Insulin therapy toxic effects

AMPHETAMINES BUPROPION 1. t plasma concentrations of these substrates, with risk of toxic effects 2. t risk of seizures. This risk is marked in elderly people, patients with a history of seizures, those with an addiction to opiates/ cocaine/stimulants, and those with diabetes treated with oral hypoglycaemics or insulin 1. Bupropion and its metabolite hydroxybupropion inhibit CYP2D6 2. Bupropion is associated with a dose-related risk of seizures. These drugs that lower seizure threshold are individually epileptogenic. They have additive effects when combined 1. Initiate therapy with these drugs, particularly those with a narrow therapeutic index, at the lowest effective dose. Interaction is likely to be important with substrates for which CYP2D6 is considered the only metabolic pathway (e.g. amphetamines) 2. Extreme caution. The dose of bupropion should not exceed 450 mg/day (or 150 mg/day in those with severe hepatic cirrhosis)... 

In patients with diabetes mellitus, niacin should be used cautiously, since niacin-induced insulin resistance can cause severe hyperglycemia. Niacin use in patients with diabetes mellitus often mandates a change to insulin therapy. If niacin is prescribed for patients with known or suspected diabetes, blood glucose levels should be monitored at least weekly until proven to be stable. Niacin also elevates uric acid levels a history of gout is a relative contraindication for niacin use. Rarer reversible side effects include toxic amblyopia and toxic maculopathy. Atrial tachyarrhythmias and atrial fibrillation have been reported, more commonly in elderly patients. Niacin, at doses used in humans, has been associated with birth defects in animal models and should not be taken by pregnant women. 

The first half of the 20th century brought further attempts to use drugs and other therapies to treat mental illness. For example, tests were conducted on the effectiveness of giving amphetamines to depressed and narcoleptic patients, and carbon dioxide inhalation procedures were used in the treatment of illnesses referred to as psychoses and neuroses. Also used in the treatment of psychoses were antihistamines, insulin shock, and psychosurgery. Electroshock therapy was used to treat severe depression (a procedure still used today). Finally, in 1949 an Australian physician named John Cade discovered that the alkali metal lithuim successfully moderated manic conditions, although concerns about toxic reactions to it prevented its approval for use in the United States until 1970. Lithium remains a mainstay in the treatment of bipolar illnesses today. 

Ultrasound was used as a complementary imaging method. The size of the lesion was checked every two months. Blood samples were taken to determine red blood cell, white blood cell and platelet counts, and complete biochemistry parameters including insulin and glucose levels were measured every two weeks during the two months following therapy. The results were used to determine possible side effects of the radionuclide treatment, with particular attention given to kidney toxicity. Insulin and glucose levels were also monitored constantly. 

The therapeutic use of homologous human proteins - including insulin, growth hormone, and colony stimulating factors - in replacement therapy, has been adequately supported by subchronic toxicity studies in animal species reactive to their pharmacological or physiological effects. Extension to chronic studies has usually not provided valuable additional safety information. 

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