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BMJ Case Reports 2009The present report highlights the possible adverse effects of doxylamine, a common over the counter sleep aid. Doxylamine is an antihistamine that at toxic doses can...
The present report highlights the possible adverse effects of doxylamine, a common over the counter sleep aid. Doxylamine is an antihistamine that at toxic doses can cause anticholinergic effects, including seizures, rhabdomyolysis and death. The following case describes a patient with doxylamine toxicity who presented with seizure and confusion. Our patient was managed symptomatically, and remained otherwise stable throughout his hospitalisation. This case is atypical in terms of a delayed rhabdomyolysis and a false positive urine drug screen test for methadone. There is evidence that doxylamine at toxic levels can lead to false positives for methadone and phencyclidine testing using immunoassay-based urine drug screen kits. Urine drug screen testing on patients who are hospitalised is typically performed using immunoassays. However, in certain cases confirmatory secondary testing may be required. Doxylamine is prone to abuse and knowledge of the clinical presentation of its toxicity and the management of acute overdose can be life-saving.
PubMed: 21686586
DOI: 10.1136/bcr.09.2008.0879 -
Journal of Medical Toxicology :... Dec 2008
Topics: Acetaminophen; Analgesics, Non-Narcotic; Antitussive Agents; Citrus; Crystallization; Dextromethorphan; Doxylamine; Drug Combinations; Gas Chromatography-Mass Spectrometry; Histamine H2 Antagonists; Illicit Drugs; Nasal Decongestants; Nonprescription Drugs; Pseudoephedrine; Solutions; Substance-Related Disorders
PubMed: 19031385
DOI: 10.1007/BF03161217 -
Indian Journal of Pharmaceutical... 2008Two UV spectrophotometric methods have been developed, based on first derivative spectrophotometry for simultaneous estimation of doxylamine succinate, pyridoxine...
Two UV spectrophotometric methods have been developed, based on first derivative spectrophotometry for simultaneous estimation of doxylamine succinate, pyridoxine hydrochloride, and folic acid in tablet formulations. In method I, the concentrations of these drugs were determined by using linear regression equation. Method II is also based on first derivative spectrophotometry however simultaneous equations (Vierdot's method) were derived on derivative spectra. The first derivative amplitudes at 270.0, 332.8 and 309.2 nm were utilized for simultaneous estimation of these drugs respectively by both methods. In both the methods, linearity was obtained in the concentration range 2.5-50 mug/ml, 1-40 mug/ml and 1-30 mug/ml for doxylamine succinate, pyridoxine hydrochloride, and folic acid respectively. The developed methods show best results in terms of linearity, accuracy, precision, LOD, LOQ and ruggedness for standard laboratory mixtures of pure drugs and marketed formulations. The common excipients and additives did not interfere in their determinations.
PubMed: 20046784
DOI: 10.4103/0250-474X.44607 -
Chemical Research in Toxicology Jun 2007We have previously shown that the anticancer agent doxorubicin undergoes oxidation and inactivation when exposed to myeloperoxidase-containing human leukemia HL-60...
We have previously shown that the anticancer agent doxorubicin undergoes oxidation and inactivation when exposed to myeloperoxidase-containing human leukemia HL-60 cells, or to isolated myeloperoxidase, in the presence of hydrogen peroxide and nitrite. In the current study we report that commercial fetal bovine serum (FBS) alone oxidizes doxorubicin in the presence of hydrogen peroxide and that nitrite accelerates this oxidation. The efficacy of inactivation was dependent on the concentration of serum present; no reaction was observed when hydrogen peroxide or serum was omitted. Peroxidase activity assays, based on oxidation of 3,3',5,5'-tetramethylbenzidine, confirmed the presence of a peroxidase in the sera from several suppliers. The peroxidative activity was contained in the >10000 MW fraction. We also found that hemoglobin, a heme protein likely to be present in commercial FBS, is capable of oxidizing doxorubicin in the presence of hydrogen peroxide and that nitrite further stimulates the reaction. In contrast to intact doxorubicin, the serum + hydrogen peroxide + nitrite treated drug appeared to be nontoxic for PC3 human prostate cancer cells. Together, this study shows that (pseudo)peroxidases present in sera catalyze oxidation of doxorubicin by hydrogen peroxide and that this diminishes the tumoricidal activity of the anthracycline, at least in in vitro settings. Finally, this study also points out that addition of H2O2 to media containing FBS will stimulate peroxidase-type of reactions, which may affect cytotoxic properties of studied compounds.
Topics: Aniline Compounds; Anthracyclines; Antibiotics, Antineoplastic; Benzidines; Blood Proteins; Cell Line, Tumor; Cell Survival; Dose-Response Relationship, Drug; Doxorubicin; Doxylamine; Hemeproteins; Humans; Hydrogen Peroxide; Mass Spectrometry; Methemoglobin; Methimazole; Molecular Structure; Oxidation-Reduction; Peroxidases; Phthalic Acids; Salicylates; Sodium Nitrite
PubMed: 17497896
DOI: 10.1021/tx700002f -
Emergency Medicine Journal : EMJ Apr 2007To compare the effectiveness and side effects of lactated Ringer's solution (LR) and 0.9% saline (NS) in the treatment of rhabdomyolysis induced by doxylamine... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To compare the effectiveness and side effects of lactated Ringer's solution (LR) and 0.9% saline (NS) in the treatment of rhabdomyolysis induced by doxylamine intoxication.
METHODS
In this 15-month-long prospective randomised single-blind study, after excluding 8 patients among 97 doxylamine-intoxicated patients, 28 (31%) patients were found to have developed rhabdomyolysis and were randomly allocated to NS group (n = 15) or LR group (n = 13).
RESULTS
After 12 h of aggressive hydration (400 ml/h), urine/serum pH was found to be significantly higher in the LR group, and serum Na+/Cl- levels to be significantly higher in the NS group. There were no significant differences in serum K+ level and in the time taken for creatine kinase normalisation. The amount of sodium bicarbonate administered and the frequency administration of diuretics was significantly higher in the NS group. Unlike the NS group, the LR group needed little supplemental sodium bicarbonate and did not develop metabolic acidosis.
CONCLUSION
LR is more useful than NS in the treatment of rhabdomyolysis induced by doxylamine intoxication.
Topics: Adult; Doxylamine; Female; Fluid Therapy; Histamine H1 Antagonists; Humans; Isotonic Solutions; Male; Prospective Studies; Rhabdomyolysis; Ringer's Lactate; Single-Blind Method; Sodium Chloride; Statistics, Nonparametric; Treatment Outcome
PubMed: 17384382
DOI: 10.1136/emj.2006.043265 -
Canadian Family Physician Medecin de... Dec 2006A recent Motherisk article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described,...
QUESTION
A recent Motherisk article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described, however, different physicians used different drugs. How can one be sure which drugs work?
ANSWER
The study of 26 women who had had severe morning sickness during previous pregnancies showed that using antiemetics before symptoms of morning sickness started appeared to prevent recurrence of severe morning sickness in subsequent pregnancies. Physicians in the United States used various antinauseant drugs. Physicians in Canada administered only one drug, the combination of doxylamine-pyridoxine (Diclectin), to 12 women. Subanalysis of these 12 women revealed that pre-emptive use of doxylamine-pyridoxine significantly decreased the likelihood that severe morning sickness would recur.
Topics: Antiemetics; Dicyclomine; Doxylamine; Drug Combinations; Female; Humans; Morning Sickness; Ondansetron; Pregnancy; Pyridoxine; Secondary Prevention
PubMed: 17279232
DOI: No ID Found -
The Journal of the American Board of... 2004Ten percent to 40% of adults have intermittent insomnia, and 15% have long-term sleep difficulties. This article provides a review of the classification, differential... (Review)
Review
Ten percent to 40% of adults have intermittent insomnia, and 15% have long-term sleep difficulties. This article provides a review of the classification, differential diagnosis, and treatment options available for insomnia. We performed a MEDLINE search using OVID and the key words "insomnia," "sleeplessness," "behavior modification," "herbs," "medicinal," and "pharmacologic therapy." Articles were selected based on their relevance to the topic. Evaluation of insomnia includes a careful sleep history, review of medical history, review of medication use (including over-the-counter and herbal medications), family history, and screening for depression, anxiety, and substance abuse. Treatment should be individualized based on the nature and severity of symptoms. Nonpharmacologic treatments are effective and have minimal side effects compared with drug therapies. Medications such as diphenhydramine, doxylamine, and trazodone can be used initially, but patients may not tolerate their side effects. Newer medications such as zolpidem and zaleplon have short half-lives and minimal side effects. Both are approved for short-term use in the insomniac.
Topics: Algorithms; Benzodiazepines; Complementary Therapies; Humans; Hypnotics and Sedatives; Psychotherapy; Sleep Initiation and Maintenance Disorders
PubMed: 15226287
DOI: 10.3122/jabfm.17.3.212 -
American Family Physician Jul 2003Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed,... (Review)
Review
Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as ginger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxylamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition.
Topics: Acupressure; Antiemetics; Diagnosis, Differential; Doxylamine; Female; Zingiber officinale; Humans; Hyperemesis Gravidarum; Nausea; Ondansetron; Pregnancy; Pregnancy Complications; Vomiting
PubMed: 12887118
DOI: No ID Found -
Birth Defects Research. Part A,... Feb 2003Bendectin was the primary pharmaceutical treatment of nausea and vomiting of pregnancy (NVP) in the United States until the early 1980s. Its manufacture was then...
BACKGROUND
Bendectin was the primary pharmaceutical treatment of nausea and vomiting of pregnancy (NVP) in the United States until the early 1980s. Its manufacture was then discontinued after public allegations that it was causing birth defects. Subsequently, meta-analyses of the many epidemiological cohort and case/control studies used to examine that hypothesis have demonstrated the absence of a detectable teratogenic effect. This study presents an ecological analysis of the same hypothesis that examines specific malformations.
METHODS
Annual birth defect prevalence data for the 1970s to the 1990s have been obtained for specific birth defects from the Center for Disease Control's nationwide Birth Defect Monitoring Program. These data for the US have been compared graphically to the annual US Bendectin sales for the treatment of NVP. Data have also been obtained for annual US rates for hospitalization for NVP. The three data sets have been temporally compared in graphic analysis.
RESULTS
The temporal trends in prevalence rates for specific birth defects examined from 1970 through 1992 did not show changes that reflected the cessation of Bendectin use over the 1980-84 period. Further, the NVP hospitalization rate doubled when Bendectin use ceased.
CONCLUSIONS
The population results of the ecological analyses complement the person-specific results of the epidemiological analyses in finding no evidence of a teratogenic effect from the use of Bendectin.
Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Adverse Drug Reaction Reporting Systems; Animals; Antiemetics; Dicyclomine; Doxylamine; Drug Approval; Drug Combinations; Drug Utilization; Female; Fetus; Hospitalization; Humans; Incidence; Infant, Newborn; Liability, Legal; Nausea; Pregnancy; Pregnancy Complications; Pyridoxine; Safety; United States; United States Food and Drug Administration; Vomiting
PubMed: 12769504
DOI: 10.1002/bdra.10034 -
Canadian Family Physician Medecin de... Feb 2002One of my patients suffers from a moderate-to-severe form of morning sickness. She responded only partially to doxylamine and pyridoxine (Dicletin), and I wish to try...
QUESTION
One of my patients suffers from a moderate-to-severe form of morning sickness. She responded only partially to doxylamine and pyridoxine (Dicletin), and I wish to try adding another medication. What should my priority be?
ANSWER
An algorithm used by Motherisk to manage thousands of patients takes a hierarchical approach to this condition. This approach is evidence based with regard to fetal safety as well as efficacy.
Topics: Adult; Algorithms; Antiemetics; Evidence-Based Medicine; Female; Humans; Nausea; Pregnancy; Pregnancy Complications; Vomiting
PubMed: 11889884
DOI: No ID Found