Celecoxib-induced erythema multiforme with glyburide cross-reactivity

Erythema multiforme is an acute inflammatory skin reaction that often is caused by drugs, especially sulfonamides and their derivatives. Celecoxib, a cyclooxygenase-2 inhibitor, is a sulfonamide derivative commonly prescribed to treat arthritis in patients who cannot tolerate or who have a contraindication for taking traditional nonsteroidal antiinflammatory agents. A 57-year-old man with a previously undocumented sulfa allergy experienced an allergic skin reaction and had difficulty breathing secondary to throat swelling. His condition was believed to be erythema multiforme associated with the introduction of celecoxib into his drug regimen. His drug therapy was discontinued, but a subsequent reaction occurred when the sulfonamide derivative glyburide was reintroduced. It is important for clinicians to obtain a careful history and perform a thorough medical evaluation in all patients receiving sulfonamides and their derivatives, as a potentially life-threatening allergic reaction may be prevented.     

Persistent erythema multiforme and CMV infection

Persistent erythema multiforme is a rare disorder with only 23 known cases reported in the literature. Persistent erythema multiforme has been reported in association with Epstein-Barr virus, herpes virus, hepatitis C virus, influenza, inflammatory bowel disease, and a variety of neoplasms. To our knowledge, this case is the first case of persistent erythema multiforme reported in association with cytomegalovirus infection.     

交沙霉素致多形性红斑药疹2例

例1女,35岁,因咽喉疼痛1周,于2002年7月15日来我院就诊。患者既往无药物食物过敏史。查体:T36.5℃,全身皮肤、粘膜未见黄染、出血点及皮疹,咽部明显充血,未见糜烂,双侧扁桃体无肿大,心、肺正常。诊断为“咽炎”,给予交沙霉素0.4g,po,tid 。5h后患者复诊,诉服药2h后全身出现皮疹,伴瘙痒。查体:T36.8℃,P75次·min-1,BP120/75mmHg(1mmHg=0.133kPa),咽部充血明显,心、肺未见异常,全腹平软,无压痛反跳痛,肝脾肋下未触及。皮肤症状:颈部、躯干、四肢皮肤散在分布钱币大小的水肿性圆形红斑,丘疹,边缘清晰,中心呈紫红色,未见水疱、糜烂及渗出,…     

A case of ciprofloxacin-induced erythema multiforme

A 25 year old male admitted to the medical college hospital with presenting complaint of fever, skin rashes and itching. Before admission he had consulted a local doctor for fever, who had prescribed him Tablet ciprofloxacin 500mg twice daily and Tablet. Paracetamol 500 mg thrice daily. The patient had taken 6 tablets of ciprofloxacin before he developed the above symptoms. On detailed clinical examination multiple erythematous papule and plaques were present on the face, abdomen and neck. Target (Iris) lesions were seen on the extersor surface of both upper and lower limbs measuring about 1-2 cm in size. Multiple erythematous lesion were also found in mucosa of soft and hard palate, Uvula and posterior pharyngeal wall. Lower lips were swollen and edematous, Lymphnodes in the neck were enlarged and tender. The clinical features with which the patient presented were similar to those seen in a typical case of erythema multiforme and the patient recovered after stopping ciprofloxacin, Further rechallenge with oral ciprofloxacin was not done in the interest of patient and due to ethical constraints. This case is being reported for rare and potential fatal drug reaction with ciprofloxacin.     

炔雌醇环丙孕酮致重症多形红斑型药疹

1例43岁女性患者因功能失调性子宫出血予炔雌醇环丙孕酮口服治疗,每次1片（每片含醋酸环丙孕酮2 mg和炔雌醇0.035 mg）,1次/d。患者规律服药,第9天全身出现散在虹膜样红斑伴瘙痒,当日停服该药。次日,患者全身虹膜样红斑增多、增大,瘙痒难忍,疼痛剧烈,颜面部皮疹融合成片状,面部肿胀明显,诊断为多形红斑型药疹。给予咪唑斯汀、氯雷他定及甘草酸二铵口服,复方倍他米松单次肌内注射。第3天起加用地塞米松5 mg入5%葡萄糖注射液500 ml和甘草酸二铵氯化钠注射液150 mg（250 ml）静脉滴注,1次/d;曲安奈德益康唑乳膏外用。8 d后患者症状减轻,红斑渐消退。     

Dapsone in the treatment of persistent erythema multiforme

Erythema multiforme (EM) is usually an acute and self-limited inflammatory reaction of the skin and mucous membranes. Attacks may be sporadic or recurrent, and generally last for 1 to 3 weeks. Rarely, an episode of EM may fail to abate. This continuous and uninterrupted occurrence of typical and atypical lesions is known as persistent EM. We present a case responsive to dapsone.     

依替米星致多形性红斑1例

1 病例资料患者,男,60岁,体质量70 kg.于2019年6月2日12:00因腹痛腹泻入天津市第五中心医院肠道门诊,诊断为腹痛待查,急性胃肠炎.患者既往体健,否认食物过敏史,有口服左氧氟沙星过敏史,表现仅为轻微皮肤瘙痒,可耐受且未处理,后自行缓解.父亲青霉素过敏(程度不详).患者入院查体:体温37.5℃,心率每分钟...     

异甘草酸镁致多形性红斑1例

病例     

New combination therapies with cell-cycle agents

Cancer cells have deregulated cell-cycle progression with overexpression of positive regulators and inhibition of negative regulators, giving them unlimited replication potential. Therefore, development of agents targeting the deregulated cell cycle has been considered as an ideal strategy for cancer therapy. Cell-cycle-based agents have been categorized as cyclin-dependent kinase inhibitors, Cdc25 inhibitors, checkpoint inhibitors and mitotic inhibitors. These drugs have demonstrated preclinical efficacy, but their efficacy in the clinic has been modest and has been hampered by various side effects. Alternatively, their combination with chemotherapeutic drugs has been studied in different preclinical and clinical settings. Initial reports from these combination studies have been encouraging and suggest that combined drugs may be useful in lowering cancer burden.     

藻酸双酯钠在寒冷性多形红斑治疗中的疗效观察

目的 观察藻酸双酯钠治疗寒冷性多形红斑的疗效和安全性。方法 对寒冷性多形红斑患者，以口服藻酸双酯钠100mg，每日3次；西替利嗪片10mg，每日1次及外用复方维生素E乳膏治疗为治疗组，并以单纯口服西替利嗪片10mg，每日1次及外用复方维生素E乳膏治疗为对照组，疗程14d，进行对比观察。结果 共有40例患者纳入疗效分析，治疗组（n=20）及对照组（n=20）的总显效率分别为95％和70％（P〈0．05），治疗组疗效明显优于对照组。结论 联合应用藻酸双酯钠治疗寒冷性多形红斑具有较好的疗效。     

Treating dyslipidemic patients with lipid-modifying and combination therapies

Updated guidelines from the National Cholesterol Education Program give greater emphasis to lipoproteins other than low-density lipoprotein cholesterol (LDL) than previous guidelines. Although statins remain first-line therapy for most patients to lower LDL, combination therapy is the next logical step in achieving goals in patients with mixed dyslipidemia or elevated LDL despite statin therapy. As the prevalence of diabetes, metabolic syndrome, and atherogenic dyslipidemia rises, the importance of treating the total lipid profile becomes even more crucial. Niacin, fibrates, and bile acid sequestrants are effective in combination with statins in lowering LDL, triglycerides, and total cholesterol levels and increasing high-density lipoprotein cholesterol (HDL). Although combination therapies may increase the risk of myopathy, both fibrate-statin and niacin-statin combinations are considered safe. In addition, niacin-statin therapy reduces atherosclerotic progression and coronary events. New pharmacologic formulations exist that will further affect treatment: a single-tablet combination of lovastatin and extended-release niacin is available, as is ezetimibe, a cholesterol-absorption inhibitor. In all, both HDL and triglyceride levels correlate with cardiovascular risk and should be considered secondary targets of therapy. Combination therapy can be safe and effective and can be constructed to affect all lipoprotein parameters.     

替吉奥胶囊致重症多型红斑型药疹

1例57岁男性胰腺癌患者术后行吉西他滨（1.6 g静脉滴注,第1、8天）联合替吉奥胶囊（每粒胶囊含替加氟20 mg、吉美嘧啶5.8 mg及奥替拉西钾19.6 mg,3粒/次,2次/d口服,第1~14天）化疗,21 d为1个周期。用药第3天,患者出现全身烧灼样疼痛,体温最高达39.6 ℃,四肢及胸背部散发紫红色斑疹。立即停用替吉奥胶囊,吉西他滨继续应用。用药第5天,患者四肢内侧及胸背部出现大面积多型性皮疹,部分皮疹中心出现水泡,部分皮疹呈红色大疱并融合成片,部分大疱破溃、暴露创面;同时伴有口腔黏膜糜烂。给予对症处理,2周后患者皮疹基本消失。1周后行吉西他滨联合氟尿嘧啶化疗2个周期,卡培他滨化疗2个周期,未再出现皮疹。     

Intraocular pressure-lowering combination therapies with prostaglandin analogues

Intraocular pressure (IOP) reduction is currently the only therapeutic approach demonstrated to preserve visual function in patients with glaucoma. The first line of glaucoma treatment consists of topical IOP-lowering medications, usually initiated as monotherapy. A significant proportion of patients require more than one medication to reach a target IOP at which optic nerve damage will not progress. As prostaglandin analogues (PGAs) are the most effective class for reducing IOP, one of the other commonly used classes (β-adrenoceptor antagonist [β-blocker], carbonic anhydrase inhibitor or α(2)-adrenoceptor agonist) is frequently combined with a PGA. In the last decade, the use of fixed combinations containing two medications in a single bottle has steadily increased. Fixed combinations have the potential to simplify the dosing regimen, increase patient adherence, avoid the washout effect of the second drop on the first medication instilled, decrease exposure to preservatives and, sometimes, reduce the cost of treatment. Clinical trials have evaluated PGA-based fixed combinations versus unfixed combinations (individual components administered concomitantly) or versus individual monotherapies; however, any advantage that the fixed combinations may have in terms of IOP-lowering efficacy is still debated. For these reasons, the PGA-based fixed combinations are not approved by regulatory authorities in some countries, such as the US. We review the published studies evaluating the efficacy and tolerability of the IOP-lowering unfixed and fixed combination therapies with PGAs. Regarding unfixed combinations, the review shows that α(2)-adrenergic agonists-PGA and carbonic anhydrase inhibitor-PGA combinations seem to be at least as effective at reducing IOP as the β-blocker-PGA combinations. As for the fixed combinations, the review shows that the three PGA-timolol fixed combinations are more effective than their component medications used separately as monotherapy and are better tolerated than the three respective prostaglandins. The three PGA-timolol fixed combinations are less effective at reducing IOP than the unfixed combinations but are better tolerated. The advantage of the fixed combinations in terms of patient adherence and persistence is supported by a very small number of studies and remains to be more accurately determined. Most studies, but not all, seem to show that PGA-timolol fixed combinations are more effective than other available β-blocker fixed combinations (dorzolamide-timolol fixed combinations) at reducing IOP and are similarly tolerated.     

Safety considerations with combination therapies for psoriasis

ABSTRACT

Introduction: Psoriasis is a chronic inflammatory skin disease that waxes and wanes, and long-term remission can be difficult to achieve regardless of disease severity. Currently, numerous treatment options are available for psoriasis including steroid and non-steroid topical agents, phototherapy, oral systemic agents, and biologics, with many more therapeutic agents under development.

Areas covered: This article will review various combination therapy strategies such as rotational therapy and sequential therapy and describe a variety of safe and effective combination therapies for the treatment of psoriasis. Two or more agents with different mechanisms of action and safety profiles can be used to achieve and/or maintain adequate disease control while minimizing the toxicity of treatments. Combination therapy can also be used when a single agent is not enough for treating recalcitrant disease. Choosing a combination regimen that maximizes safety and efficacy while considering patient usability and compliance can be a challenge.

Expert opinion: Given the various treatment options currently available for psoriasis and more agents under development, combination therapy will continue to be a valuable treatment strategy for any patient with psoriasis. It is crucial for clinicians to carefully consider the fine balance between safety and efficacy when combining various therapeutic agents.     

Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis

Purpose  

The elimination half-life and consequently the accumulation of enoxaparin increase as glomerular filtration rate (GFR) decreases. A dose adjustment for patients with a GFR <30 ml/min is recommended and considered relatively safe. Our intention was to identify whether the use of enoxaparin is safe and to determine what impact an enoxaparin dose adjustment has on patients with a GFR <60 ml/min.     

Thalidomide as elective treatment in persistent erythema multiforme; report of two cases

Recurrent erythema multiforme is a rare disorder, clinically characterized by symmetrically distributed, erythematous, and bullous skin and mucous lesions, mainly precipitated by a preceding herpes simplex infection. In rare cases, EM presents continuous or persistent relapses, and has been related to an Epstein-Barr virus infection. We report 2 cases of severe, persistent erythema multiforme, treated with thalidomide, with complete disease suppression in both cases. Thalidomide induces immunomodulator, anti-inflammatory, and anti-angiogenic effects, and may be considered as the elective treatment of this rare variety of erythema multiforme. However, in order to avoid neuropathic side effects, patients under thalidomide therapy should be monitored every 6 months with nerve conduction studies while taking the drug.     

海普林软膏治疗寒冷性多形红斑50例疗效观察

目的 分析海普林软膏治疗寒冷性多形红斑疗效。方法 采用海普林软膏与维生素E霜,外用对比疗效。结果 海普林软膏有效率为88％,维生素E有效率为54％,两组间差异有显著性。结论 海普林软膏治疗寒冷性多形红斑疗效肯定,无副作用。     

A graph model of combination therapies

The simultaneous use of multiple medications causes drug–drug interactions (DDI) that impact therapeutic efficacy. Here, we argue that graph theory, in conjunction with game theory and ecosystem theory, can address this issue. We treat the coexistence of multiple drugs as a system in which DDI is modeled by game theory. We develop an ordinary differential equation model to characterize how the concentration of a drug changes as a result of its independent capacity and the dependent influence of other drugs through the metabolic response of the host. We coalesce all drugs into personalized and context-specific networks, which can reveal key DDI determinants of therapeutical efficacy. Our model can quantify drug synergy and antagonism and test the translational success of combination therapies to the clinic.