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Journal of Community Hospital Internal... 2021is a gram-negative bacterium that colonizes domestic animals. It is commonly implicated in bite and scratch wounds, potentially resulting in cellulitis, superficial...
is a gram-negative bacterium that colonizes domestic animals. It is commonly implicated in bite and scratch wounds, potentially resulting in cellulitis, superficial abscesses, osteomyelitis, or peritonitis. Rarely, it can lead to bacteremia and septic shock in high-risk patients. We present an atypical presentation of bacteremia and sepsis in a patient with stage 4 decompensated cirrhosis. The patient presented with melena and altered mental status with CT imaging showing a heterogeneous nodular liver along with an enlarged portal vein, gastric varices, and ascites consistent with decompensated cirrhosis. The patient was initially managed with intravenous (IV) octreotide and pantoprazole, blood and platelet transfusions, and broad-spectrum antibiotics. Upper endoscopy showed diffuse non-bleeding esophageal and gastric varices, which required band ligation and continued IV octreotide therapy. The infection resolved after a 7-day course of IV ceftriaxone.
PubMed: 34234911
DOI: 10.1080/20009666.2021.1906490 -
Therapeutics and Clinical Risk... 2015Coprescribing of clopidogrel and other drugs is common. Available reviews have addressed the drug-drug interactions (DDIs) when clopidogrel is as an object drug, or... (Review)
Review
BACKGROUND
Coprescribing of clopidogrel and other drugs is common. Available reviews have addressed the drug-drug interactions (DDIs) when clopidogrel is as an object drug, or focused on combination use of clopidogrel and a special class of drugs. Clinicians may still be ignorant of those DDIs when clopidogrel is a precipitant drug, the factors determining the degree of DDIs, and corresponding risk management.
METHODS
A literature search was performed using PubMed, MEDLINE, Web of Science, and the Cochrane Library to analyze the pharmacokinetic DDIs of clopidogrel and new P2Y12 receptor inhibitors.
RESULTS
Clopidogrel affects the pharmacokinetics of cerivastatin, repaglinide, ferulic acid, sibutramine, efavirenz, and omeprazole. Low efficacy of clopidogrel is anticipated in the presence of omeprazole, esomeprazole, morphine, grapefruit juice, scutellarin, fluoxetine, azole antifungals, calcium channel blockers, sulfonylureas, and ritonavir. Augmented antiplatelet effects are anticipated when clopidogrel is coprescribed with aspirin, curcumin, cyclosporin, St John's wort, rifampicin, and angiotensin-converting enzyme inhibitors. The factors determining the degree of DDIs with clopidogrel include genetic status (eg, cytochrome P540 [CYP]2B6*6, CYP2C19 polymorphism, CYP3A5*3, CYP3A4*1G, and CYP1A2-163C.A), species differences, and dose strength. The DDI risk does not exhibit a class effect, eg, the effects of clopidogrel on cerivastatin versus other statins, the effects of proton pump inhibitors on clopidogrel (omeprazole, esomeprazole versus pantoprazole, rabeprazole), the effects of rifampicin on clopidogrel versus ticagrelor and prasugrel, and the effects of calcium channel blockers on clopidogrel (amlodipine versus P-glycoprotein-inhibiting calcium channel blockers). The mechanism of the DDIs with clopidogrel involves modulating CYP enzymes (eg, CYP2B6, CYP2C8, CYP2C19, and CYP3A4), paraoxonase-1, hepatic carboxylesterase 1, P-glycoprotein, and organic anion transporter family member 1B1.
CONCLUSION
Effective and safe clopidogrel combination therapy can be achieved by increasing the awareness of potential changes in efficacy and toxicity, rationally selecting alternatives, tailoring drug therapy based on genotype, checking the appropriateness of physician orders, and performing therapeutic monitoring.
PubMed: 25848291
DOI: 10.2147/TCRM.S80437 -
Journal of Immunology Research 2021Ion transport modulators are most commonly used to treat various noncommunicable diseases including diabetes and hypertension. They are also known to bind to receptors...
Ion transport modulators are most commonly used to treat various noncommunicable diseases including diabetes and hypertension. They are also known to bind to receptors on various immune cells, but the immunomodulatory properties of most ion transport modulators have not been fully elucidated. We assessed the effects of thirteen FDA-approved ion transport modulators, namely, ambroxol HCl, amiloride HCl, diazoxide, digoxin, furosemide, hydrochlorothiazide, metformin, omeprazole, pantoprazole, phenytoin, verapamil, drug X, and drug Y on superoxide production, nitric oxide production, and cytokine expression by THP-1-derived macrophages that had been stimulated with ethanol-inactivated BCG. Ambroxol HCl, diazoxide, digoxin, furosemide, hydrochlorothiazide, metformin, pantoprazole, phenytoin, verapamil, and drug Y had an inhibitory effect on nitric oxide production, while all the test drugs had an inhibitory effect on superoxide production. Amiloride HCl, diazoxide, digoxin, furosemide, phenytoin, verapamil, drug X, and drug Y enhanced the expression of IL-1 and TNF-. Unlike most immunomodulatory compounds currently in clinical use, most of the test drugs inhibited some inflammatory processes while promoting others. Ion pumps and ion channels could therefore serve as targets for more selective immunomodulatory agents which do not cause overt immunosuppression.
Topics: Ambroxol; Cells, Cultured; Humans; Immunomodulation; Inflammation; Interleukin-1beta; Ion Transport; Macrophages; Membrane Transport Modulators; Mycobacterium bovis; THP-1 Cells; Tumor Necrosis Factor-alpha
PubMed: 33928172
DOI: 10.1155/2021/8832586 -
Journal of Veterinary Internal Medicine 2015Short-term intravenous co-administration of famotidine and pantoprazole is used by some veterinarians to treat gastrointestinal bleeding in critically ill dogs. However,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Short-term intravenous co-administration of famotidine and pantoprazole is used by some veterinarians to treat gastrointestinal bleeding in critically ill dogs. However, clinical studies have not evaluated the efficacy of combination acid suppressant treatment in dogs.
HYPOTHESIS/OBJECTIVES
To compare the effect of intravenous co-administration of famotidine and pantoprazole to monotherapy with pantoprazole on intragastric pH in dogs. We hypothesized that single agent pantoprazole would be more effective than combination with famotidine.
ANIMALS
Twelve healthy adult colony dogs.
METHODS
Randomized, 2-way crossover design. All dogs received placebo (0.9% saline) for 24 hours followed by 1.0 mg/kg i.v. q12h pantoprazole or combination treatment with famotidine and pantoprazole for 3 consecutive days. Intragastric pH monitoring was used to continuously record intragastric pH for 96 hours beginning on day 0 of treatment. Mean percentage time (MPT) that intragastric pH was ≥3 and ≥4 were compared between groups using ANOVA with a posthoc Tukey-Kramer test (α = 0.017).
RESULTS
The MPT ± standard deviation intragastric pH was greater than ≥3 and 4 were 79 ± 17% and 68 ± 17% for pantoprazole and 74 ± 19% and 64 ± 23% for combination treatment, respectively. There were no significant differences in MPT intragastric pH was ≥3 and 4 between groups. Pantoprazole administered alone achieved pH goals established for humans with acid-related disorders.
CONCLUSIONS AND CLINICAL IMPORTANCE
These results suggest that short-term combination treatment with famotidine and pantoprazole is not superior to pantoprazole alone for increasing intragastric pH in dogs.
Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Animals; Anti-Ulcer Agents; Cross-Over Studies; Dogs; Drug Therapy, Combination; Famotidine; Female; Hydrogen-Ion Concentration; Injections, Intravenous; Male; Pantoprazole; Stomach
PubMed: 25711717
DOI: 10.1111/jvim.12555 -
Trials Dec 2023The REVISE (Re-Evaluating the Inhibition of Stress Erosions in the ICU) trial will evaluate the impact of the proton pump inhibitor pantoprazole compared to placebo in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The REVISE (Re-Evaluating the Inhibition of Stress Erosions in the ICU) trial will evaluate the impact of the proton pump inhibitor pantoprazole compared to placebo in invasively ventilated critically ill patients.
OBJECTIVE
To outline the statistical analysis plan for the REVISE trial.
METHODS
REVISE is a randomized clinical trial ongoing in intensive care units (ICUs) internationally. Patients ≥ 18 years old, receiving invasive mechanical ventilation, and expected to remain ventilated beyond the calendar day after randomization are allocated to either 40 mg pantoprazole intravenously or placebo while mechanically ventilated.
RESULTS
The primary efficacy outcome is clinically important upper GI bleeding; the primary safety outcome is 90-day mortality. Secondary outcomes are ventilator-associated pneumonia, Clostridioides difficile infection, new renal replacement therapy, ICU and hospital mortality, and patient-important GI bleeding. Tertiary outcomes are total red blood cells transfused, peak serum creatinine concentration, and duration of mechanical ventilation, ICU, and hospital length of stay. Following an interim analysis of results from 2400 patients (50% of 4800 target sample size), the data monitoring committee recommended continuing enrolment.
CONCLUSIONS
This statistical analysis plan outlines the statistical analyses of all outcomes, sensitivity analyses, and subgroup analyses. REVISE will inform clinical practice and guidelines worldwide.
TRIAL REGISTRATION
www.
CLINICALTRIALS
gov NCT03374800. November 21, 2017.
Topics: Adolescent; Humans; Critical Illness; Gastrointestinal Hemorrhage; Intensive Care Units; Pantoprazole; Pneumonia, Ventilator-Associated; Proton Pump Inhibitors; Respiration, Artificial; Adult
PubMed: 38057875
DOI: 10.1186/s13063-023-07794-z -
European Journal of Hospital Pharmacy :... Jul 2019Hospital admission rates for hypoglycaemia now exceed those for hyperglycaemias among older adults. A growing number of reports associating hypoglycaemia with...
OBJECTIVES
Hospital admission rates for hypoglycaemia now exceed those for hyperglycaemias among older adults. A growing number of reports associating hypoglycaemia with non-antidiabetic drugs have been published. Clinical pharmacists are often faced with hypoglycaemia in patients taking multiple medications. This study assessed the potential relationship between prescribed drugs and episodes of hypoglycaemia during hospitalisation.
METHODS
Point-of-care blood glucose values and prescribed drugs were analysed in patients admitted to a regional hospital. Hypoglycaemia cases were defined as patients with at least one hypoglycaemic event (random glucose value ≤3.9 mmol/L), and normoglycaemic cases as those with random glucose concentrations within the range of 4.5-5.8 mmol/L. Analyses were carried out using multivariate logistic regressions and Cox proportional hazard models.
RESULTS
373 patients (53% males; median age=74 years) were included in the analysis and of these, 64 (17%) had at least one hypoglycaemic event. Patients who experienced a hypoglycaemic event had a longer length of stay (median=10 vs 7 days, p<0.01) and a higher rate of antidiabetic drugs prescription (83% vs 37%, p<0.01). The number of non-antidiabetic drugs was associated with an increased risk of hypoglycaemia during hospitalisation (HR 2.3, 95% CI 1.4 to 4, p<0.01). After adjusting by confounders, heparin and pantoprazole were found to be associated with hypoglycaemia.
CONCLUSIONS
The relationship between hypoglycaemia and polypharmacy reinforces the advice to limit polymedication as much as possible, especially in elderly patients. This result underlines the potential involvement of clinical pharmacists with the aim to reduce the risk of hypoglycaemia during hospitalisation.
PubMed: 31338167
DOI: 10.1136/ejhpharm-2017-001375 -
Nutrients Jun 2021Due to multifactorial reasons, such as decreased thirst and decreased total body water, elderly patients are vulnerable to dehydration. Mild cognitive impairment (MCI)...
Due to multifactorial reasons, such as decreased thirst and decreased total body water, elderly patients are vulnerable to dehydration. Mild cognitive impairment (MCI) or dementia increase the risk of dehydration and, in turn, dehydration decreases cognitive performance. The study aims to identify and assess differences in hydration status, taking into account patients' drug treatment and diseases, using bioelectrical impedance vector analysis (BIVA), thereby revealing unfavorable aspects of prognosis. 447 geriatric patients (241 women, 206 men) including information on medication and bioelectrical impedance analysis (BIA) were investigated, which allowed studying the association between 40 drugs and the hydration status. First, patients were divided into disease groups. Renal disease and diuretic treatment were significantly different in both sexes, whereas cardiovascular patients differed exclusively for females. Next, drug enrichment was examined in either hyperhydrated or dehydrated patients. Simvastatin, candesartan, bisoprolol, amlodipine, olmesartan, furosemide, torasemide, allopurinol, mirtazapine, pantoprazole, cholecalciferol, and resveratrol showed enrichment depending on hydration status. This study demonstrated that patients can be differentiated and stratified by BIVA, taking into account medication and disease associated with hydration status. Although patients diagnosed with MCI and therefore treated with resveratrol, BIVA still showed evaluated dehydration. This is unfavorable in terms of prognosis and requires special attention.
Topics: Aged; Aged, 80 and over; Body Composition; Cognitive Dysfunction; Dehydration; Female; Geriatrics; Humans; Male; Nutrition Assessment; Nutritional Status; Organism Hydration Status; Pharmaceutical Preparations
PubMed: 34199738
DOI: 10.3390/nu13061929 -
Heliyon Aug 2021In the present study the bioavailability and pharmacokinetics properties of pantoprazole (proton pump inhibitor)/amitriptyline (tricyclic antidepressant) in novel...
Synchronous LC-MS/MS determination of pantoprazole and amitriptyline in rabbit plasma: application to comparative in vivo pharmacokinetic study of novel formulated effervescent granules with its marketed tablet dosage form.
In the present study the bioavailability and pharmacokinetics properties of pantoprazole (proton pump inhibitor)/amitriptyline (tricyclic antidepressant) in novel formulated effervescent granules was estimated in rabbit plasma using a validated, selective and rapid LC-MS/MS method. Separation and detection of pantoprazole, amitriptyline and internal standards namely omeprazole and dothiepin, respectively, were achieved at ambient column temperature on C. Acetonitrile: 4mM ammonium acetate solution (comprising 0.05 % formic acid) (40:60, v/v) was used as mobile phase and the flow rate of 0.6 mLmin was applied. Liquid-liquid extraction technique with diethyl ether: dichloromethane (70:30, v/v) was used to extract the cited drugs from rabbit plasma. Multiple reactions monitoring (MRM) in the positive ionization mode was carried out for quantification. The method was validated over linear concentration range of 0.01-4μgmL and 0.001-0.1 μgmL for Pan and Ami respectively, with regression coefficient (r) ≥ 0.9961. The intra- and inter-run precisions (%CV) were ≤4.03. The extraction recoveries were in the range of 95.92%-100.24 %. Pan and Ami were stable during three freeze-thaw cycle and post-preparative stability. The work also aimed to formulate immediate release novel effervescent granules by melt granulation technique. Nine formulae were assessed by validated dissolution test for their micrometric properties and dissolution profile. Experimental design was applied to select formula that fulfilled the desired criteria of optimum release of pantoprazole and amitriptyline with optimum micrometric properties for the study. A single period randomized open-label parallel design was applied on Chancellor's rabbit. The selected formula showed superior pharmacokinetic parameters for pantoprazole and amitriptyline than that of marketed products.
PubMed: 34435144
DOI: 10.1016/j.heliyon.2021.e07752 -
JFMS Open Reports 2016A 7-year-old male castrated domestic short-haired cat was evaluated for a 4 week history of intermittent vomiting, ptyalism, lethargy and weight loss. Serum biochemistry...
CASE SUMMARY
A 7-year-old male castrated domestic short-haired cat was evaluated for a 4 week history of intermittent vomiting, ptyalism, lethargy and weight loss. Serum biochemistry revealed mild mixed hepatopathy. Abdominal ultrasonography identified multiple heterogeneous hepatic masses and a linear, hyperechoic focus with associated reverberation artifact in the wall of the stomach consistent with a gastric ulcer. Serum gastrin concentrations were markedly increased. Cytologic interpretation of a fine-needle aspirate of the hepatic masses was consistent with neuroendocrine neoplasia, and a diagnosis of gastrinoma was established. Deterioration of the cat's condition, despite at-home acid-suppressant therapy, led to hospitalization. The cat was initially stabilized with intravenous crystalloid fluid therapy, maropitant, pantoprazole and octreotide. A continuous radiotelemetric intragastric pH monitoring system was used to monitor the response of intragastric pH to therapy. Long-term therapy was continued with omeprazole (orally q12h), octreotide (subcutaneously q8h) and thrice-weekly toceranib administered orally. Toceranib therapy led to gastrointestinal upset and was discontinued. Gastric ulceration resolved within 8 weeks, and palliation of clinical signs was achieved for approximately 5 months.
RELEVANCE AND NOVEL INFORMATION
Including this report, only six cases of feline gastrinoma have been reported in the veterinary literature. Little is known regarding non-surgical therapy, and octreotide has not been previously reported for medical management of feline gastrinoma. Results of intragastric pH monitoring and clinical improvement suggest that medical therapy using octreotide and proton pump inhibitors represents a novel therapeutic option for cats with gastrinoma where surgical excision is not feasible.
PubMed: 28491421
DOI: 10.1177/2055116916646389 -
Przeglad Gastroenterologiczny 2018Proton pump inhibitors therapy success in the treatment of gastroesophageal reflux disease (GERD) is a difficult task because the extent of mucosal damage has no...
INTRODUCTION
Proton pump inhibitors therapy success in the treatment of gastroesophageal reflux disease (GERD) is a difficult task because the extent of mucosal damage has no relation with the severity of the symptoms.
AIM
To establish the efficacy of pantoprazole treatment in patients with erosive reflux disease (ERD) and in those with non-erosive reflux disease (NERD), by assessing symptom relief and quality of life. Treatment duration and adverse events associated with pantoprazole treatment were analysed.
MATERIAL AND METHODS
This meta-analysis was based on three multicentre, prospective, open-label, phase IV trials conducted in Slovenia, Poland, and the Russian Federation. In total, 252 patients with GERD were included and treated with pantoprazole 40 mg once daily for 4 or 8 weeks, depending on the fulfilment of predefined healing criteria. Symptoms were assessed by patients on a scale from 0 to 3 and the quality of life on a rating scale from 1 to 10.
RESULTS
Forty-five percent of patients fulfilled the healing criteria after 4 weeks of treatment, and 70% of patients after 8 weeks of treatment. Patients who failed to reach the healing criteria reported significant reduction of symptoms severity. The response to 8-week treatment was significantly higher in patients with ERD (76%) when compared to patients with NERD (64%). Discontinuation of treatment after 4 weeks was not associated with worsening of symptoms and did not affect quality of life. Pantoprazole treatment was associated with improvement of symptoms and the quality of life of GERD patients over 8 weeks of treatment and showed that GERD patients with persisting symptoms benefit from prolonging treatment to 8 weeks. Treatment with pantoprazole 40 mg was very well tolerated - more than 90% of patients were without adverse events throughout the whole study and only 4 patients discontinued the treatment due to adverse events related to pantoprazole treatment.
CONCLUSIONS
Pantoprazole 40 mg was associated with complete relief of GERD-related symptoms in the majority of patients with ERD and NERD. Furthermore, the severity of symptoms was significantly reduced in patients without complete relief of symptoms. Pantoprazole also continuously improved the quality of life of GERD patients over 8 weeks of treatment and was very well tolerated throughout the whole study. Therefore, this meta-analysis suggests that pantoprazole 40 mg once daily is an effective and well-tolerated choice for providing symptom relief of patients with GERD.
PubMed: 29657605
DOI: 10.5114/pg.2018.74556