Increase in side effect

Renal function, urine pH because alkaline urine may lead to an accumulation of the drug and a possible increase in side effects... 

Two dose effect studies with haloperidol allow a statement to be made regarding adequate doses, at least for this antipsychotic a double-blind comparison between daily doses of 10, 30 and 80 mg of haloperidol in 87 recently hospitalized patients with schizophrenia revealed no advantage of the two higher doses over the dose of lOmg per day (Rifkin ei al., 1991), and a study by McEvoy et cd. (1991) in 106 patients with schizophrenia and schizoaffective psychoses showed that an increase in dose above an individually optimal level (mostly less than lOmg per day in this study) produced no additional therapeutic effect but rather an increase in side effects, especially EPS. 

In summary, impurities in the active substance and final pharmaceutical preparation can show structural similarity to the drug molecule or present completely different chemical characteristics, can present no biological activity or show significant pharmacological activity (even toxicity), and can cause an increase in side effects (Fig. 8.1)... 

Oral steroid is most frequently used for maintenance treatment (prednisolone 5 to 15 mg/day or equivalent). " Alternate-day regimens, although not evaluated, are often used in children to minimize growth retardation. Monthly pulse IV steroids in conjunction with cyclophosphamide resulted in more sustained remission, fewer relapses, and no significant increase in side effects. This combination has also been shown by meta-analysis to be more beneficial than steroid or cyclophosphamide alone. Cyclophosphamide, because of its bladder and gonadal toxicity, has been given as monthly and then bimonthly intravenous injection, instead of daily administration, for up to 2 or more years. However, toxicity is still a concern. A recent trial in Emope showed that after initial lower pulse doses of IV cyclophosphamide, oral azathioprine was able to attain remission rates similar to those of higher initial pulse doses of cyclophosphamide with quarterly foUow-up doses. ... 

It is important to obtain details regarding history of keloid or hypertrophic scar formation. Previously, we used to recommend delaying a procedure for a period of 6-12 months in patients being treated by isotretinoin [49], This recommendation has been revised and changed by us and others, and currently we peel patients, especially those with thick and oily skin, on low-dosage isotretinoin (up to 40 mg a week) with no increase in side-effect rate. Active acne is not a contraindication for chemical peel. In these cases, the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scars reappearance. 

Pneumococcal vaccine is administered intramuscularly or subcutaneously as one 0.5-mL dose. Pneumococcal vaccine may be administered at the same time as influenza vaccine (by separate injection in the other arm) without an increase in side effects or decreased antibody response to either vaccine (42,43). Pneumococcal vaccine also may be administered concurrently with other vaccines. 

The discussion of the last section is then useful in considering the evaporative cycles. We shall see that the effect of water injection downstream of the compressor (and possibly in the cold side of the heat exchanger) may lead towards the [CBTJiXr type of plant, with increased cold side effective specific heat and hence increased heat exchanger effectiveness. Water injection in the compressor may lead to a plant with isothermal compression. 

Only a small number of drug interactions have been reported with donepezil. In vitro studies show a low rate of binding of donepezil to cytochrome P-450 (CYP)3A4 or 2D6. Whether or not donepezil has the potential for enzyme induction is not known. No interactions with theophylline, cimeti-dine, warfarin, digoxin, or ketoconazole have been documented. In vitro studies show that inhibitors of CYP3A4 and 2D6 have the potential to inhibit the metabolism of donepezil. The clinical relevance of this is unknown. However, monitoring for possible increased peripheral side effects is advised... 

CYP3A4 and 2D6 are the major enzymes involved in the metabolism of galantamine. Pharmacokinetic studies with inhibitors of this system have resulted in increased galantamine concentrations or reductions in clearance. Similarly to donepezil, if inhibitors are given concurrently with galantamine, monitoring for increased cholinergic side effects should be done. Studies with inducers of these enzymes have not been completed.37... 

What are the expected differences in side-effect profiles between ethnic groups, in particular with selective serotonic re-uptake inhibitors and atypical antipsychotics Can the morbidity of medication side effects be reduced, hence increasing treatment compliance and effectiveness ... 

How does physical exercise alleviate depression One possibility is that it increases the release of endorphins that produce a sense of well-being, sometimes referred to as the runner s high . Another possibility is that it is a placebo effect. But even if it is a placebo effect, consider the differences between exercise and antidepressants in side effects. Side effects of antidepressants include sexual dysfunction, nausea, vomiting, insomnia, drowsiness, seizures, diarrhoea and headaches. Side effects of physical exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone, greater life expectancy, increased strength and endurance and improved cholesterol levels. So if both antidepressants and exercise work by means of the placebo effect, which placebo would you prefer ... 

In the event of increased anticholinergic side effects, plasma levels of disopyramide should be monitored and the dose of the drug adjusted accordingly. A reduction of the dose by one third, from the recommended 600 mg/day to 400 mg/day, would be... 

The effectiveness of each admixture may vary, depending on its concentration in the concrete, the time of addition in the mixing cycle and various constituents of the concrete. Although each class of admixture is defined by its main effect (i.e. water reduction, set acceleration), it may have one or more secondary effects (retardation of set, increased bleeding, air entrainment) and its use may result in side effects. Side effects are those modifications of properties produced in the concrete that, even though unsought, are both inevitable and independent of an admixture s main function. Prior to selecting an admixture for an intended application, these... 

Geriatric Considerations - Summary Ensure that the older adult can adequately use the inhalation device. A spacer maybe beneficial in fhose unable fo coordinate device operation and inhalation. Spacer devices improve drug delivery to the lungs, therefore monitor closely as the patient may also experience increased systemic side effects with improved exposure to albuterol. Monitor cardiac status. 

Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects ... 

Besides the stabilization of charged transition states, the effect as entropy traps is decisive for the effect as a catalyst. Entropy trap refers to the ability of a catalyst to bind substrates in a favorable orientation and thus to freeze out translational and rotational degrees of freedom of the substrate (Chapter 2, Section 2.2.3). The result corresponds to a drastic increase in the effective molarity of the substrate, to a concentration level which can never be reached in free solution. The transesterification reaction in Figure 18.5 (Schultz, 1993) would be difficult to conduct in water under ordinary circumstances as the hydrolysis side reaction is aided by a water concentration of 55.5 m. A comparison of kcM/KM [(m s) x] with the uncatalyzed reaction in water [s-1] (strictly speaking, [H20] at 55.5 m has to be considered as well, so a dimension of [(m s) 11 again results) yields an effective molarity of 106 m. 

Commonly used drugs (other than isoniazid) affected by NAT2 polymorphism were procainamide, hydralazine, dapsone, and sulfonamides with an increase of side effects in all cases. A selective substrate of NATl is -aminosalicylic acid (PAS), but its genetic variation was never clinically important (52). Because of such lack of importance, more attention is often paid to the fact that various industrial chemicals with carcinogenic potential, and mutagenic heterocyclic amines, are substrates of both N-acetyltransferases (53). The presence or absence of these transferases will determine some incidences of cancer (54). Attempts have been made to ascribe cancer incidences in different populations to acetyltransferase differences (55). 

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