Central nervous system adverse events

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. 

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,... 

Drug interactions Proleukin may affect central nervous system function. Therefore interactions could occur following concomitant administration of psychotropic drugs. Concurrent administration of drugs possessing nephrotoxic, myelotoxic, cardiotoxic, or hepatotoxic effects with Proleukin may increase toxicity in these organ systems. Reduced kidney and liver function secondary to Proleukin treatment may delay elimination of concomitant medications and increase the risk of adverse events from those drugs. Beta-blockers and other antihypertensives may potentiate the hypotension seen with Proleukin. 

Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000 343 1833-1838. 

Ephedra supplements typically contain caffeine, and users may consume caffeine in carbonated beverages, coffee, or tea. Researchers suspect that caffeine may enhance ephedra s stimulant effects on cardiovascular and/or central nervous system responses. This may account for the types of adverse events that have been reported by ephedra users. 

The most probable cause of a submarine sinking is flooding caused by an event that breaches the outer hull. The force required would have to be substantial. Potential causes include surface collision, grounding, external explosion, and catastrophic failure of a hull valve. It is likely that such an event also would start a fire within the submarine. The immediate concern for the crew is the release of toxic gases that are produced as the combustion products of on-board fires (U.S. Navy 1998). Human exposure to these gases can lead to adverse health effects, particularly respiratory and central nervous system effects, and even... 

The safety and tolerability of zolpidem have been investigated in two multicenter studies, in which 8.9% and 7.5% of the patients reported an adverse event (10). The most frequent events were related to the central nervous system (somnolence, headache, confusion, vertigo), but gastrointestinal and cutaneous symptoms were also frequently reported. 

In 3995 patients who took azithromycin 1.5 g in divided doses over 5 days or who took 1 g as a single dose for urethritis/cervicitis adverse events occurred in 12% (1). In patients over 65 years the rate was 9.3%, and in children under 14 years of age it was 5.4%. The most common adverse effects were gastrointestinal (9.6%) central nervous system and peripheral nervous system effects were reported in 1.3%. Overall, 59% of the adverse events were considered mild, 34% moderate, and only 6% severe, involving mainly the gastrointestinal tract. Adverse events resulted in withdrawal in 0.7% of patients, lower than the rate reported with other macro-lides. Treatment-related rises in liver enzymes were uncommon (under 2%), as was leukopenia (1.1-1.5%). 

In a retrospective analysis there were no chnically important differences in the safety profile of ciprofloxacin in patients aged under or over 65 years (65). The incidence of drug-related adverse events was higher in those under 65 years (25%) than in those aged 65 years or more (17%) the most common adverse events affected the gastrointestinal and central nervous systems. 

Efavirenz is a non-nucleoside reverse transcriptase inhibitor with excellent inhibitory activity against HTV-l. Its most frequent adverse effects involve the central nervous system and the skin (1). At the start of therapy, dizziness, insomnia, or fatigue is observed in most patients, and headache and even psychotic reactions have also been observed. A maculopapular rash is seen in about 10%. These adverse effects usually vanish within the first 2-4 weeks of therapy (2). About 1-2% of individuals stop taking efavirenz because of neurological or dermatological adverse events. Administration of efavirenz at bedtime reduces the incidence of severe adverse effects, and the rash can be managed by short-term antihistamines or topical corticosteroids (1). Nausea and vomiting are less often observed than in patients treated with zidovudine, lamivudine, or indinavir. 

In an open comparison of efavirenz and indinavir (plus two nucleoside analogues) in predominantly treatment-naive patients efavirenz-based triple therapy provided at least similar antiviral effects over 48 weeks (7). Furthermore, fewer patients discontinued efavirenz-based triple therapy than indinavir-based therapy because of adverse events. Adverse effects associated with efavirenz included a maculopapular rash and central nervous system disturbances (dizziness, vivid dreams, poor concentration, sleep disturbances), which generally occurred (but later resolved) within the first weeks of therapy. 

In an open study of the effects of topiramate 100-1600 mg/day in 292 adults (mean age 33 years) with partial and/or generalized seizures previously resistant to antiepileptic drug therapy over 50% of the patients achieved at least a 50% reduction in seizures (1). The most commonly reported adverse events were related to the central nervous system, including headache, difficulty in concentrating, somnolence, anorexia, fatigue, dizziness, nervousness, nausea, confusion, and paresthesia 32% discontinued because of adverse events. 

Female reproduction may be recognized to be complex because it has been studied in greater detail and many more aspects of the female reproductive system are defined than for the male. Certainly the female reproductive system is overtly more dynamic and, perhaps because of this dynamicism, more susceptible to physical, chemical, and emotional stressors. The discrete series of events of the ovarian cycle which requires precise coordination between the central nervous system, hypothalamus, and pituitary in order for gametogenesis and ovulation to take place provides the opportunity for environmental changes to adversely influence normal processes. If these events are delayed or altered appreciably, some form of short-term infertility will most likely result. When this is compared to the male, the relatively monotonous production of hormone and gametes is not as likely to be overtly influenced by short-term events. 

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