Cardiac Network GPs via email • Network website ( http://www.sewcn.wales.nhs.uk ; http://nww.sewcn.wales.nhs.uk ) • Highlight in next e-Newsletter and Heart Matters Date of Issue: 21 st May 2010 Review Date: May 2011 Date published on Network Website: 10 th May 2010 South East Wales Cardiac Network Advice for Primary Care Regarding Beta-Blockers in Heart Failure and QOF Author: Trudi Phillips. SEWCN and Cwm Taf Date: 7th May 2010 Status: Final HB Intended Audience: Page: 1 of 3 Cardiac Network GPs Primary Care Staff Advice for primary care regarding Beta-blockers in Heart Failure and QOF Carvedilol, Bisoprolol and Nebivolol (in the elderly) are the only three beta-blockers currently licensed for use in heart failure in the UK. Beta-blockade therapy for heart failure should be introduced in a ‘ start low, go slow ’ manner, with assessment of heart rate, blood pressure, and clinical status after each titration. Beta blocker Starting dose Maximum target dose Bisoprolol 1.25 mg od 10 mg od Carvedilol 3.125 mg bd 25mg bd Nebivolol (in the elderly) 1.25 mg od 10 mg od For patients with mild to moderate heart failure maximum dose of Carvedilol is 50 mg twice daily if weight more than 85 kg How to use: • Start with a low dose (see above).
    [Show full text]
  • Therapeutic Class Overview Irritable Bowel Syndrome Agents
    Therapeutic Class Overview Irritable Bowel Syndrome Agents Therapeutic Class Overview/Summary: This review will focus on agents used for the treatment of Irritable Bowel Syndrome (IBS).1-5 IBS is a gastrointestinal syndrome characterized primarily by non-specific chronic abdominal pain, usually described as a cramp-like sensation, and abnormal bowel habits, either constipation or diarrhea, in which there is no organic cause. Other common gastrointestinal symptoms may include gastroesophageal reflux, dysphagia, early satiety, intermittent dyspepsia and nausea. Patients may also experience a wide range of non-gastrointestinal symptoms. Some notable examples include sexual dysfunction, dysmenorrhea, dyspareunia, increased urinary frequency/urgency and fibromyalgia-like symptoms.6 IBS is defined by one of four subtypes. IBS with constipation (IBS-C) is the presence of hard or lumpy stools with ≥25% of bowel movements and loose or watery stools with <25% of bowel movements. When IBS is associated with diarrhea (IBS-D) loose or watery stools are present with ≥25% of bowel movements and hard or lumpy stools are present with <25% of bowel movements. Mixed IBS (IBS-M) is defined as the presence of hard or lumpy stools with ≥25% and loose or water stools with ≥25% of bowel movements. Final subtype, or unsubtyped, is all other cases of IBS that do not fall into the other classes. Pharmacological therapy for IBS depends on subtype.7 While several over-the-counter or off-label prescription agents are used for the treatment of IBS, there are currently only two agents approved by the Food and Drug Administration (FDA) for the treatment of IBS-C and three agents approved by the FDA for IBS-D.
    [Show full text]
  • What Are the Acute Treatments for Migraine and How Are They Used?
    2. Acute Treatment CQ II-2-1 What are the acute treatments for migraine and how are they used? Recommendation The mainstay of acute treatment for migraine is pharmacotherapy. The drugs used include (1) acetaminophen, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans and (5) antiemetics. Stratified treatment according to the severity of migraine is recommended: use NSAIDs such as aspirin and naproxen for mild to moderate headache, and use triptans for moderate to severe headache, or even mild to moderate headache when NSAIDs were ineffective in the past. It is necessary to give guidance and cautions to patients having acute attacks, and explain the methods of using medications (timing, dose, frequency of use) and medication use during pregnancy and breast-feeding. Grade A Background and Objective The objective of acute treatment is to resolve the migraine attack completely and rapidly and restore the patient’s normal functions. An ideal treatment should have the following characteristics: (1) resolves pain and associated symptoms rapidly; (2) is consistently effective; (3) no recurrence; (4) no need for additional use of medication; (5) no adverse effects; (6) can be administered by the patients themselves; and (7) low cost. Literature was searched to identify acute treatments that satisfy the above conditions. Comments and Evidence The acute treatment drugs for migraine generally include (1) acetaminophens, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans, and (5) antiemetics. For severe migraines including status migrainosus and migraine attacks refractory to treatment, (6) anesthetics, and (7) corticosteroids (dexamethasone) are used (Tables 1 and 2).1)-9) There are two approaches to the selection and sequencing of these medications: “step care” and “stratified care”.
    [Show full text]
  • Management of Chronic Problems
    MANAGEMENT OF CHRONIC PROBLEMS INTERACTIONS BETWEEN ALCOHOL AND DRUGS A. Leary,* T. MacDonald† SUMMARY concerned. Alcohol may alter the effects of the drug; drug In western society alcohol consumption is common as is may change the effects of alcohol; or both may occur. the use of therapeutic drugs. It is not surprising therefore The interaction between alcohol and drug may be that concomitant use of these should occur frequently. The pharmacokinetic, with altered absorption, metabolism or consequences of this combination vary with the dose of elimination of the drug, alcohol or both.2 Alcohol may drug, the amount of alcohol taken, the mode of affect drug pharmacokinetics by altering gastric emptying administration and the pharmacological effects of the drug or liver metabolism. Drugs may affect alcohol kinetics by concerned. Interactions may be pharmacokinetic or altering gastric emptying or inhibiting gastric alcohol pharmacodynamic, and while coincidental use of alcohol dehydrogenase (ADH).3 This may lead to altered tissue may affect the metabolism or action of a drug, a drug may concentrations of one or both agents, with resultant toxicity. equally affect the metabolism or action of alcohol. Alcohol- The results of concomitant use may also be principally drug interactions may differ with acute and chronic alcohol pharmacodynamic, with combined alcohol and drug effects ingestion, particularly where toxicity is due to a metabolite occurring at the receptor level without important changes rather than the parent drug. There is both inter- and intra- in plasma concentration of either. Some interactions have individual variation in the response to concomitant drug both kinetic and dynamic components and, where this is and alcohol use.
    [Show full text]
  • The Influence of a Muscarinic M1 Receptor Antagonist on Brain Choline Levels in Patients with a Psychotic Disorder and Healthy Controls
    MHENS School for Mental Health and Neuroscience The influence of a muscarinic M1 receptor antagonist on brain choline levels in patients with a psychotic disorder and healthy controls. W.A.M. VingerhoetsA,B, G. BakkerA,B, O. BloemenA,C, M. CaanD, J. BooijB, T.A.M.J. van AmelsvoortA. A Department of Psychiatry & Psychology, Maastricht University, Maastricht, The Netherlands.. B Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands. C GGZ Centraal, Center for Mental Health Care, Hilversum, The Netherlands D Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Background • The majority of the patients with a psychotic disorder report cognitive impairments in addition to positive and negative symptoms. • It is well known that the neurotransmitter acetylcholine plays an important role in cognition. • A post-mortem study of chronic schizophrenia patients demonstrated a reduction of up to 75% in the number of the acetylcholine muscarinic M1 receptors (1). • Research has shown that muscarinic cholinergic receptors play a major role in cognitive processes. Objective • To investigate in-vivo whether there are differences in baseline choline levels in the anterior cingulate cortex (ACC) and striatum between recent onset medication-free patients with a psychotic disorder and healthy control subjects. • To investigate in-vivo the influence of a muscarinic antagonist on choline levels in the ACC and striatum in recent onset medication-free patients with Figure 2. Example of a striatal spectrum. a psychotic disorder and healthy control subjects. Results Methods • No significant differences were found in baseline choline levels between the two groups in both the striatum (p=0.336) and the ACC (p=0.479).
    [Show full text]