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Gregory L Kearns - One of the best experts on this subject based on the ideXlab platform.
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Serum sickness like Reaction to cefaclor lack of in vitro cross reactivity with loracarbef
Clinical Pharmacology & Therapeutics, 1998Co-Authors: Gregory L Kearns, Gary J Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
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Serum sickness—like Reaction to cefaclor: Lack of in vitro cross‐reactivity with loracarbef
Clinical pharmacology and therapeutics, 1998Co-Authors: Gregory L Kearns, J. Gary Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
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Serum sickness like Reactions associated with cefprozil therapy
The Journal of Pediatrics, 1994Co-Authors: Nancy Lowery, Ronald A Young, Gregory L Kearns, Gary J WheelerAbstract:Abstract Four patients had Serum sickness–like Reactions during treatment with cefprozil, a new cephalosporin. Two patients had had previous mild Reactions associated with cephalosporin therapy. It remains uncertain whether ceprozil-associated Serum sickness–like Reaction represents a unique or a class-related adverse drug Reaction. (J P EDIATR 1994;125:325-8)
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Serum sickness–like Reactions associated with cefprozil therapy
The Journal of pediatrics, 1994Co-Authors: Nancy K. Lowery, Ronald A Young, Gregory L Kearns, J. Gary WheelerAbstract:Abstract Four patients had Serum sickness–like Reactions during treatment with cefprozil, a new cephalosporin. Two patients had had previous mild Reactions associated with cephalosporin therapy. It remains uncertain whether ceprozil-associated Serum sickness–like Reaction represents a unique or a class-related adverse drug Reaction. (J P EDIATR 1994;125:325-8)
Joanne Reid - One of the best experts on this subject based on the ideXlab platform.
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Serum sickness like Reaction to cefaclor lack of in vitro cross reactivity with loracarbef
Clinical Pharmacology & Therapeutics, 1998Co-Authors: Gregory L Kearns, Gary J Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
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Serum sickness—like Reaction to cefaclor: Lack of in vitro cross‐reactivity with loracarbef
Clinical pharmacology and therapeutics, 1998Co-Authors: Gregory L Kearns, J. Gary Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
Thierry Vial - One of the best experts on this subject based on the ideXlab platform.
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Safety profile of etifoxine: A French pharmacovigilance survey.
Fundamental & Clinical Pharmacology, 2016Co-Authors: Judith Cottin, Aurore Gouraud, Marie-josèphe Jean-pastor, Anne Dautriche, Charlène Boulay, Hélène Géniaux, Marine Auffret, N. Bernard, Jacques Descotes, Thierry VialAbstract:: Etifoxine chlorhydrate is a benzoxazine derivative approved for the treatment of psychosomatic manifestations of anxiety since 1979. Previously labeled adverse drug Reactions (ADRs) only include drowsiness, benign cutaneous Reactions, and acute hypersensitivity Reactions. The objectives were to examine recent data on etifoxine-related ADR by reviewing Individual Case Safety Reports (ICSRs) recorded in France especially unexpected ADRs. Etifoxine-related ICSRs were extracted from the French Pharmacovigilance database from 1 January 2000 to 30 April 2012 and data from the marketing authorization holder up to 31 December 2011 were also obtained. Of the 350 cases retained for analysis, 123 (35%) were considered serious. Dermatological or acute hypersensitivity Reactions were the most frequent ADRs (59%) mainly isolated cutaneous eruptions. However, there were 24 cases of severe toxidermia (DRESS in 5, erythema multiforme in 10 and Stevens-Johnson syndrome in 5) with etifoxine as the most suspected drug in 11 patients, and seven cases of vasculitis or Serum Sickness-Like Reaction. Liver disorders were reported in 34 patients of whom 25 developed acute hepatitis with a cytolytic biological pattern in 16. Other unexpected ADRs included 16 reversible cases of metrorrhagia with positive rechallenge in 5, and three cases of biopsy-proven microscopic colitis of which one recurred after etifoxine re-administration. Although etifoxine has been marketed for more than 30 years, this survey identified a number of unexpected and sometimes serious ADRs, in particularly severe toxidermia and acute cytolytic hepatitis. A recent update of the French etifoxine summary of the product characteristics (SPC) was based on these findings.
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Safety profile of etifoxine: A French pharmacovigilance survey.
Fundamental & Clinical Pharmacology, 2016Co-Authors: Judith Cottin, Aurore Gouraud, Marie-josèphe Jean-pastor, Anne Dautriche, Charlène Boulay, Hélène Géniaux, Marine Auffret, N. Bernard, Jacques Descotes, Thierry VialAbstract:: Etifoxine chlorhydrate is a benzoxazine derivative approved for the treatment of psychosomatic manifestations of anxiety since 1979. Previously labeled adverse drug Reactions (ADRs) only include drowsiness, benign cutaneous Reactions, and acute hypersensitivity Reactions. The objectives were to examine recent data on etifoxine-related ADR by reviewing Individual Case Safety Reports (ICSRs) recorded in France especially unexpected ADRs. Etifoxine-related ICSRs were extracted from the French Pharmacovigilance database from 1 January 2000 to 30 April 2012 and data from the marketing authorization holder up to 31 December 2011 were also obtained. Of the 350 cases retained for analysis, 123 (35%) were considered serious. Dermatological or acute hypersensitivity Reactions were the most frequent ADRs (59%) mainly isolated cutaneous eruptions. However, there were 24 cases of severe toxidermia (DRESS in 5, erythema multiforme in 10 and Stevens-Johnson syndrome in 5) with etifoxine as the most suspected drug in 11 patients, and seven cases of vasculitis or Serum Sickness-Like Reaction. Liver disorders were reported in 34 patients of whom 25 developed acute hepatitis with a cytolytic biological pattern in 16. Other unexpected ADRs included 16 reversible cases of metrorrhagia with positive rechallenge in 5, and three cases of biopsy-proven microscopic colitis of which one recurred after etifoxine re-administration. Although etifoxine has been marketed for more than 30 years, this survey identified a number of unexpected and sometimes serious ADRs, in particularly severe toxidermia and acute cytolytic hepatitis. A recent update of the French etifoxine summary of the product characteristics (SPC) was based on these findings.
Michael J. Rieder - One of the best experts on this subject based on the ideXlab platform.
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Paediatric Serum Sickness-Like Reaction: A 10-year retrospective cohort study
Paediatrics & Child Health, 2021Co-Authors: Blanca R Del Pozzo-magaña, Michael J. Rieder, Awatif Abuzgaia, Barbara Murray, Alejandro Lazo-langnerAbstract:Abstract Background Serum Sickness-Like Reaction (SSLR) is an acute inflammatory condition affecting predominantly children. The pathophysiology remains unclear, but drugs are considered the main trigger. Objective The aim of this study was to describe the clinical and laboratory features, triggers, and treatment modalities in children diagnosed with SSLR. Methods We conducted a 10-year retrospective cohort study including all paediatric patients (0 to 18 years old) with query SSLR referred to the Adverse Drug Reactions Clinic at the Children’s Hospital of Western Ontario. Diagnostic criteria included acute skin rash plus joint inflammation with or without fever. Results We included 83 patients (47 females). Age ranged from 11 months to 12 years (mean 3.2 years). Amoxicillin was the trigger in 82.7% of patients. The mean time between the exposure to the triggering drug and the development of the symptoms was 8.5 days. Urticaria-like and Erythema multiforme-like lesions were present in 35% and 38.5% of the cases, respectively. Joint inflammation affecting hands/feet was present in 60%. Pruritus, lip/eye swelling, and fever were reported in 33, 31, and 45% of patients, respectively. The lymphocyte toxicity assay (LTA) showed incremental T-cell toxicity in 32 of 34 patients. Children that received treatment with antihistamines/nonsteroidal anti-inflammatory drugs (NSAIDs) plus oral steroids had a mean recovery time shorter than those treated only with antihistamines/NSAIDs (6 versus 8 days; P=0.09). Conclusions In our study, SSLR was mostly triggered by amoxicillin and had a mean time presentation of 8.5 days. Further prospective and well-conducted studies are needed.
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Serum Sickness–like Reaction Possibly Associated with Meropenem Use
2016Co-Authors: Edward D. Ralph, Michael J. Rieder, Michael John, Anne Marie BombassaroAbstract:Serum sickness–like Reactions most commonly occur sec-ondary to drug administration. We describe a Serum sick-ness–like Reaction that was possibly associated with mero-penem therapy. In 1905, von Pirquet and Schick [1] characterized the classic syndrome of Serum sickness after administration of heterolo-gous antitoxin Serum. Reactions with clinical features slightly different from those of classic Serum sickness, with the source of antigen not being heterologous Serum, are referred to as “Serum sickness–like Reactions ” (SSLRs) [2]. Today, SSLRs oc-cur most commonly secondary to drug administration [2–4]. This case report describes an SSLR that was possibly associated with receipt of meropenem therapy. Case report. The patient was a 34-year-old man who had a ventriculoperitoneal shunt placed in 1982 for hydrocephalu
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Serum Sickness-Like Reaction possibly associated with meropenem use.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2003Co-Authors: Edward D. Ralph, Michael J. Rieder, Michael John, Anne Marie BombassaroAbstract:Serum Sickness-Like Reactions most commonly occur secondary to drug administration. We describe a Serum Sickness-Like Reaction that was possibly associated with meropenem therapy.
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Serum sickness like Reaction to cefaclor lack of in vitro cross reactivity with loracarbef
Clinical Pharmacology & Therapeutics, 1998Co-Authors: Gregory L Kearns, Gary J Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
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Serum sickness—like Reaction to cefaclor: Lack of in vitro cross‐reactivity with loracarbef
Clinical pharmacology and therapeutics, 1998Co-Authors: Gregory L Kearns, J. Gary Wheeler, Michael J. Rieder, Joanne ReidAbstract:Objectives A lymphocyte-based in vitro rechallenge technique was used to examine the potential for cross-reactivity between loracarbef and cefaclor in children who had had adverse Reactions to cefaclor. Study design The study cohort included 10 patients (2.2 ± 1.1 years old) with a Serum Sickness-Like Reaction to cefaclor, five patients (4.1 ± 4.6 years old) with immediate-type hypersensitivity Reactions to the drug, and five patients (1.5 ± 0.9 years old) who had a delayed hypersensitivity Reaction to cefaclor without joint involvement (i.e., not a Serum Sickness-Like Reaction). Peripheral blood mononuclear cells were isolated from each patient and were exposed to cefaclor, loracarbef, and the metabolites of each generated with phenobarbital-induced murine hepatic microsomes. Results Among patients with cefaclor-associated Serum Sickness-Like Reactions, lymphocyte killing (expressed as percentage cell kill above baseline) in the presence of cefaclor metabolites (83.6% ± 42.2%) was significantly (p < 0.02) higher than that observed among the patients with either immediate-type (1.1% ± 2.4%) or delayed hypersensitivity (0%) Reactions. In contrast, loracarbef did not produce significant in vitro cytotoxicity among any of the patient subgroups. Our in vitro evidence was supported at therapeutic rechallenge with loracarbef among three children with cefaclor-associated Serum Sickness-Like Reactions who tolerated a full course of therapy without adverse Reactions. Conclusion The metabolite-mediated cytotoxicity associated with cefaclor among patients who had had Serum Sickness-Like Reactions after therapeutic administration of the drug was not shared with loracarbef. The extent to which the apparent lack of in vitro cross-reactivity between cefaclor and loracarbef may be predictive of clinical cross-reactivity is not known. Clinical Pharmacology & Therapeutics (1998) 63, 686–693; doi:
Neil H Shear - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of severe drug hypersensitivity.
Seminars in cutaneous medicine and surgery, 2014Co-Authors: Roni P. Dodiuk-gad, Philip M. Laws, Neil H ShearAbstract:Epidemiological studies of severe drug hypersensitivities are important to understanding the morbidity and mortality of this heterogeneous group of disorders. These insights also allow greater identification of at-risk patient groups. However, epidemiological studies of drug hypersensitivity Reactions are challenging due to the variable diagnostic criteria applied and incomplete data sets studied. We review the epidemiology of severe drug hypersensitivity Reactions with a particular focus on severe cutaneous adverse Reactions (SCARs). SCAR diseases include: Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, Serum-Sickness-Like Reaction and acute generalized exanthematous pustulosis.
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Recognition and management of severe cutaneous drug Reactions.
Dermatologic clinics, 2007Co-Authors: Sandra R Knowles, Neil H ShearAbstract:Cutaneous drug Reactions are among the most common types of adverse drug Reactions. This article focuses on the recognition and management of severe cutaneous drug eruptions, including the drug-hypersensitivity syndrome, Serum Sickness-Like Reaction, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Cutaneous Reactions are considered severe when they can result in serious skin damage or involve multiple organs. Some of these Reactions can cause significant morbidity or death. Each may be confounded by diagnostic difficulties, confusion in ascertaining causality, and treatment challenges.
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Serum sickness like Reaction associated with clopidogrel
British Journal of Clinical Pharmacology, 2003Co-Authors: Elizabeth J Phillips, Sandra R Knowles, Neil H ShearAbstract:Clopidogrel (Plavix®) is a selective inhibitor of platelet aggregation used preventively in the setting of myocardial infarction, coronary stent implantation and stroke [1]. Clopidogrel structurally resembles another thienopyridine antiplatelet drug ticlopidine (Ticlid®) differing only by the presence of a carboxymethyl side group on clopidogrel. The drugs differ in their toxicity profile, with ticlopidine being more significantly associated with haematological adverse events such as agranulocytosis [2]. Recent reports have described a syndrome of arthritis and rash or pruritus associated with both clopidogrel and ticlopidine [3, 4]. We describe a case of Serum Sickness-Like Reaction (SSLR) associated with clopidogrel that along with the earlier reports, highlights that SSLR may be an uncommon but potentially underreported adverse event associated with the thienopyridine antiplatelet drugs. A 51-year-old man presented with an acute coronary syndrome. Longstanding medications included atorvastatin, metoprolol and enteric coated aspirin 325 mg daily. Subsequent cardiac catheterization revealed an angioplastable lesion. Following the insertion of a coronary artery stent, he was started on clopidogrel 75 mg once daily. Ten days later he developed fever followed by arthralgias and skin rash. Physical examination revealed an exanthematous rash over the chest and back and stress pain of the shoulder and knee joints bilaterally. Complete blood count, liver function tests, creatinine and urine microscopy were normal. Symptoms resolved over a week with discontinuation of clopidogrel and a tapering dose of prednisone. He remains on atorvastatin, aspirin and metoprolol. The constellation of fever, arthritis, and rash occurring 10 days following initiation of a new drug support the diagnosis of clopidogrel-associated SSLR. Other recent reports suggest that SSLR may be associated with both clopidogrel and ticlopidine [3, 4]. Dakik et al. reported a 65-year-old woman who developed an urticarial rash and arthritis 12 days after starting ticlopidine 250 mg twice daily after coronary artery stent placement [3]. The authors labelled this as ‘hypersensitivity vasculitis’; however, the time sequence, arthritis, urticarial rash and lack of internal organ involvement are most consistent with SSLR. Garg et al. described two cases of ‘arthritis’ associated with clopidogrel. One was a 76-year-old woman who developed pruritus and symmetrical polyarthritis 2 weeks after starting clopidogrel following coronary stent insertion [4]. The second case was a monoarthritis occurring 3 weeks after initiation of clopidogrel and may have been unrelated to drug [4]. In all cases the symptoms were self-limited with no recurrence after discontinuation of ticlopidine and clopidogrel, respectively [3, 4]. Although cutaneous Reactions and arthritis have been associated with both clopidogrel and ticlopidine in postmarketing reports, no specific cases of SSLR have been reported. The structural similarity between clopidogrel and ticlopidine would suggest the potential generation of similar, although as yet unidentified, reactive metabolites. These metabolites along with immunological and host factors are thought to be important for the pathophysiological basis of SSLR [5]. Interestingly, bupropion (Zyban®), an antidepressant which has also been associated with SSLR, shares some structural features with clopidogrel and ticlopidine, although the putative reactive metabolite is unknown [6]. Although none of the cases, including ours, was rechallenged with the drug in question, these cases should increase awareness of a potential association between ticlopidine and clopidogrel and SSLR.
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Serious Adverse Reactions Induced by Minocycline: Report of 13 Patients and Review of the Literature
Archives of dermatology, 1996Co-Authors: Sandra R Knowles, Lori E. Shapiro, Neil H ShearAbstract:Background: Minocycline has been reported to cause serious, albeit rare, adverse events, including Serum sickness—like Reaction, hypersensitivity syndrome Reaction, and drug-induced lupus. A retrospective review of patients seen in our Adverse Drug Reaction Clinic as well as information obtained from the Health Protection Branch was done to identify patients with minocycline-induced Reactions. In addition, the literature concerning serious Reactions to minocycline was reviewed. Observations: Six patients with a hypersensitivity syndrome Reaction, 6 patients with a Serum sickness—like Reaction, and 1 patient who had symptoms consistent with drug-induced lupus were identified. A review of the literature identified 11 cases of hypersensitivity syndrome Reaction, 1 case of Serum sickness—like Reaction, and 24 cases of drug-induced lupus. Serum sickness—like Reactions occur sooner than hypersensitivity syndrome Reactions (15.6 vs 23.7 days,P=.04). Drug-induced lupus occurs on average 2 years after the start of minocycline therapy. Conclusions: Dermatologists need to be aware of the serious adverse Reactions that can develop after minocycline use. In patients who may require long-term therapy with minocycline (>1 year), we suggest that antinuclear antibody and hepatic transaminase levels be determined at baseline. Rechallenge with minocycline or other tetracyclines is currently not recommended for patients who develop these serious Reactions. Arch Dermatol. 1996;132:934-939
