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The Medical Letter on Drugs and... Dec 2018
Review
Topics: Antidepressive Agents; Benzodiazepines; Chronic Disease; Cognitive Behavioral Therapy; Humans; Hypnotics and Sedatives; Plant Preparations; Receptors, Melatonin; Sleep Initiation and Maintenance Disorders
PubMed: 30625122
DOI: No ID Found -
American Family Physician Nov 2018Women often see their primary care physicians for common acute conditions during pregnancy. These conditions may be caused by pregnancy (obstetric problems) or worsened... (Review)
Review
Women often see their primary care physicians for common acute conditions during pregnancy. These conditions may be caused by pregnancy (obstetric problems) or worsened by pregnancy (obstetrically aggravated problems), or they may require special consideration during pregnancy because of maternal or fetal risks (nonobstetric problems). Primary care physicians should know the differential diagnosis for common conditions during pregnancy and recognize the important findings of obstetric and urgent nonobstetric problems. The family physician can evaluate and treat most nonobstetric problems, although obstetric problems require referral to a primary maternity care clinician. A tiered approach, including routinely looking for all-cause red flag symptoms and signs, while remaining aware of estimated gestational age, allows for high-quality care and shared decision making between the family physician and the pregnant patient. When treating common causes of nausea and epigastric pain/gastroesophageal reflux, lifestyle modifications are considered the safest and first-choice therapy, followed by well-established low-risk therapies, such as vitamin B6 (pyridoxine) and doxylamine for nausea, and antacids not containing salicylates (found in bismuth combination products) for gastroesophageal reflux. Other common conditions during pregnancy are best treated with low-risk therapies, such as using antihistamines or topical steroids for rashes, first-generation cephalosporins or amoxicillin for cystitis, and physical therapy and acetaminophen for low back pain and headaches.
Topics: Acute Disease; Diagnosis, Differential; Female; Humans; Pregnancy; Pregnancy Complications; Primary Health Care
PubMed: 30325641
DOI: No ID Found -
PloS One 2022To compare patterns in use of different antiemetics during pregnancy in Canada, the United Kingdom, and the United States, between 2002 and 2014.
OBJECTIVE
To compare patterns in use of different antiemetics during pregnancy in Canada, the United Kingdom, and the United States, between 2002 and 2014.
METHODS
We constructed population-based cohorts of pregnant women using administrative healthcare data from five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan), the Clinical Practice Research Datalink from the United Kingdom, and the IBM MarketScan Research Databases from the United States. We included pregnancies ending in live births, stillbirth, spontaneous abortion, or induced abortion. We determined maternal use of antiemetics from pharmacy claims in Canada and the United States and from prescriptions in the United Kingdom.
RESULTS
The most common outcome of 3 848 734 included pregnancies (started 2002-2014) was live birth (66.7% of all pregnancies) followed by spontaneous abortion (20.2%). Use of antiemetics during pregnancy increased over time in all three countries. Canada had the highest prevalence of use of prescription antiemetics during pregnancy (17.7% of pregnancies overall, 13.2% of pregnancies in 2002, and 18.9% in 2014), followed by the United States (14.0% overall, 8.9% in 2007, and 18.1% in 2014), and the United Kingdom (5.0% overall, 4.2% in 2002, and 6.5% in 2014). Besides use of antiemetic drugs being considerably lower in the United Kingdom, the increase in its use over time was more modest. The most commonly used antiemetic was combination doxylamine/pyridoxine in Canada (95.2% of pregnancies treated with antiemetics), ondansetron in the United States (72.2%), and prochlorperazine in the United Kingdom (63.5%).
CONCLUSIONS
In this large cohort study, we observed an overall increase in antiemetic use during pregnancy, and patterns of use varied across jurisdictions. Continued monitoring of antiemetic use and further research are warranted to better understand the reasons for differences in use of these medications and to assess their benefit-risk profile in this population.
Topics: Pregnancy; Female; Humans; Antiemetics; Abortion, Spontaneous; Cohort Studies; Retrospective Studies; Gastrointestinal Agents; Alberta
PubMed: 36454900
DOI: 10.1371/journal.pone.0277623 -
Pediatrics Nov 2021In 2008, over-the-counter cough and cold medications (CCMs) underwent labeling changes in response to safety concerns, including fatalities, reported in children exposed...
BACKGROUND AND OBJECTIVES
In 2008, over-the-counter cough and cold medications (CCMs) underwent labeling changes in response to safety concerns, including fatalities, reported in children exposed to CCMs. The objective of this study is to describe fatalities associated with exposures to CCMs in children <12 years old that were detected by a safety surveillance system from 2008 to 2016.
METHODS
Fatalities in children <12 years old that occurred between 2008 and 2016 associated with oral exposure to one or more CCMs were identified by the Pediatric Cough and Cold Safety Surveillance System. An expert panel reviewed all cases to determine the causal relationship between the exposure and death, if the intent of exposure was therapeutic, and if the dose was supratherapeutic. Other contributing factors related to the child's death were also identified as part of a root cause analysis.
RESULTS
Of the 180 eligible fatalities captured during the study period, 40 were judged by the expert panel to be either related or potentially related to the CCM. Of these, the majority ( = 24; 60.0%) occurred in children <2 years old and involved nontherapeutic intent ( = 22; 55.0%). The most frequently involved index ingredient was diphenhydramine ( = 28; 70.0%). In 6 cases ( = 6; 15.0%), the CCM was administered to murder the child. In another 7 cases ( = 7; 17.5%), death followed the intentional use of the CCM to sedate the child.
CONCLUSIONS
Pediatric fatalities associated with CCMs occurred primarily in young children after deliberate medication administration with nontherapeutic intent by a caregiver.
Topics: Antitussive Agents; Brompheniramine; Child; Child, Preschool; Chlorpheniramine; Dextromethorphan; Diphenhydramine; Doxylamine; Drug Labeling; Drug-Related Side Effects and Adverse Reactions; Female; Guaifenesin; Homicide; Humans; Infant; Male; Nonprescription Drugs; Phenylephrine; Pseudoephedrine
PubMed: 34607934
DOI: 10.1542/peds.2020-049536 -
Journal of Hazardous Materials Jan 2021Pharmaceutical contaminants in environment induce unexpected effects on ecological systems and human; thus, development of efficient technologies for their removal is...
Pharmaceutical contaminants in environment induce unexpected effects on ecological systems and human; thus, development of efficient technologies for their removal is immensely necessary. In this study, biodegradation and metabolic fate of a frequently found pharmaceutical contaminant, doxylamine by Typha angustifolia and Ipomoea aquatica was investigated. Microbial community of the plant rhizosphere has been identified to understand the important roles of the functional microbes. The plants reduced 48-80.5 % of doxylamine through hydrolysis/dehydroxylation and carbonylation/decarbonylation. A constructed phytobed co-planted with T. angustifolia and I. aquatica removed 77.3 %, 100 %, 83.67 %, and 61.13 % of chemical oxygen demand, total nitrogen, total phosphorus, and doxylamine respectively from real wastewater. High-throughput sequencing of soil and rhizosphere indicated that the phyla Proteobacteria, Bacteroidetes, Firmicutes, Planctomycetes, Actinobacteria, and Cyanobacteria dominated the microbial communities of the phytobed. Current study has demonstrated the applicability of the developed phytobeds for the treatment of doxylamine from municipal wastewater and provide a comprehensive understanding of its metabolism through plant and its rhizospheric microbial communities.
Topics: Biodegradation, Environmental; Doxylamine; Humans; Ipomoea; Microbiota; Rhizosphere; Soil Microbiology; Typhaceae; Wastewater
PubMed: 32659588
DOI: 10.1016/j.jhazmat.2020.123404 -
Maedica Dec 2020Prescribing drugs in pregnancy is a challenging approach for doctors. To evaluate drugs used in pregnancy. A prospective, cross-sectional, descriptive study was carried...
Prescribing drugs in pregnancy is a challenging approach for doctors. To evaluate drugs used in pregnancy. A prospective, cross-sectional, descriptive study was carried out by collecting and evaluating prescriptions on various parameters. More than 50% of antenatal care attendees belonged to the 18-24 age group, and 102 (41.46%) were primigravidae. The main presenting complaints were abdominal pain (25.16%), followed by nausea and vomiting (22.60%) and fever (11.14%); the maximum number of visits to hospital was seen in the first trimester (40.53%), followed by the third trimester (38.42%). It was observed that 25.78% of prescriptions did not contain any medicine. The average number of prescribed medicines was 2.32, with the lowest in the first trimester (1.77) and the highest in the second trimester (2.78). It was noticed that 74.11% and 71.26% of all prescribed medicines were from essential medicine list and generics, respectively. Of all prescribed drugs, 11.52% were antimicrobials, and 4.11% injectable dosage forms. Vitamins and minerals were the preferred prescribed medicines (34.82%), followed by antimicrobial agents (11.52%) and doxylamine plus pyridoxine (10.16%). Also, doctors who made the drug choice during antenatal visits were more confident in evidence-based safety as per New Pregnancy and Lactation Rule (PPLR); 45.37% of drugs were prescribed from category A, followed by 38.25% from category B and none from group X. Doctors were concerned about prescribing safer drugs in pregnancy and were more confident in evidence-based medication.
PubMed: 33603908
DOI: 10.26574/maedica.2020.15.4.503 -
Journal of Pharmaceutical and... Oct 2022A simple, rapid, sensitive and specific LC-MS/MS method was developed and validated for the quantitative determination of doxylamine in human plasma, using isotope...
A simple, rapid, sensitive and specific LC-MS/MS method was developed and validated for the quantitative determination of doxylamine in human plasma, using isotope doxylamine-d5 as internal standard (IS). The detection was conducted on a QTRAP 5500 tandem mass spectrometer coupled with electrospray ionization (ESI) source in positive ion mode. Quantification was achieved by positive electrospray ionization containing multiple reaction monitoring (MRM) transitions of m/z 271.0→182.0 for doxylamine and m/z 276.2→187.3 for IS. The mobile phase A was methanol, and mobile phase B was 20 mM ammonium acetate (0.2 % formic acid) in water, using a gradient elution procedure at a flow rate of 0.6 mL/min. The method was validated with a sensitivity of 0.500 ng/mL and a linear concentration range of 0.500-200 ng/mL. The inter-batch precision (%CV) was less than 5.4 %, and the accuracy deviation (%RE) ranged from - 10.6 % to 3.7 %; the inter-batch precision (%CV) was less than 6.6 %, and the accuracy deviation (%RE) was ranged from - 2.7 % to 0.1 %. The selectivity, sensitivity, extraction recovery, matrix effect, carryover, dilution reliability, stability and other characteristics were within the acceptable range. This validated method was successfully applied to a bioequivalence study that orally administered 25 mg of doxylamine succinate tablets in 60 healthy Chinese volunteers.
Topics: Administration, Oral; China; Chromatography, Liquid; Doxylamine; Healthy Volunteers; Histamine H1 Antagonists; Humans; Methanol; Reproducibility of Results; Spectrometry, Mass, Electrospray Ionization; Tablets; Tandem Mass Spectrometry; Therapeutic Equivalency
PubMed: 35994945
DOI: 10.1016/j.jpba.2022.114984 -
The Medical Letter on Drugs and... Jul 2022
Topics: Humans; Hypnotics and Sedatives; Imidazoles; Pyrrolidines; Sleep Initiation and Maintenance Disorders
PubMed: 35802843
DOI: No ID Found -
Obstetrics and Gynecology Feb 2015
Topics: Doxylamine; Female; Humans; Morning Sickness; Ondansetron; Pregnancy; Pyridoxine
PubMed: 25611628
DOI: 10.1097/AOG.0000000000000651 -
Frontiers in Microbiology 2020Pharmaceutical contaminants (PCs) have been recognized as emerging contaminants causing unexpected consequences to environment and humans. There is an urgent need for...
Pharmaceutical contaminants (PCs) have been recognized as emerging contaminants causing unexpected consequences to environment and humans. There is an urgent need for development of efficient technologies to treat these PCs from water. The current study has investigated the removal capacity of a green microalgal species, , for doxylamine, chemical oxygen demand (COD), and nutrients from real wastewater. Results have indicated that can grow well in the doxylamine-polluted wastewater with the achievement of 56, 78.5, 100, and 89% removal of doxylamine, COD, total nitrogen (TN), and total phosphorus (TP). Addition of 2 g L bicarbonate enhanced the removal of doxylamine up to 63% and slightly inhibited the removal of COD. Decreased carbohydrate (28-26%) and increased protein content (30-33%) of the harvested biomass have been observed after cultivation in the wastewater. The current study has shown the feasibility of using microalgae-based biotechnologies for PC-contaminated wastewater.
PubMed: 33224120
DOI: 10.3389/fmicb.2020.584020