Flush syndrome

Chronic moderate to heavy drinking raises the blood pressure and reduces, to some extent, the effectiveness of antihypertensive drugs. A few patients may experience postural hypotension, dizziness and fainting shortly after having drank alcohol. Alpha blockers may enhance the hypotensive effect of alcohol in subjects susceptible to the alcohol flush syndrome. 

However, as a side-effect of the therapy, his patients suffered from a massive flush syndrome (harmless but mostly unpleasant reddening ofthe skin on the face, neck, chest and upper arm). For a better assessment, Hoffer himself took gram quantities of niacin over several months, and discovered to his surprise that this treatment had healed his serious inflammatory gum disease. Inspired by Rudolf Virchow s hypothesis, that atherosclerosis was an inflammatory process, which was associated with serum cholesterol, Rudolf Altschul (1901-1963), Hoffer s former histology teacher, demonstrated in his hypercholesterolemic rabbit model, that within a few days niacin brought cholesterol levels back to normal. This prompted corresponding studies by Hoffer in the psychiatric patients. 

Because of the flush syndrome, nicotinic acid was initially marketed in the USA only in 1997, after the development of an extended-release form. In Germany, Merck KGaA launched the drug as Niaspar for the first time in 2004. 

Clinical tolerance is generally excellent with only mild abdominal pain or discomfort and slight fever which disappear in less than 3 days. A flush syndrome may occur in the post embolization period in patients with carcinoid primary, and should be systematically prevented. During the post PVE period. 

Doxorubicin 3 hours cycles 1 2 and then infused over 1 hour thereafter repeat every 28 days mucositis, alopecia, flushing, shortness of breath, hypotension, headaches, cardiotoxicity, hand-foot syndrome dysfunction. 2. Do not give if total bilirubin is greater than 5 mg/dL. 

Rituximab -monoclonal antibody to CD20 (B-cell surface antigen) -fever, chills, malaise -nausea, vomiting -flushing -bronchospasm, angioedema, urticaria -rhinitis -pain at disease sites -tumor lysis syndrome may occur in patients with high peripheral lymphocyte count... 

Sargramostim (GM-CSF) -hematopoietic growth factor -nausea and vomiting -flushing -capillary leak syndrome -fevers and chills -headache -bone pain -myalgias, arthralgias -leukocytosis... 

Of the following drugs, which would not produce a syndrome of flushing, headache, nausea, vomiting, sweating, hypotension, and confusion after ethanol consumption ... 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

Camarasa and Serra-Baldrich [94] reported allergic contact dermatitis after repeated contact with TPP-treated plastics. Meeker and Stapleton [95] indicated endocrine disruptive properties for TPP and TDCiPP, through a negative correlation with semen quality and thyroid hormone levels, respectively. Kanazawa et al. [71] associated mucosal symptoms of the sick building syndrome with high indoor exposure to TBP. These symptoms include irritation to the eyes, nose, and throat symptoms such as flushing, and mucosal symptoms such as irritation to the eyes, nose, and throat the latter symptoms were strongly associated with TBP levels in air and dust. 

Loss of blood glucose control When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue the drug and give insulin. Disulfiram-like syncframe. A sulfonylurea-induced facial flushing or breathlessness reaction may occur when some sulfonylureas are administered with alcohol. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Water retention and dilutional hyponatremia have occurred after administration of sulfonylureas to type 2 diabetes patients, especially those with CHF or hepatic cirrhosis. 

Adverse reactions occurring in 3% or more of patients include the following abnormal lab tests, back pain, flu syndrome, headache, hemoptysis, hypotension, increased alkaline phosphatase, increased cough, increased GGT, insomnia, muscle cramps, nausea, palpitations, pneumonia, syncope, tongue pain, trismus, vasodilation (flushing), vomiting. 

Possible adverse reactions include headache anorexia nausea vomiting diarrhea palpitations tachycardia angina pectoris toxic reactions (particularly the LE cell syndrome) lacrimation conjunctivitis dizziness tremors psychotic reactions rash urticaria pruritus fever chills arthralgia eosinophilia constipation paralytic ileus lymphadenopathy splenomegaly nasal congestion flushing edema muscle cramps hypotension paradoxical pressor response dyspnea urination difficulty ... 

Other-Fever, flushing hyperglycemia inappropriate antidiuretic hormone syndrome rash alopecia. Ethylenediamine in aminophylline can cause sensitivity reactions, including exfoliative dermatitis and urticaria. Cardiovascular Palpitations tachycardia extrasystoles hypotension circulatory failure life-threatening ventricular arrhythmias. 

Adverse reactions may include headache anorexia nausea vomiting urinary frequency hypersensitivity reactions sore gums flushing dizziness anemia hemolytic anemia (possibly related to G-6-PD deficiency) nephrotic syndrome hepatic necrosis aplastic anemia exacerbation of gout uric acid stones with or without hematuria renal colic or costovertebral pain. 

Adverse reactions occurring in at least 3% of patients with advanced PD (with levodopa) included the following abdominal pain accidental injury accommodation abnormalities akathisia amnesia arthritis asthenia chest pain confusion constipation diarrhea dizziness dream abnormalities dry mouth dyskinesia dyspnea dystonia extrapyramidal syndrome falls flushing gait... 

Serious toxic reactions with delirium can arise when specific serotonin reuptake inhibitors (SSRIs) are taken with other drugs that increase central and peripheral serotonergic activity. Known as the serotonin syndrome , this reaction consists of excitation, restlessness, fluctuations in consciousness, with tremor, rigidity, myoclonus, sweating, flushing, pyrexia, cardiovascular changes, and rarely coma and death (Sternbach, 1991). The syndrome has occurred when SSRIs have been combined with irreversible monoamine oxidase... 

Vancomycin can cause red-man syndrome consisting of diffuse flushing, presumably mediated by histamine-release. This problem can be prevented by limiting the infusion rate. The most serious adverse reactions are ototoxicity and nephrotoxicity. The toxicity for both organ systems is potentiated by aminoglycosides. Vancomycin will cross the placenta barrier and has the potential to cause fetal ototoxicity. 

Hypoprothrombinemia may occur in malabsorption syndromes and also the use of broad-spectrum antibiotics may produce a hypoprothrombinemia that responds readily to small doses of vitamin K. In premature infants and in infants with hemorrhagic disease of the newborn the use of vitamin K may be indicated. However, the main indication for the use of vitamin K is to antagonize the anticoagulant activity of coumarins. Oral absorption of phytonadione and the menaquinones is by the lymph while menadione and its water-soluble derivatives are absorbed directly. The absorption of phytonadione is energy-dependent and saturable. Intravenous administration of phytonadione has produced flushing, dyspnea, chest pains, and cardiovascular collapse. 

The common side effects seen in chronic therapy (Table 19.3) are mostly related to vasodilation—headaches, dizziness, facial flushing, hypotension, and so forth. High doses of verapamil in elderly patients are known to cause constipation. Serious side effects, especially following the intravenous use of verapamil, include marked negative inotropic effects and depression of preexisting sick sinus syndrome, A-V nodal disease, and... 

Serotonin also constricts veins, and venoconstriction with increased capillary filling appears to be responsible for the flush that is observed after serotonin administration or release from a carcinoid tumor. Serotonin has small direct positive chronotropic and inotropic effects on the heart, which are probably of no clinical significance. However, prolonged elevation of the blood level of serotonin (which occurs in carcinoid syndrome) is associated with pathologic alterations in the endocardium (subendocardial fibroplasia), which may result in valvular or electrical malfunction. 

Rapid intravenous administration may result in hypotension. Adverse idiosyncratic responses such as flushing, abdominal discomfort, and rash have also been observed. Pulmonary complications (eg, acute respiratory distress syndrome) have been reported in some patients undergoing deferoxamine infusions lasting longer than 24 hours, and neurotoxicity and increased susceptibility to certain infections (eg, with Yersinia enterocolitica) have been described after long-term therapy of iron overload conditions (eg, thalassemia major). 

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