Central nervous system , adverse

In patients taking NSAIDs, monitor for increases in blood pressure, weight gain, edema, skin rash, and central nervous system adverse effects such as headaches and drowsiness. 

Use of diethylpropion for a period longer than 3 months is associated with an increased risk for development of pulmonary hypertension. When used as directed, reported common central nervous system adverse effects included overstimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, jitteriness, anxiety, nervousness, depression, drowsiness, malaise, mydriasis, and blurred vision. In addition, diethylpropion can decrease seizure threshold, subsequently increasing a patient s risk for an epileptic event. Other organ systems also can adversely be affected, resulting in tachycardia, elevated blood pressure, palpitations, dry mouth, abdominal discomfort, constipation,... 

Keyset LA, Karl M, Nafziger AN, Bertino JS Jr. (2000) Comparison of central nervous system adverse effects of amantadine and rimantadine used as sequential prophylaxis of influenza a in elderly nursing home patients. Arch Intern Med 160 1485-1488... 

One unexpected finding was that the plasma ammonia level appeared to increase as a result of zinc deficiency. We have reported similar findings in zlnc-deflclent rats (16). This may have important health implications concerning zinc deficiency In man, because in liver disease hyperammonemia is believed to affect the central nervous system adversely. 

Most studies have focused on the central nervous system adverse effects of ciclosporin, and there have been few reports of peripheral neuropathy. 

The frequency of central nervous system adverse effects is 1-9%. Headache, dizziness, vertigo, insomnia, drowsiness, and agitation have been reported. Hallucinatory symptoms and generalized tonic-clonic seizures have also been described (SEDA-16, 109). Toxic encephalitis can be part of a general toxic reaction (2). Diclofenac provoked aseptic meningitis in patients with systemic lupus erythematosus (SEDA-17,109). 

Central nervous system adverse effects are common with felbamate, and consist mainly of insomnia, headache, impaired concentration, ataxia, dizziness, somnolence, behavioral disturbances, and mood changes. Movement disorders, psychosis, increased seizures, status epilepticus, and withdrawal seizures are less common (SEDA-19, 67) (SEDA-20, 61). The incidence of these effects is increased in the elderly, possibly owing to reduced drug clearance (4), whereas patients with mental retardation may be more prone to behavioral disorders (SEDA-19, 68). 

There is no clear evidence of specific central nervous system adverse effects due to G-CSF. In one patient, neurological symptoms, such as blurred vision, weakness, and headache, were attributed to G-CSF-induced extreme hyperleukocytosis with subsequent hyperviscosity (SEDA-21, 377). Encephalopathy, cortical blindness and seizures have also been mentioned in single case report (SEDA-21, 377). 

Local tolerability with intramuscular administration is reportedly good (17). Serum creatine kinase activity can increase slightly. Gastrointestinal disorders, central nervous system adverse events, and skin rashes have been reported with intramuscular administration. 

Central nervous system adverse events are mostly mild and transient and consist especially of drowsiness and fatigue. Other effects include irritability, nervousness, dizziness, headache, confusion, and depression. In a double-blind add-on trial at dosages of 2 or 3 g/day, drowsiness, diplopia. 

When assessing toxicity of therapy, patients should be asked first if they are having any problems with their medications. This open-ended question can be followed with more direct questions relating to the most common adverse effects associated with the respective medication. Symptoms of abdominal pain, heartburn, nausea, or change in stool color provide valuable clues to the presence of GI complications. Patients also should be monitored for the development of hypertension, weight gain, edema, skin rash, and central nervous system adverse effects such as headaches and drowsiness. Baseline serum creatinine, complete blood count, and serum transaminases are repeated at 6- to 12-month intervals to identify GI, renal, hepatic, and hematologic toxicities. 

A lithium-free interval of 24-48 hours is recommended before surgical intervention or narcosis, since the lithium-treated patient is generally endangered by the necessary restriction of water intake prior to such interventions, especially in polyuric patients. The action of muscle relaxants that are used during general anesthesia or ECT (pancuronium bromide, succinylcholine bromide, and vancuronium bromide) can be prolonged by lithium.There are reports of increased central nervous system adverse reaction such as delirium and amnestic reaction when lithium and muscie reiaxants are combined. 

Furthermore, there have been no drug withdrawals due to enzyme elevations in patients treated with SDZ ENA 713 while approximately 25% of patients treated with tacrine discontinue due to liver enzyme elevation. There appear to be no associated cardiac, renal or central nervous system adverse effects. The most commonly reported adverse effects are nausea, vomiting and diarrhoea of mild intensity. 

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