Intravenous tolerability

ACAID is a special form of peripheral tolerance. About 98% of the antigen that is inoculated into the eye is carried into the bloodstream within 6h of injection (Wilbanks and Streilein, 1989). It was suggested that ACAID is Just a manifestation of intravenously induced tolerance. However, ACAID was demonstrated to be distinctly different from intravenously induced tolerance. Intravenous tolerance is mediated by a CD8+ afferent T suppressor/regulator cell, and in intravenous tolerance... 

Seitz CS, Brocker EB, Trautmann A. Management of allergy to heparins in postoperative care subcutaneous allergy and intravenous tolerance. Dermatol Online J 2008 14(9) 4. 

Scott, B. (1975) Acute intravenous tolerance of etidocaine. Acta anaesth. scand., Suppl 60, 117. 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Darragh A, Lambe R, Kenny M, et al Tolerance of healrhy volunteers to intravenous administration of the benzodiazepine antagonist Ro 15-1788. EurJ Clin Pharmacol 24 569-370, 1983... 

While epinephrine is usually well tolerated in young and healthy individuals, there may be problems in elderly patients with cardiac arrhythmia or previous myocardial infarction episodes [31-33]. Pharmacological effects of epinephrine include rapid rise in blood pressure, pallor, anxiety, tachycardia, headache and tremor as well as vertigo. Most commonly these effects occur after intravenous injection or after overdosing epinephrine. Cardiac arrhythmia or pulmonary edema may develop in serious cases [33, 34]. 

Clonazepam, a typical 1 4 benzodiazepine, is effective in absence seizures, myoclonic jerks and tonic-clonic seizures and given intravenously it attenuates status epilepticus. It is less sedative than phenobarbitone but tolerance develops and its withdrawal, as... 

Profuse or prolonged vomiting can lead to complications of dehydration and metabolic abnormalities. Patients must have adequate hydration and electrolyte replacement orally (if tolerated) or intravenously to prevent and correct these problems. Some pharmacologic treatments work locally in the GI tract (e.g., antacids and prokinetic agents), whereas others work in the central nervous system (e.g., antihistamines and antiemetics).1... 

Because the patient is not able to tolerate oral iron therapy (constipation and nausea), changing to intravenous iron therapy is appropriate. 

Patients with severe intestinal disease or liver abscess should receive metronidazole 750 mg three times daily for 10 days, followed by the luminal agents indicated above. The pediatric dose of metronidazole is 50 mg/kg per day in divided doses, which should be followed by a luminal agent. An alternative regimen of metronidazole is 2.4 g/day for 2 days in combination with the luminal agent. Tinidazole (Tindamax, recently introduced on the United States market) administered in a dose of 2 g daily for 3 days (pediatric dose 60 mg/kg for 5 days) is an alternative to metronidazole. If there is no prompt response to metronidazole or aspiration of the abscess, an antibiotic regimen should be added. Patients who cannot tolerate oral doses of metronidazole should receive an equivalent dose intravenously. 

Intravenous allopurinol (Aloprim ) 625- 1250/day As above. Reserve for patients who cannot tolerate or take oral medications. Maximum dose = 600 mg/day. 

Iron-deficiency anemia in chronic PN patients may be due to underlying clinical conditions and the lack of iron supplementation in PN. Parenteral iron therapy becomes necessary in iron-deficient patients who cannot absorb or tolerate oral iron. Parenteral iron should be used with caution owing to infusion-related adverse effects. A test dose of 25 mg of iron dextran should be administered first, and the patient should be monitored for adverse effects for at least 60 minutes. Intravenous iron dextran then may be added to lipid-free PN at a daily dose of 100 mg until the total iron dose is given. Iron dextran is not compatible with intravenous lipid emulsions at therapeutic doses and can cause oiling out of the emulsion. Other parenteral iron formulations (e.g., iron sucrose and ferric gluconate) have not been evaluated for compounding in PN and should not be added to PN formulations. 

---