This case of probable isotretinoin-induced IBD suggests that patients with suspected IBD should be asked about current or past use of isotretinoin to improve documentation of this serious adverse event.
Background:
Poor adherence in pediatric oncology leads to significant morbidity and mortality. Currently used medication reminder aids have shown little to no benefit in improving adherence. Phone applications (apps) have demonstrated improved adherence in recent studies involving the adult and pediatric patients. At this time, no pediatric oncology center is recommending a particular phone app.
Objective:
The objective of this study was to determine the proportion of parents of pediatric oncology patients interested in using a phone app for medication reminders and desired features.
Methods:
In this single-center observational trial, 45 questionnaires were completed by parents accompanying their child at a pediatric oncology center. See Supplemental Digital Content 1 (http://links.lww.com/JPHO/A327) for a copy of the questionnaire. Participants had a child on active cancer treatment and were able to read and write English. Primary outcomes included a number of parents currently using a phone app, the number of parents interested in using a phone app, main reasons for not using a phone app and desired phone app features.
Results:
Overall, 95.6% of parents had never used a phone app to aid in medication adherence. Over 85% of these parents were highly interested in using a phone app, but most were not aware of available phone apps to use (57.1%). Desired features included: refill notifications, tracking doses administered, personalizable medication schedule, free of charge, no advertisements, ability to input special instructions, use on multiple devices, unique alarms, tracking child’s results, and privacy protection.
Conclusions:
A majority of parents at an outpatient pediatric oncology clinic were interested in using a phone app to assist in medication adherence but were unaware of an available phone app. An ideal criteria list was created with 10 desired features to evaluate available phone apps that may be recommended for this population. Further studies are needed to evaluate if phone apps recommended by this tool improve adherence.
An adverse event is described which appeared when the macrolide antibiotic erythromycin was added to a regimen of risperidone 0.5 mg bid and clomipramine 50 mg tid in a 15-year-old male being treated for Tourette's, obsessive-compulsive, and attention-deficit hyperactivity disorders. An acute onset of behavioral symptoms, including agitation, labile mood, incessant talking, and argumentativeness, began within 24 h of starting the erythromycin and persisted for 9 days after its discontinuation. It was followed by a return to stable functioning on the prior risperidone-clomipramine regimen. Erythromycin, risperidone, and clomipramine are all metabolized by the hepatic cytochrome P450 system. It is postulated that the addition of erythromycin, a known inhibitor of CYP3A and CYP1A2, resulted in alterations in the metabolism of clomipramine and risperidone. Clomipramine metabolism is dependent upon the isoenzymes CYP2D6 and CYP1A2, and risperidone is a substrate for CYP2D6. Erythromycin would inhibit demethylation of clomipramine at the 1A2 isoenzyme and lead to a dual interaction between risperidone and clomipramine at the CYP2D6 isoenzyme. The subsequent increases in plasma levels of clomipramine, risperidone, their metabolites, or a combination of these agents could explain the adverse effects noted in this patient. In the absence of risperidone, clomipramine could have been metabolically cleared by CYP2D6. In the absence of clomipramine, risperidone clearance would not be affected by erythromycin. So the proposed mechanism requires an interaction involving all three agents: erythromycin, clomipramine, and risperidone. Alterations in plasma protein binding may also have played a role, because all three agents are extensively protein bound. Caution is urged when prescribing erythromycin with psychotropic drugs that are highly protein bound and/or are metabolized by the same P450 isoenzymes.
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