Gastrointestinal complaints

Some patients with mastocytosis report flushing, shortness of breath, palpitations, nausea, diarrhea, hypotension or even syncope [9, 24]. Lethargy and fatigue lasting several hours may follow. Gastrointestinal complaints are common in patients with SM [9, 24]. Abdominal pain is the most frequent symptom, followed by nausea. 

SSRIs are the drugs of choice for PD. All SSRIs have demonstrated effectiveness in controlled trials, with 60% to 80% of patients achieving a panic-free state.28,48,49 With similar efficacy reported and no trials comparing SSRIs with other SSRIs, selection generally is based on pharmacokinetics, drug interactions, side effects, and cost differences (see Chap. 35 for more discussion). The most common side effects of SSRIs include headaches, irritability, nausea and other gastrointestinal complaints, insomnia, sexual dysfunction, increased anxiety, drowsiness, and tremor.49 SSRIs should not be discontinued abruptly to avoid a withdrawal syndrome characterized by dysphoric mood, irritability, and agitation. 

The most commonly observed side effects of valproate are gastrointestinal complaints, tremor, sedation, and weight gain. Gastrointestinal symptoms such as nausea. 

Adverse effects. The frequent gastrointestinal complaints (epigastric pain, diarrhea, constipation) necessitate intake of iron preparations with or after meals, although absorption is higher from the empty stomach. 

Frequently occurring adverse effects are gastrointestinal complaints and dose related CNS effects including fatigue, sedation, ataxia, dysarthria and other symptoms of incoordination. Rare but potentially dangerous reactions are bone marrow depression and pancreatitis. The risk of serious and potentially fatal hepatotoxicity is greater in children under 2 years. 

Adverse reactions occur more frequently in slow acetylators. They include acute hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency, and agranulocytosis. Fever, arthralgias, and rashes occur in up to 20% of patients. Gastrointestinal complaints are common. Hypersensitivity reactions including photosensitivity are also seen. Less frequent are hepatic function disturbances. 

Agents include acarbose, miglitol and voglibose. Only bacterial breakdown products of acarbose are absorbed which are then rapidly eliminated by the kidneys. Adverse events mainly consist of gastrointestinal complaints which in rare cases can be confused with ileus. Some hepatotoxicity has been reported. 

Repaglinide is metabolized in the liver with an elimination half-life of 1 hour. Also its adverse reaction profile is very similar to that of the sulfony-lureas, i.e. apart from hypoglycemia, gastrointestinal complaints and skin reactions. 

Oral formulations are very poorly absorbed with bioavailability ranging from less than 1-6%. Doses should be taken on an empty stomach to improve absorption. Increasing the dose will lead to gastrointestinal complaints. Of the absorbed dose 20-50% is adsorbed to bone and only very slowly released. Free bisphosphonates are eliminated in the urine with an apparent half-live of about 20 hours. However, the elimination half-life of risedronic acid is more than... 

The most frequent adverse reactions are gastrointestinal complaints like abdominal pain, nausea, vomiting and diarrhoea. CNS effects include headache, dizziness and insomnia but also, although rarely, hallucinations and seizures. Hypersensitivity reactions vary from rashes and urticaria to Stevens-Johnson syndrome and anaphylaxis. 

Patients should be warned that rifampicin colors urine, tears and other body fluids reddish-orange. Adverse effects further include rashes and pruritus and gastrointestinal complaints like nausea, anorexia and diarrhoea. With intermittent therapy a probably allergic hypersensitivity reaction can occur which mostly manifests itself as a flu-like syndrome with fever but can also result in nephritis and acute tubular necrosis. Elevation of serum transaminase levels occur frequently but clinical hepatitis is rare. Fatal outcome has been reported however. 

Halofantrine is usually well tolerated. Gastrointestinal complaints as well as pruritus and skin rashes may occur. It can prolong the QTc interval which can result in ventricular dysrythmias. Lume-fantrine has many similarities to halofantrine but seems not to prolong QTc. It is thus far only used in a fixed dose combination with artemether (see Section VI.a.2.5). 

Suramin is a non-specific inhibitor of many enzymes. Suramin can only be given intravenously. Toxic reactions are frequent and sometimes severe, including gastrointestinal complaints, nephrotoxicity, peripheral neuritis and exfoliative dermatitis. 

Dose-related adverse effects are generally rare and include mild gastrointestinal complaints. Some neurotoxicity is mostly seen in children. Hypersensitivity reactions can occur. 

Sulfasalazine has been used for the management of RA and ankylosing spondylitis with apparently similar effectiveness as penicillamine and with less toxicity. While 5-aminosalicylic acid is the active agent in inflammatory bowel disease, it is believed that sulfapyridine is mostly responsible for the antirheumatoid effects. Gastrointestinal complaints, dizziness and photosensitivity are the most frequently observed adverse events. With levamisole and also with sulfasalazine and olsalazine a delay of 2-3 months is to be expected before positive responses will be observed. 

The adverse effects of methotrexate include gastrointestinal complaints, bone marrow suppression, alopecia and nephrotoxicity. The toxic effects of methotrexate may be terminated by administering the fully reduced folate coenzyme leucovorin (folinic acid). Leucovorin rescue permits the administration of high doses of methotrexate, for example in situations where partially resistance has occurred or to obtain cytotoxic concentrations of methotrexate in the CNS. 

Pemetrexed is chemically similar to folic acid. It inhibits three enzymes used in purine and pyrimidine synthesis - thymidylate synthetase, dihydrofolate reductase, and glycinamide ribonucleotide formyl transferase. By inhibiting the formation of precursor purine and pyrimidine nucleotides, pemetrexed prevents the formation of DNA and RNA. In 2004 it was approved for treatment of malignant pleural mesothelioma and as a second-line agent for the treatment of non-small cell lung cancer. Adverse effects include gastrointestinal complaints, bone marrow suppression, alopecia, allergic and neurotoxic reactions. 

Less common adverse effects include blurred vision, hallucinations, and paradoxical reactions consisting of excitement, stimulation, and hyperactivity. Also, a variety of gastrointestinal complaints occur, and blood dyscrasias have been reported, but these are rare. Benzodiazepine administration during pregnancy, delivery, or lactation has the potential to have adverse effects on the fetus or newborn. 

Dose-related myelosuppression is the major adverse effect produced by 6-thioguanine. Patients deficient in thiopurine methyltransferase (TPMT), a cytosolic enzyme required for metabolism of 6-thioguanine, are at heightened risk. Other adverse effects include gastrointestinal complaints and elevations of liver transaminases. There have been rare reports of more serious he-patotoxicity, including acute hepatitis, acute cholestasis, and hepatic venoocclusive disease. 

Lamivudine is the best-tolerated NRTI. Its most common adverse effects include headache, malaise, fatigue, and insomnia. Pancreatitis is rare. Gastrointestinal complaints are common with lamivudine-zidovudine therapy but are probably mainly due to the zidovudine component. Lamivudine resistance sometimes occurs early in treatment. Cross-resistance to zal-citabine, didanosine, and abacavir can occur simultaneously. Withdrawal of lamivudine in patients infected with both hepatitis B virus and HIV can cause a flare-up of hepatitis symptoms. 

Abacavir is associated with side effects such as anorexia, nausea, vomiting, malaise, headache, and insomnia. A potentially fatal hypersensitivity reaction develops in approximately 5% of patients, usually early in the course of treatment. Fever and rash are the most common symptoms of this reaction malaise, respiratory symptoms, and gastrointestinal complaints may also occur. Resistance to abacavir may be associated with resistance to zidovudine, didanosine, and lamivudine. 

There appears to be little difference between benzodiazepines and kava extract in anxiolytic activity. However, kava extracts seem to have fewer side effects. Two studies with more than 3000 patients each found unwanted events in about 2% of patients during treatment with kava extract. The more frequently reported side effects were gastrointestinal complaints, allergic skin reactions, headache, and photosensitivity (Pittler and Ernst, 2000). There have been isolated reports of hepatotoxicity and acute liver failure (Escher et ah, 2001). Kava may potentiate the sedative effects of other medications including barbiturates and benzodiazepines. Kava can also cause behavioral disinhibition in a minority of individuals, including children. The most common problem, which is usually associated with persistent and excessive usage, is a scaly skin rash called kava dermopathy, which is reversible. 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Tacrolimus can be administered orally or intravenously. The half-life of the intravenous form is approximately 9-12 hours. Like cyclosporine, tacrolimus is metabolized primarily by P450 enzymes in the liver, and there is potential for drug interactions. The dosage is determined by trough blood level at steady state. Its toxic effects are similar to those of cyclosporine and include nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperkalemia, and gastrointestinal complaints. 

N.A. Achilleine, tannins, cineole, chamazulene, sesquiterpene, lactones, menthol, camphor, sterols, triterpenes.98,99,100,101,102 103 Reduce fever, anti-inflammatory, treat common cold, diarrhea, dysentery, hypertension, and gastrointestinal complaints. 

Mycophenolate mofetil reduces the risk of first acute rejection by 50%. Toxicity is minor, but includes bone marrow suppression and gastrointestinal complaints. A higher incidence of CMV disease compared to azathioprine control wxs observed in the clinical trials. Recent registry studies appear to indicate that renal transplant recipients receiving mycophenolate have improved long-term outcomes. 

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