In this article we summarize suspected adverse events following immunization (AEFI) of pericarditis, myocarditis and perimyocarditis that were reported by our regional pharmacovigilance centre after COVID-19 mRNA-vaccination and discuss their association with these vaccines. Seventeen cases were reported between March and July 2021. Of these, nine had perimyocarditis, five myocarditis and three pericarditis. Twelve patients were male (71 %). The median age was 38 years (range 17 - 88). The most commonly observed presenting symptom was acute chest pain (65%). While 47% of the patients were previously healthy, 53% had at least one pre-existing comorbidity, with hypertension being the most prevalent (24%). The European Society of Cardiology diagnostic criteria for the reported AEFIs were fulfilled in twelve cases (71%). The AEFIs occurred after the first vaccine dose in six cases (35%), after the second vaccine dose in ten cases (59%) and after both doses in one case (6%). The median latency of all AEFIs taken together was 14 days (range 1 - 28) after the first vaccination and 3 days (range 1 - 17) after the second one. All patients except one were hospitalized (94%) with a median length of stay of 7.5 days (range 3 - 13). The majority of patients (n = 11, 65%) did not experience any complications, and 13 (77%) of the patients were recovered or recovering at the time of discharge. In 16 of the 17 cases (94%), the association between the AEFI and mRNA-vaccination was considered possible by the pharmacovigilance centre.
We present the case of a 34-year-old woman with recurrent depressive disorder who ingested purple foxglove with suicidal intent. She bought a foxglove plant (Digitalis purpurea) over the internet and used all of its leaves to make a tea that she then drank over a period of a few hours. Seventeen hours later, she developed abdominal pain, emesis and bradycardia and was admitted via the emergency department to the intensive care unit for further treatment and monitoring. The plasma digoxin concentration measured 3.53 nmol/l (therapeutic reference range 0.77-1.50 nmol/l) 21 hours after ingestion of the tea. She remained heamodynamically and neurologically stable, was treated with antiemetics and simple analgesia and did not require digoxin-specific antibodies. Despite normal renal function, her plasma digoxin half-life was prolonged (estimated 76 h), reflecting the long half-life of the parent compound digitoxin which is the main cardiac glycoside in Digitalis purpurea. She was transferred to psychiatric care 48 h after admission. In this report, we compare this case to other similar cases, which to date have only been rarely reported in the literature.
Zusammenfassung. Zur Linderung einer Hustensymptomatik können diverse Arzneimittel mit verschiedenen protussiven oder antitussiven Wirkmechanismen eingesetzt werden. Für gewisse Indikationen spielen auch Phytopharmaka eine bedeutende Rolle. In der Ursachensuche eines persistierenden Hustens ist die Dauermedikation kritisch zu prüfen und bei Verdacht auf eine unerwünschte Arzneimittelwirkung gegebenenfalls anzupassen.
Zusammenfassung. Palliative Care umfasst die Behandlung und Begleitung von unheilbar kranken und sterbenden Menschen und ihren Angehörigen. Es handelt sich oft um komplexe Patientensituationen mit grosser Symptomlast. Körperliche Beschwerden wie Schmerzen und Atemnot sollen erfasst und in Hinblick auf die bestmögliche Lebensqualität behandelt werden. Dazu nehmen Opioide einen wichtigen Stellenwert ein. Um den optimalen Nutzen zu erreichen und die Rate an unerwünschten Arzneimittelwirkungen möglichst gering zu halten, muss die Indikationsstellung sowie die Wahl des Wirkstoffes, der Dosierung und der Applikationsform an die Patientensituation angepasst erfolgen. Neben den körperlichen Symptomen werden auch Bedürfnisse auf der psychischen, sozialen und spirituellen Ebene berücksichtigt. Die ganzheitliche Erfassung, Betreuung und Behandlung der Patienten ist von grösster Bedeutung. Die interprofessionelle Zusammenarbeit von verschiedenen Berufsgruppen stellt in der Palliative Care deshalb ein tragendes Element dar.
Abstract. This short review addresses disease-drug interactions requiring special attention, namely interactions between common conditions and over-the-counter medication and interactions between rare conditions and drugs that are absolutely contraindicated. We specifically examine over-the-counter analgesics, antiemetics and drugs used to treat allergy symptoms and underlying disease conditions they can exacerbate. Resources for avoiding disease-drug interactions in patients with rare conditions, such as myasthenia gravis, glucose-6-phosphate deficiency, mitochondriopathies and long QT-syndrome are given. We also discuss methods for avoiding disease-drug interactions in clinical practice. These include awareness, regular diagnosis- and drug-history taking, consulting the product information, good communication between healthcare providers and patient education. Furthermore, pharmacovigilance activities help in the early identification and characterization of adverse drug reactions resulting from disease-drug interactions.
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