Gastrointestinal intolerance

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

Although their effectiveness is similar to the tetracyclines, the use of erythromycin and clindamycin is often limited due to their potential adverse outcomes. Erythromycin has treatment failure due to resistance and a high incidence of gastrointestinal intolerance, while clindamycin causes diarrhea and carries a risk of developing pseudomembranous colitis with long-term use.3,8... 

Zidovudine (AZT, ZDV) Retrovi r 1 00-mg caps, 300-mg tabs, 1 0 mg/mF intravenous solution, 1 0 mg/mF oral solution 300 mg bid 1 00 mg tid in severe renal impairment or HD None Bone marrow suppression macrocytic anemia or neutropenia gastrointestinal intolerance, headache, insomnia, asthenia Glucuronyl transferase and renal... 

Calvo N, Sanchez-Fructuoso Al, Conesa J, Moreno A, Barrientos A. (2006) Renal transplant patients with gastrointestinal intolerability to mycophenolate mofetil Conversion to enteric-coated mycophenolate sodium. Transplant Proc 38 1396-2391. 

The absorption of vitamin C is saturated at high doses, and therefore intakes above 1 g/day would be associated with negligible increased uptake at tissue levels, but they increase the risk of adverse gastrointestinal effects. Indeed, acute gastrointestinal intolerance (e.g., abdominal distension, flatulence, diarrhea, transient colic) has been observed. 

Adverse effects consist mainly of gastrointestinal intolerance such as nausea, epigastric pain and diarrhea and, especially in the elderly constipation with continued therapy. All ferrous salts may cause a black coloration of the faeces. Children are particularly susceptible to potentially lethal iron intoxications. Oral iron preparations should not be administered concurrently with tetracyclines as mutual interference with absorption will occur. 

Adverse effects are rare and comprise allergic reactions or gastrointestinal intolerance. Severe effects like hepatotoxicity, severe dermatitis, haemolytic anemia, agranulocytosis have been reported infrequently. As might be expected hypoglycaemia is the... 

The major adverse reactions reported are hypersensitivity rashes and diarrhea. The rash is usually itchy, morbilliform, and general. Gastrointestinal intolerance with abdominal pain, nausea, and vomiting occurs infrequently. Hepatotoxicity and bone marrow suppression have been noted. 

Adverse reactions tend to occur within a few hours of administration. They include gastrointestinal intolerance with nausea, vomiting, and abdominal discomfort. This may be due to the liberation of helminth proteins from dead worms rather than any direct effect of the drug. 

Anorexia, nausea, vomiting, and diarrhea occasionally accompany oral administration. Gastrointestinal intolerance, which is due to a direct stimulation of gut motility, is the most common reason for discontinuing erythromycin and substituting another antibiotic. 

The advantages of clarithromycin compared with erythromycin are lower incidence of gastrointestinal intolerance and less frequent dosing. Except for the specific organisms noted above, the two drugs are otherwise therapeutically very similar, and the choice of one over the other usually turns out to be cost and tolerability. 

Clofazimine is given for sulfone-resistant leprosy or when patients are intolerant to sulfones. A common dosage is 100 mg/d orally. The most prominent untoward effect is skin discoloration ranging from red-brown to nearly black. Gastrointestinal intolerance occurs occasionally. 

Valacyclovir is generally well tolerated, although nausea, vomiting, or rash occasionally occur. At high doses, confusion, hallucinations, and seizures have been reported. AIDS patients who received high-dosage valacyclovir chronically (ie, 8 g/d) had an increased incidence of gastrointestinal intolerance as well as thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome this dose was associated with confusion and hallucinations in transplant patients. 

Foscarnet is available in an intravenous formulation only poor oral bioavailability and gastrointestinal intolerance preclude oral use. Cerebrospinal fluid concentrations are 43-67% of steady-state serum concentrations. Although the mean plasma half-life is 3-6.8 hours, up to 30% of foscarnet may be deposited in bone, with a half-life of several months. The clinical repercussions of this are unknown. Clearance of foscarnet is primarily renal and is directly proportional to creatinine clearance. Serum drug concentrations are reduced approximately 50% by hemodialysis. 

A relative indication for corticotropin is the occasional gastrointestinal intolerance that occurs with oral glucocorticoids. In these cases, however, only the local effects of the glucocorticoids can be avoided, and not their systemic effects on the gastrointestinal tract (25). 

Adverse effects With chronic use, procainamide causes a high incidence of side effects, including a reversible lupus erythe-matosus-like syndrome that develops in 25 to 30% of patients. Toxic concentrations of procainamide may cause asystole or induction of ventricular arrhythmias. Central nervious system (CNS) side effects include depression, hallucination and psychosis. With this drug, gastrointestinal intolerance is less frequent than with quinidine. 

This pilot study with a small number of infants does not permit firm conclusions about metal absorption in infants However we have learned that bottle-fed infants tolerate the metal isotope solutions better than breast-fed infants In a subsequent study many (6/20) breast-fed babies spit up the milk-isotope mixture within 30 minutes of feeding Two others refused it entirely In contrasty all bottle-fed babies (12/12) drank the isotope-formula mixture and none had emesis The doses of isotopes could probably be reduced by at least half without sacrificing analytical sensitivity and this would probably reduce gastrointestinal intolerance ... 

Symptoms of gastrointestinal intolerance in patients taking aceclofenac commonly require withdrawal, at a rate of 3-15% (SEDA-20, 91). 

Bromhexine can cause gastrointestinal intolerance and impair the mucous barrier in the stomach it has been suggested it should not be given to patients with gastric ulceration. Reactivation of ulcers has been reported in a few patients, but hematemesis, melena, or other comph-cations have not been described (2). 

Gastrointestinal symptoms due to ciclosporin are usually mild and transient. In rheumatoid arthritis, gastrointestinal intolerance has been reported in 50% of patients, being the main cause for withdrawal of ciclosporin in 8% (83). Whereas worsening colitis did not occur in patients with inflammatory bowel disease, ciclosporin was involved in the development of acute colitis in isolated reports (SED-13,1125). 

Moreover, the overall incidence of gastrointestinal symptoms in patients taking celecoxib was only slightly lower than that of patients taking the traditional NSAIDs, as was the rate of withdrawal due to gastrointestinal intolerance in both users and non-users of low-dose aspirin. 

Like oral iron, parenteral iron is used too widely. When iron is truly needed, oral administration is generally preferable (9). Intractable gastrointestinal intolerance to oral formulations, hyperemesis in pregnancy, very severe blood loss, and possibly ulcerative colitis are some of the few valid indications for parenteral iron. A low ironbinding capacity (for example due to prior saturating iron therapy or malnutrition), folic acid deficiency, and an allergic constitution predispose the patient to adverse reactions to parenteral iron. Iron injections have been reported to provoke hemolytic anemia in cases of paroxysmal nocturnal hemoglobinuria. 

Levamisole has been used experimentally in leprosy, particularly in combination with dapsone. This combination was used in a documented series of Indian patients, some currently lepromatous and others in the course of a leprosy reaction (1). When using doses sufficient to provide as good an effect as that obtained with clofazimine + dapsone in a comparison group, adverse effects were limited to gastrointestinal intolerance (which was usually mild), affecting only five of the 30 patients treated an incidental case developed pyrexia. 

Qf 48 patients taking pyrazinamide 30 mg/kg/day plus levofloxacin 500 mg/day for 1 year, 27 discontinued therapy within 4 months owing to adverse events. Gastrointestinal intolerance was the major adverse event that resulted in early withdrawal (18). 

Miltefosine has been compared with the most effective standard treatment, amphotericin, in a randomized, open comparison in India, in which 299 patients, aged 12 years or over, received oral miltefosine (50 or 100 mg) and 99 patients received intravenous amphotericin deoxycho-late (1 mg/kg every other day to a total of 15 injections) (4). Vomiting and diarrhea were more common with miltefosine. However, the effects were mild in almost all cases, and only 3-4% of patients needed antiemetic drugs in both groups. One patient who took miltefosine withdrew because of gastrointestinal intolerance and one developed Stevens-Johnson syndrome. 

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