Purpose There is an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes. Methodology PubMed, Scopus and grey literature databases were searched from inception to January 2022 using search terms “rasburicase” and “methemoglobinemia” without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer. Result A total of 24 reports including 27 patients (23 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 5 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia. Conclusion Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD.
Antipsychotic medications are the primary therapeutic interventions in the treatment of patients with psychiatric disorders. Prescribing trends of antipsychotics has modified over the decade with accessibility of atypical antipsychotics. Hence continuous studies on contemporary prescribing patterns are needed to provide most upgraded, effective and rational treatment of psychoses. A cross sectional study of patients receiving antipsychotics was carried out in the Psychiatry Out Patients Department (OPD) of K R Hospital, Mysuru for a period of six months. All relevant data of the enrolled patients was collected from various data sources and documented in a suitably designed data collection forms to evaluate and to understand the pattern and extent of medication use by using WHO-CORE indicators and to systematically classify drugs using WHO-ATC system and to represent diagnosed psychiatric disorder according to WHO-ICD 10 version. We incorporated an aggregate of 200 study population. Male preponderance (55%) was observed when compared to females (45%) who attended the psychiatry OPD. The most prevalent psychiatric disorder was F20 (Psychosis/Unspecified psychosis/Schizophrenia/ Chronic Psychosis/ Delusional disorder/ Unspecified psychosis with Depression) comprised 60% of the most prevalent psychiatric disorders in our study population. The average number of antipsychotic per prescription was 1.33±0.46. 90.63% of antipsychotic drugs were prescribed by their generic names. Additionally, 2% of antipsychotic injectables were present in the prescription, 0.34% minimal antibiotic medications were prescribed and no fixed dose combinations were documented. Higher inclination towards atypical antipsychotics was observed than Typical antipsychotics. Olanzapine was the most routinely prescribed antipsychotic followed by Risperidone. Antipsychotic polypharmacy was observed in 21% patients in our study population. The WHO Core Prescribing indications corresponded with the optimal values, suggesting rational drug therapy and thus eradicating probability of irrational prescribing practices. The findings are able to be used as benchmark for the healthcare facilities and as a basis for further follow up of quality of drug use.
Background: Brivaracetam (BRV) is an anti-convulsant belonging to third-generation antiepileptic and approved by FDA as an add-on therapy as well as monotherapy for management of partial onset seizures in both adults and pediatrics as young as 1 month of age. Brivaracetam induces psychiatric adverse reactions, including non-psychotic and psychotic symptoms. Case Report: A 26-year-old male patient having a past medical history of dyslexia was diagnosed with Seizure disorder during February 2021. Initially, the patient was prescribed Levetiracetam 500 mg BD to control his seizure. The drug was well tolerated and there were no episodes of seizure for a period of 6 months. In August 2021, the patient had a recurrence of convulsions. As a consequence, Brivaracetam 50mg BD and Sodium Valproate 500mg BD were prescribed. The patient gradually started exhibiting unusual behavioral and psychiatric adverse events. The reaction was primarily ascribable to brivaracetam based on the temporal association between non-contributable disease and co-medication. The WHO causality assessment scale graded the ADR to be ‘probable’ and Naranjo’s algorithm with a score of 6. The physician recommended discontinuation of Brivaracetam and advised to continue Sodium Valproate 500mg BD, while Clobazam 5mg BD was added to patient treatment regimen. The patient’s symptoms progressively alleviated, and his behavior returned to normal within one week of discontinuing the Brivaracetam. Conclusion: When initiating treatment with Brivaracetam, close clinical assessment and monitoring is required and recommended to identify any behavioral and psychiatric adverse effects to achieve optimum treatment outcome.
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