Adverse Drug Reactions Journal

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临床论著

Efficacy and safety of autologous peripheral blood stem cell transplantation in treatment of patients with secondary progressive multiple sclerosis

Su Lia;Ji Bingxina;Dong Huiqingb;Hui Wuhana;Zhang Pub;Xu Juana

2010, 12(3): 153-4.

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Objective: To restrospectively analyze the efficacy and safety of autologous peripheral blood stem cell transplantation(APBSCT) in treatment of patients with secondary progressive multiple sclerosis（MS）. Methods: Between 2001 and 2010, 41 patients with secondary progressive multiple sclerosis in Xuanwu Hospital of Capital Medical University entered the study. They comprised 31 women and 10 men with mean age of 36 years. All patients received SC G-CSF 5 μg/kg for five days to mobilize hematopoietic stem cells. Peripheral blood mononuclear cells were collected by cell separator, and CD34⁺ cells selected by CliniMACS in 28 cases. The mononucleur cell or CD34⁺ cells were stored at -80℃ in refrigerator. The patients received a BEAM conditioning regimen comprising becenum (camustine) 300 mg/m²×1 d, etoposide (teriposide) 150 mg/m²×4 d, cytosine arabinoside 200 mg/m²×4 d, and melphalan 140 mg/m²×1 d. After the conditioning regimen, the CD34⁺ cells or PBMC preserved at low temperature were restored, and were infused intravenously. The degree of recovery in the neurological function after APBSCT was evaluated with EDSS and the adverse reactions were evaluation with Common Terminology Criteria for Adverse Events V 3.0. Results: Two patients were lost to followup. The followup duration to 39 patients after APBSCT ranged from 6 to 100 (mean 51) months. Of them, 16 patients’state was improved, 8 stable, and 15 recurrence and progression. The cumulative 100month progressionfree survival rate was 55.5%. The adverse reactions due to APBSCT were as follows: after the conditioning regimen, the neutrophils and platelet counts in 41 patients were <0.5×10⁹/L and <25×10⁹/L, respectively, and hematopoietic reconstitution was achieved after supportive treatment in all patients, 37 patients developed diarrhea; 3 patients presented with tenipeideinduced anaphylaxis; 26 patients experienced infections, including 19 cases of neutropenia with fever, 2 cases of soft tissue abscess, 2 cases of septicemia,1 case of pulmonary fungal infection,1 case of skin infection, and 1 case of alimentary tract infection. Six patients developed engraftment syndrome. There was no death associated with APBSCT. Conclusion: APBSCT is a relatively effective and safe therapy for the secondary progressive multiple sclerosis; however, closely observing the possible occurrence of adverse reactions during the use of APBSCT is necessary.

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临床论著

Efficacy and safety of telbivudin in preventing mother-to-infant HBV transmission

Zhang Yanfang;Hu Yuhong

2010, 12(3): 157-3.

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Objective: To evaluate the efficacy and safety of telbivudine in preventing mothertoinfant HBV transmission in HBVinfected pregnant women during the last trimester of pregnancy. Methods:A total of 120 pregnant women, who had positive HBsAg and HBeAg with a HBV DNA level of ≥1×10⁶ copies/mL,were divided into two groups: the telbivudine group aged 2336 years and the control group aged 24-37 years. Each group comprised 60 cases. The subjects in the telbivudine group received telbivudine 600 mg once daily from 28 weeks of pregnancy till 1 month after delivery. The subjects in the control group did not receive telbivudine. The serum HBV DNA levels in the two groups were measured at 28 weeks of pregnancy, upon delivery and 6 months after delivery, respectively. The adverse reactions to subjects in the telbivudine group were observed. The infants in the two groups received IM HBIG 200 U immediately after birth and 1 month after birth, and IM hepatitis B vaccine 10 μg immediately after birth as well as 1 month and 6 months after birth, respectively. The serum HBsAg and HBV DNA levels in all infants were measured 24 hours, 6 months, and 1 year after birth, respectively. Results:There was no significant difference in serum HBV DNA levels between the telbivudine group[(6.62±0.90)×10⁶ copies/mL] and the control group[(7.22±1.27) ×10⁶ copies/mL] at 28 weeks of pregnancy. The serum HBV DNA level in the telbivudine group[(0.49±0.54) ×10³ copies/mL] was significantly decreased compared with the control group[(7.46±1.06) ×10⁶ copies/mL] immediately after delivery(P<0.05). There was no significant difference in HBV DNA levels between the telbivudine group[(6.23±0.85) ×10⁶ copies/mL] and the control group[(7.55±1.88) ×10⁶ copies/mL] 6 months after delivery. Thirteen subjects in the telbivudine group had a mild elevation in creatine kinase during 2836 weeks of pregnancy. Telbivudine was stopped. Two weeks later，the creatine kinase levels in the subjects mentioned above returned to normal range. The number of 6monthold infants, who were positive for HBsAg and HBV DNA, was significantly lower in the telbivudine group (1 case) than that in the control group (11 cases) (P<0.05). The rate of mothertoinfant HBV transmission in 12monthold infants in the telbivudin group and the control group were 98.3% and 81.7%, respectively. The difference was statistically significant (P<0.05). Abnormal development was not found in the infants in the two groups. Conclusion:Telbivudine appears to be effective and safe in preventing HBV mothertoinfant transmission and has no influence on infant development.

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实验研究

Study on relationship between Tween-80 contained in injections of Chinese herbal medicine and anaphylactic reactions

Luo Xia;Wang Qing;Zhou Lian;Dong Yan;Jiang Yiping

2010, 12(3): 160-6.

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ＡＢＳＴＲＡＣＴObjective: To observe the effects of different concentrations of Tween-80 solutions and injections of Chinese herbal medicine with different contents of Tween-80 on degranulation of RBL-2H3 cells in order to explore the relationship between Tween-80 and anaphylaxis caused by injections of Chinese herbal medicine. Methods:RBL-2H3 cells were cultured in vitro and the different concentrations (40, 20, 10, 2, 1, 0.2, 0.1, 0.05mg/mL) of Tween80 solutions were added into the supernatants and then stained with neutral red. The degranulated cells in the different concentrations of Tween-80 solutions and the control groups were counted, respectively; the percentage of degranulated cells were calculated, and the amount of β-hexosaminidase and histamine release from the cells in the supernatants were measured. The contents of Tween-80 in the chuanghuning and xiangdan injections were determined, and the 50% concentration of inhibition (IC₅₀) of the 2 injections to the RBL-2H3 cells and histamine release from the cells in the supernatants in the 2 injection groups were measured. Results:The experiment of neutral red staining showed degranulation of RBL-2H3 cells, manifested as enlarged mast cells with vacuoles. The percentage of degranulation of RBL-2H3 cells in the 40, 20, 10, 2, 1, 0.2, 0.1 mg/mL Tween-80 solution groups and the RPMI 1640 control group were (57.38±0.47）, (32.54±2.33), (21.74±0.72), (16.96±0.26), (11.40±1.70), (9.71±0.26), (7.22±0.15), and (1.51±1.39)%, respectively. There were significant differences between the two groups (P<0.05，P<0.01). The percentage of βhexosaminidase release from RBL2H3 cells in the 40, 20, 2, 1, 0.2 mg/mL Tween-80 solution groups and the RPMI 1640 control group were (52.44±1.53), (18.91±0.77), (7.50±1.82), (6.65±0.20), (6.15±0.27), and (0.35±0.06)%, respectively. There were significant differences between the two groups (P<0.05, P<0.01). The different concentrations of Tween-80 solutions induced different levels of histamine release. There was a linear relationship between the percentage of degranulation, β-hexosaminidase release, histamine release from RBL-2H3 cells and the concentration (20-0.1mg/mL) of Tween-80 solutions (r=0.986 2, r=0.984 9, r=0.974 0). The contents of Tween-80 in the chuanghuning and xiangdan injections were (0.086±0.004) and (0.070±0.007) μg/mL, respectively. The IC₅₀ of the two injections to RBL-2H3 cells were (57.4±1.2) and (1.0±0.2) μL/mL, respectively. The levels of histamine release in the chuanghuning and xiangdan injection groups were (2.39±0.01) and (1.87±0.00) ng/mL, respectively. Conclusion:Tween-80 can induce RBL-2H3 cells to release inflammatory mediators; the levels of histamine release from the RBL2H3 cells are related to the contents of Tween-80 in the injections of Chinese herbal medicine；Tween-80 contained in injections of Chinese herbal medicine may be related to the anaphylaxis.

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病例报告

Hematuria induced by oral ciprofloxacin

Zhu Yuxia;Chang Junlan;Yue Ling

2010, 12(3): 165-2.

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A 40-year-old man took ciprofloxacin 0.2 g by himself for upper respiratory infections. Two hours later, he developed gross hematuria. Ciprofloxacin was stopped, and gross hematuria disapperaed after two days, then microscopic hematuria subsided after one months. Gross hematuria reccured after readministration of ciprofloxacin 0.2 g by himself, and vanished after the drug discontinuation.

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实验研究

Effects of fenofibrate on rat erectile function and testosterone level

Du Jiaxin;Ma Manling;Gu Yuhong

2010, 12(3): 166-3.

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Objective: To observe the effects of fenofibrate on rat erectile function and testosterone level in order to explore the reasons of fenofibrateinduced erectile dysfunction(ED). Methods:Thirty female SD rats were unsexed and, 2 weeks later, received SC injection of estradiol benzoate 20 μg and progesterone 500 μg 48 hours and 4 hours before mating experiment, respectively. Thirty male SD rats were randomly divided into two groups: the fenofibrate group and the control group. Each group comprised 15 rats. The rats in the fenofibrate group were gavaged with fenofibrate (31.5mg/kg) dissolved in distilled water (total volume 4mL) once daily for 14 days. The rats in the control group were gavaged with same volume of distilled water once daily for 14 days. The mating experiment was performed on the first day after medication withdrawl. The mount frequency (MF), intromission frequency (IF), mount latency (ML) and ejaculation latency (EL) of the rats in the two groups within 30 minutes were observed and recorded. The levels of testosterone in serum and penile tissue were measured using radioimmunoassay. Results:The MF and IF of rats in the fenofibrate group were (9.45±1.65), (4.15±1.38) times/min, ML and EL were (14.0±7.0), ( 5.3±5.9) minutes, respectively. The MF and IF of rats in the control group were (31.23±3.85), (12.8±3.02) times/min, ML and EL were (6.2±4.3), (16.2±6.0) minutes, respectively. The differences were statistically significant (all P<0.05). The levels of the testosterone in serum and penile tissue were (51.26±34.15), (62.57±46.37)nmol/L in the fenofibrate group, and (153.72±83.98), (164.89±94.02) nmol/L in the control group, respectively. The differences were statistically significant (all P<0.05). Conclusion: Fenofibrate can decrease rats’erectile function and testosterone level. The decreasing testosterone level induced by fenofibrate might be one of the main reasons of ED.

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调查研究

Efficacy and adverse reactions of homemade pazufloxacin and levofloxacin for treating bacterial infections of the respiratory and urinary systems: a metaanalysis

Lv YuanCui HongLiu Jian

2010, 12(3): 169-6.

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Objective: To assess the efficacy and adverse reactions of homemade pazufloxacin and levofloxacin for treating bacterial infections of the respiratory and urinary systems. Methods: Searching CNKI database from 1993 to 2008，the published domestic literature focusing on randomized controlled trials of pazufloxacin and levofloxacin therapy for bacterial infections of the respiratory and urinary systems were collected. According to the criteria for entering, the literature was strictly selected and the quality of selected literature was assessed based on the demand of a metaanalysis. And its results were analyzed by Revman 5.0 and Stata 10.0 software. The odds ratio (OR), 95% confidence interval (95%CI) , and P value of clinical cure rate, response rate, bacterial clearance rate, and the incidence of adverse reactions of homemade pazufloxacin and levofloxacin for treating bacterial infections of the respiratory and urinary systems were calculated. Results: Ten randomized controlled trials from 2005 to 2008 were selected. A total of 1 974 patients entered the trials. Of them, 982 patients were in the pazufloxacin group, 992 patients were in the levofloxacin group. The metaanalysis revealed the following results: the clinical cure rates in the homemade pazufloxacin and levofloxacin groups for treating bacterial infections of the respiratory and urinary systems were 66.6% and 65.7%, respectively; the response rates were 92.3% and 91.5%, respectively; the bacterial clearance rates were 95.1% and 93.3%, respectively; the incidence of adverse reaction rates were 12.5% and 12.9%, respectively; their pooled OR were 1.05（95% CI 0.86-1.27，P=0.650）, 1.10 (95% CI 0.79-1.53, P=0.560), 1.45 (95% CI 0.932.27, P=0.100), and 0.97 (95% CI 0.74-1.26, P=0.810)，respectively. The differences were no significance. Conclusion: The efficacy and adverse reactions of the homemade pazufloxacin therapy for bacterial infections of respiratory and urinary system are similar to those of levofloxacin.

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调查研究

Tong Yuanyuan;Zhang Li;Yang Jinsheng;Yang Xiaohui;Sun Zhenxiao

2010, 12(3): 175-3.

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Objective: To investigate the clinical characteristics and causes of liver damage related to Xiaohe tablets in order to provide reference for clinical rational drug use. Methods: "Xiaohe tablets" were selected as the search words and the China Hospital Knowledge Database (CHKD, 1994-2009）and Chinese Biomedical Literature Database (CBM, 1978-2009）were searched. The case reports of liver damage associated with Xiaohe tablets were collected and analysed. Results: A total of 194 patients were collected. All patients were women with age of 17 to 55 years. Of them, 68 were indicated the dosage of 2-7 pills thrice daily. The duration of drug use was 14-180 d. The patients presented with gastrointestinal symptoms such as nausea, abdominal distension after about 50 days of therapy and yellowish skin and sclera after 30-140 days of therapy. Biochemical test results were as follows: ALT 68-1 700U/L, AST 40-1 260 U/L, TBil 8.0-795.4 μmol/L, DBil 2.3-391.8 μmol/L. Of 194 patients, 10 underwent pathological examination of liver tissue, showing hepatocyte swelling, scanty cytoplasm, ballooning degeneration, and hepatocyte necrosis. Most patients restored gradually 10 days to 4 months after drug discontinuation. Of them, 190 (97.9%) were clinical cure, 3 (1.5%) improved, and 1 (0.5%) with acute liver failure died of septic shock. Conclusion: Xiaohe tablets can induce liver damage, and most of them are reversible; the liver damage may be related to dosage and duration of drug therapy; the drug should be avoided to use for patients having liver disease; and the patients’liver function should be closely monitored during the drug use.

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安全用药

Neurotoxicity of carbapenem antibiotics

Ma Lili;Zhang Jian

2010, 12(3): 178-5.

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Carbapenems are a class of βlactam antibiotics with a broad spectum of antibacterial activity. The commonly used carbapenems are imipenem, meropenem, ertapenem, faropenem, panipenem, doripenem, and so on. Carbapenem antibiotics could induce neurotoxicity and the incidence is about 0.01%-0.3%. The main clinical manifestations of neurotoxicity are headache, convulsions, seizures, myoclonus, and disorder of consciousness. The mechanism of neurotoxicity induced by carbapenem antibiotics is thought to be related to inhibition of the γ-aminobutyric acid (γ-GABA) binding to the receptors and interruption neural inhibitory effect of γ-GABA eventally resulting in seizures and other neurological disorders. The risk factors for neurotoxic reactions include decreased renal function, pathologic changes in CNS, and combination therapy. The prevention and treatment of neurotoxicity induced by carbapenems are as follows: it is essential to consider appropriate choice of carbapenem antibiotics according to the relationship between seizures and the different types of the antibiotics; dosage should be carefully adjusted in patients with renal failure; concomitant use with other drugs such as highdose theophylline, NSAIDs, probenecid, and so on should be avoided; the children and elderly patients should be monitored during treatment; if carbapeneminduced seizures occur, the agent should be stopped and diazepam or sodium valproate may be given if necessary; hemodialysis could be used for patients with uncontrolled seizures induced by the antibiotics.

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病例报告

Multiple organ dysfunction syndrome associated with isoniazid

Huang Jiantong

2010, 12(3): 182-2.

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A 74yearold woman with tuberculosis pleuritis received streptomycin, isoniazid, rifampin, and pyrazinamide. After one week of therapy, her liver and renal damage occurred. Antituberculous drugs were stopped and her liver and renal functions normalized. Antituberculous treatment was given again and the patient developed fever and skin pruritis. Her symptoms improved after discontinuing these drugs and receiving antiallergic treatment. Then she was administered isoniazid 0.2 g, pyrazinamide 1.0 g, ethambutol 0.75 g. Thirty minutes later, she experienced cold intolerance, fever, nausea, vomiting, confusion, and lip cyanosis. Her termperature was 40.5℃ and pulse was 120 beats/min. Subsequently, the patient presented with oliguresis, cervical rigidity. Her muscle strength was grade 2 in left upper and lower limbs while grade 0 in right upper and lower limbs. Laboratory tests revealed the following levels and values: ALT 41 U/L, AST 99 U/L, BUN 13.57 mmol/L, SCr 481 μmol/L, myoglobin 2 470 μg/L, troponin 0.52 μg/L, LDH 442 U/L, α-hydroxybutyric dehydrogenase 315 U/L, CK 2 789 U/L, CK-MB 50 U/L, and serum amylase 384 U/L. She was treated with symptomatic and supportive therapies and, two days later, her conditions relieved. Antituberculous treatment with pyrazinamide, ethambutol, levofloxacin was given again and there was no recurrence of any adverse reactions after further two months of treatments

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安全用药

Clostridium difficile-associated diarrhea: prevention and management

Xia Jinghong;Liu Shuang;Li Hong

2010, 12(3): 183-5.

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Clostridium difficileassociated diarrhea (CDAD) mainly occurs in association with the administration of broadspectrum antibiotics. The incidence of CDAD has been trending upward. The antibiotics frequently implicated in Clostridium difficileassociated diarrhea are amoxicillin, clindamycin, lincomycin, cephalosporins. The time to CDAD onset generally is 5-10 days after antibiotics treatment. CDAD in inpatients is 15%～25% of antibacterialassociated diarrhea(AAD) patients and the mortality is about 6%~30%. The mechanism of the occurrence of CDAD is that antibiotics inhibit normal gastrointestinal flora and enable Clostridium difficile to multiple and release toxin A (enterotoxin) and toxin B (cytotoxin) that induce intestinal mucosal injury as well as degeneration, necrosis, and fibrinous exudation of epithelial cells, leading to diarrhea and other symptoms. Clinical presentations mainly include diarrhea(watery stools), fever, abdominal pain, colitis, pseudomembranous (PMC), toxic megacolon, sepsis, and even death. The risk factors for CDAD are the elderly, serious underlying diseases, a prolonged hospitalization, administration of broadspectrum antibiotics and weakened immune function. If CDAD is confirmed, the suspected antibiotics should be withdrawn and metronidazole or vancomycin could be given. The patients with relapse may be treated with another 10~14 days course of metronidazole or vancomycin. The patients with multiple relapses may be treated with cholestyramine, probiotics, and human immulloglobulin.

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安全用药

Ibutilide-induced arrhythmias: prevention and treatment

Ren Zhenwen;Zhou Ying;Cui Yimin;

2010, 12(3): 188-6.

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Ibutilide is a class Ⅲ antiarrhythmic used in the treatment of atrial fibrillation or flutter. One of the serious adverse reactions to ibutilide is arrhythmias, manifested as QT interval prolongation and torsade de pointes ( TdP ). The time to TdP onset is within 1 hour after drug administration. The mechanism of ibutilideinduced TdP may be related to the repolarization abnormalities. The measures of prevention and treatment of ibutilideinduced arrhythmias are as follows: if arrhythemias occures, the drug showed be withdrawn immediately, electrical cardioversion, isoprenaline and atropin injections, potassium and magnesium supplements as well as beta blockers should be given; electrolyle abnormalities should be corrected before treatment strart; concomitent use of ibutilide with other antiarrhythmics should be avoided; ECG monitoring should be carried out during ibutilide treatment; Ibutilideinduced arrhythmics is liable to occure in women than men, and caution is needed when using ibutilide in women.

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滥用误用

Methamphetamine abstinence reactions and relapse

Zhang Kaigao

2010, 12(3): 194-3.

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Methamphetamine(MA), commonly called as ice, is a stimulant of the family of phenethylamines, which is one of widely abused illicit drugs in the world. Methamphetamine increases the release and blocks the reuptake of the monoamine neurontransmitter, such as dopamine, norepinephrine, and serotonin, leading to high level of the chemicals in the synaptic cleft and inducing psychological and physical effects. Methamphetamine users may develop euphoria, increased physical activity and hypersexuality. Sudden withdrawal of methamphetamine in methamphetaminedependent subjects may result in abstinence reactions including sleep disturbance, depressed mood, anxiety, agnosia, and decreased physical activity. A methamphetamine abstinence reaction can be categoried into two phases: the acute phase (lasting 7～10 days), and the subacute phase (lasting a further 2 weeks). The relapse rates to the methamphetaminedependent subjects is rather high. Preventing the occurrence of relapse is of very important practical siginifance.

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病例报告

Anaphylactic shock results from a cervus and cucumis polypeptide infusioin

Xu Weifeng

2010, 12(3): 200-2.

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A 51yearold man was hospitalised for undergoing surgery for tibial plateau fracture. One day before surgery, he received an IV infusion of cefpiramide 1.0 g twice daily. After surgery, cefpiramide was continued. After the end of cefpiramide infusion, he was given an IV infusion of cervus and cucumis polypeptide 24 mg in 0.9% sodium chloride 250 mL once daily. About 20 minutes after infusion start, the patient suddenly developed chest distress, flushing in face and neck, polyhidrosis, and undetectable blood pressure. Electrocardiogram monitoring revealed SaO₂ 0.81 and a heart rate of 114 beats/min. Cervus and cucmis polypeptide was stopped and he was treated with symptomatic and supportive therapies, and then his symptoms relieved. Subsequently, cervus and cucmis polypeptide was discontinued and cefphiramide infusion were continued for 3 days, his abovementioned symptoms did not recur.

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病例报告

Acute renal damage following highdose methotrexatebased combined chemotherapy and the relationship between renal damage and genetype

Huang JinaZhou MinaLiu JingbFang KunWang ZhidongbZhu LingbQiao AizhenbZhu Daqiang

2010, 12(3): 201-4.

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A 21yearold man received combined chemotherapy with methotrexate 3.0 g, ifosfamide 2.0 g, gemcitabine 1.0 g, vinorelbine 20 mg, bortezomib 2.05 mg, Lasparaginase 10 000 U and prednisone 100 mg before undergoing transplantation of bone marrow stem cells denoted by his mother. Twentyfour hours later, he developed oliguria. His SCr, BUN, and uric acid levels were 246 μmol/L, 16.3 mmol/L, and 497 mmol/L, respectively. Thirtysix hours later, his blood methotrexate concentration was 25 μmol/L. Ultrasound examination revealed a slightly heterogeneous distribution in the renal density and a 2.1 cm x 2.3 cm echofree area in the right upper pole of kidney. Acute renal damage was diagnosed. The patient received treatments including calcium folinated 200 mg/3 h, adequate dehydration, alkalization of urine, and hemodialysis. The blood methotrexate concentration decreased, and his SCr and BUN levels returned to normal. Analysis of methylenetetrahydrofolate reductase C677T genotype in his mother’s peripheral blood lymphocytes, the patient’s peripheral blood lymphocytes and oral epithelial cells revealed that C:T was 1:1,1:1 and 1:1.5 respectively. Therefore, it suggested that the renal damage might be link to genotype.

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病例报告

Cardiac arrest from acute cardiotoxic reactions induced by daunorubicin in a china

Duan Yanlong;Wang Bin;Ma Xiaoli;Zhang Dawei;Yang Jing;Zhang Yonghong

2010, 12(3): 204-3.

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A boy aged ten years and eight months with nonHodgkin lymphoma was hospitalized for chemotherapy. On day 8, 15, and 22 of chemotherapy, the patient received an IV push of vincristine 2 mg once daily and an IV infusion of daunorubicin 50 mg via pump. Fortytwo hours after the third administration of daunorubicin, he suddenly developed confusion, mydriasis, disappeared light reflex, respiratory arrest, undetectable blood pressure, ventricular fibrillation. Electrocardiogram showed cardiac arrest. The resuscitations were given immediately and, two minutes later, he experienced sinus rhythm and his consciousness recovered gradually. Subsequently, he presented with another two similar episodes and each episode lasted for about 10 minutes. Three days later, a 24hour ECG revealed 9 isolated atrial premature beats, 1 ventricular premature beat, and widespread STsegment changes. At 2year follow up, daunorubicin was not given and vincristine was continued, and the patient had no recurrence of similar episode.

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Hyponatremia produced by carbamazepine in four patients

Liu Aihua

2010, 12(3): 206-3.

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Four patients (three men and one woman aged 22-60 years) were diagnosed as having viral encephalitis, symptomatic epilepsy, trigeminal neuralgia and cerebral hemorrhage, respectively. They received carbamazepine 0.10.2g three times daily. Within one month after starting carbamazepine, they developed apathy, somnolence and anorexia. Their serum sodium levels decreased from 141.0, 143.0, 141.6 and 139.8mmol/L to 122.2, 112.1, 121.8 and 116.6 mmol/L, respectively. Carbamazepine was withdrawn and changed to other drugs. Meanwhile the patients received symptomatic and supportive therapies. Their levels of serum sodium returned to 138.0, 144.0, 139.2 and 144.2 mmol/L, respectively.

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病例报告

Guillain-Barre syndrome associated with monosialotetrahexosylganglioside Tang Donglei1a,2, Liu Fang1a, Sun Qingli1b, Xu Yingsheng1b

2010, 12(3): 208-2.

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A 52yearold man with trauma received an IV infusion of monosialotetrahexosylganglioside 40 mg dissolved in 0.9% sodium chloride 250 mL once daily and IM gastrodine 200 mg twice daily for 14 days. Eight days later, the patient suddenly developed aching pain in limbs with weakness. Ten days later, he experienced worsened weakness in extremities and was unable to stand upright accompanied by polyhidrosis. Physical examinations showed decreased myodynamia and muscular tension in limbs and tendon reflexes were absent. Cerebrospinal fluid testing revealed albuminocytological dissociation. He received multiple treatments, including peripheral nerve nourishment, dehydration, and improving brain cell metabolism. Monosialotetrahexosylganglioside and gastrodine were not readministered. His conditions relieved after 15 days.

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病例报告

Tardive dyskinesia attributed to sulpiride

Li Lihua;Zhao Yilei;Jiang Wei

2010, 12(3): 210-1.

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A 34-year-old man with psychosis received sulpiride 100 mg twice daily. Four weeks later, the patient experienced involuntary tongue thrusting with salivation. Sulpiride was withdrawn and he was given scopolamine and diazepam. Three hours later, his conditions relieved and, three days later, the symptoms disappeared. Subsequently, his regimen was swtiched to olanzapine for psychosis. He had no recurrence at 2month follow up.

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病例报告

Neuroleptic malignant syndrome due to combination therapy with quetiapine and zolpidem

Dai Huiqing;Zhang Wenyue;Li Quanzhi

2010, 12(3): 211-2.

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A 55yearold woman received quetiapine 0.2 g once daily and zolpidem 5 mg at bedtime for abnormal behavior, agitation, and insomnia. After 9 days of treatment, the patient developed dysphagia, polyhydrosis, followed by gradual dysphasia, occasional delirium state, involuntary convulsion of both hands and hypermyotonia in extremities. Her temperature was 38℃ and blood pressure was 171/87 mm Hg. Laboratory tests revealed the following values: WBC count 24.2×10⁹ /L, CK 22 820 U/L, CK-MB 225 U/L, myoglobin 1 790 U/L, LDH 2 565 U/L. Quetiapine and zolpidem were discontinued the electrolyte abnormalities were corrected, and she received liverprotective treatment, supportive therapy with nutrition, and hemodialysis. On day 10, the symptoms relieved obviously. And she was discharged after 36 days of hospitalization.

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病例报告

Mental disorder secondary to zolpidem tartrate

Nie Xina;Zhang Yatongb

2010, 12(3): 212-2.

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A 74yearold man with gastric cancer was hospitalised for chemotherapy. The next day, he was given zolpidem tartrate 10 mg for insomnia at night. One hour later, he developed agitation, confusion, auditory hallucinations, and delirium. These symptoms did not relieved after administration of promethazine and haloperidol. Four hours later, his symptoms subsided sponancously and his consciouness recovered, however, he could not remember the prior events. The abovementioned symptoms did not reccur after the drug discontinuation.

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病例报告

Renal damage caused by adefovir dipivoxil in 2 patients

Zhao Haiqin;Han Wenmei

2010, 12(3): 213-2.

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Two men with chronic hepatitis, aged 40 and 72 years, were treated with adefovir dipivoxil 10 mg once daily for abnormal liver function. They experienced renal damage in the third and second years, respectively. The patient 1 had a SCr level of 166 μmol/L and a serum phosphorus level of 0.69 mmol/L; the patient 2 had a SCr level of 124 μmol/L, a serum phosphorus level of 0.61 mmol/L, and a 2+ urine protein. Adefovir dipivoxil was reduced to 10 mg once every other day, and then their biochemical indices normalized gradually. Later, the patient 2 voluntarily increased adefovir dipivoxil dosage to 10 mg once daily for elevated HBV DNA level. One month later, his SCr level was 119 μmol/L. Subsequently, his renal function returned to within normal range after his dosage reduction again.

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病例报告

TypeⅡrespiratory failure with acute renal failure caused by voriconazole

Zeng Huiqing;Zheng Yali;Lv Zhi;Zhang Xueling;Wang Huiling

2010, 12(3): 215-2.

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A 71yearold man received voriconazole for aspergillosis. An IV infusion of voriconazole 300 mg twice daily on day 1 and 200 mg twice daily on day 2 were given. Two days later, the patient developed short of breath, tachycardia and was unable to keep horizontal position. A blood gas analysis revealed the following value: pH 7.32，PO₂ 7.02 kPa，PCO₂ 8.59 kPa，BE-6.25. On day 4, his 24hour urine volume was 300 mL, and his BUN and SCr levels were 28.32 mmol/L and 318 μmol/L, respectively. Voriconazole was considered to be the causative agent for type Ⅱ respiratory failure with acute renal failure. Voriconazole was discontinued and change to an IV infusion of micafungin 100 mg/d. Meanwhile symptomatic therapy and hemodialysis were given.Three days later, the patient returned to normal gradually.

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病例报告

Hepatic dysfunction induced by fluvastatin sodium

Kong Feifei;Tan Xingqi;Guo Liangjun

2010, 12(3): 216-2.

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A 65yearold woman received fluvastatin sodium 40mg once daily for decreasing the serum levels of total cholestero1 and triglyceride. Ten days later, the patient developed asthenia and fatigue. One month later, laboratory tests revealed the following levels: AST 434 U/L，ALT 550 U/L，γ-GT 307 U/L，AKP 270 U/L. Fluvastatin sodium was withdrawn immediately. The patient received an IV infusion of glutathione 1.8g in 5% glucose 250mL. After 20 days of therapy, her liver function obviously improved. Her AST and ALT levels decreased to 48U/L and 32 U/L,respectively.

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病例报告

Rhabdomyolysis related to moxifloxacin in two patients

Ren Xiaolei;Xu Pan;Li Yuzhen

2010, 12(3): 217-2.

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Two male patients, aged 87 and 74 years, respectively, received an IV infusion of moxifloxacin 0.4 g once daily for pulmonary infections. On day 3, they both developed creatine kinase elevation and positive occult blood in urine. Their CK levels were 5 964U/L and 3 531U/L, respectively. Patient 1 experienced pressing pain on bilateral calf muscle. Moxifloxacin was discontinued and the two patients were given ceftazidime and meropenem, respectively. Treatment with alkalinization of their urine was given and their symptoms improved.

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病例报告

Anaphylactic shock due to an IV infusion of ribavirin

Zhang Hongmei

2010, 12(3): 219-1.

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A 45yearold man received an IV infusion of cefotaxime sodium 4g in 0.9% sidium chloride 250 mL and Shuanghuanglian injection 40 mL in 5% glucose 250 mL for upper respiratory tract infection. On second day, IV infusions of cefotaxime sodium and Shuanghuanglian injection were given continuously and no adverse reaction developed. When receiving an IV infusion of ribavirin about 50mL, the patients developed pale, chest distress, short of breath with a BP of 40/10 mm Hg. The infusion was stopped immediately. Oxygen inhalation therapy, adrenalin, dexamethasone, dopamine, and calcium gluconate were given. The patient’s symptoms improved. On third day, the patient did not receive ribavirin infusion and he had no adverse reaction again.

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病例报告

Allopurinol hypersensitivity syndrome in a patient

Feng Renyang

2010, 12(3): 220-1.

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A 46yearold male patient received allopurinol 0.2 g twice daily for hyperuricaemia. After 28 days of therapy, the patient experienced sheeted edematous erythema with itching on his trunk and extremities. Allopurinol was stopped. Subsequently, his symptoms worsened and he presented with generalized flushing, and swelling with purpura, palpebral edema, perioral exudation and sabbing. Laboratory examinations revealed a WBC count of 20.2×109/L with 0.32 eosinophils and an ALT level of 52 U/L. A bone marrow smear showed his eosinophils increased.The patient was treated with an IV infusion of methylprednisolone 80 mg dissolved in 5% glucose 250 mL. Three days later, his symptoms improved.

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病例报告

Repaglinide-associated atypical hypoglycemia occurring in a patient with hypothyroidism

Zhang Renlinga;Qi Yingb

2010, 12(3): 221-1.

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A 66yearold woman with hyperthyroidism received levothyroxine sodium 50 μg once daily for three years. She was recently diagnosed with type II diabetes. Repaglinide 1 mg twice daily was added to her regimen.One week later, the patient developed unconsciouness. Laboratory testing showed a blood glucose level of 2.3 mmol/L. Hypoglycemia was diagnosed and repaglinide was stopped. Glucose injection was given. Her blood glucose levels increased to 3.9,5.1, and 8.7 mmol/L. Her consciouness gradually recovered. Her repaglinide therapy was replaced with neteglinide 120 mg thrice daily. And her hypoglycemia did not recur

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病例报告

Hematuria induced by Pulean tablets

Hao Zhiqiang

2010, 12(3): 222-1.

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A 45yearold man suffering from prostatitis took 4 Pulean tablets thrice daily. He developed hematuria after one week of treatment. Pulean tablets were discontiuned and routine urine test showed that hematuria disappeared. Two months later, the patient took pulean tablets again according to his previous dosage and then hematuria recurred . The drug was stopped, and his hematuria did not recur at oneyear follow up.

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中药不良反应

Liver damage induced by Sanjiuweitai

Luo Xiao;Cheng Sheng

2010, 12(3): 223-2.

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A 51yearold woman received Sanjiuweitai for chronic atrophic gastritis. Three months later, the patient developed icteric sclera and dark urine. Laboratory tests revealed the following levels and values: ALT 215 U/L, AST 158 U/L, ALP 134 U/L, γ-GT 129 U/L, TP 69.5g/L, ALB 33.5 g/L, TBil 139.2 μmol/L, DBil 71.0 μmol/L, IBil 68. 2 μmol/L. Viral hepatitis was excluded. Liver biospy revealed hepatocellular swelling and necrosis. Druginduced liver damage was diagnosed. Sanjiuweitai was discontinued and liverprotective treatment were given. One month later, her hepatic function returned to normal.

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2010 Volume 12 Issue 3 Published: 28 June 2010

临床论著

实验研究

病例报告

实验研究

调查研究

安全用药

病例报告

安全用药

滥用误用

病例报告

病例报告

中药不良反应