The follow-up care of children born to hcv-infected mothers.
13 Melkersson KI, Hulting A-L, Brismar KE. Different influences of classical antipsychotics and clozapine on glucose-insulin homeostasis in patients with schizophrenia or related psychoses. J Clin Psychiatry 1999; 60: 78391. Melkersson K, Hulting A-L. Insulin and leptin levels in patients with schizophrenia or related psychoses a comparison between different antipsychotic agents. Psychopharmacology 2001; 154: 20512. Melkersson K, Khan A, Hilding A, Hulting A-L. Different effects of antipsychotic drugs on insulin release in vitro. Eur Neuropsychopharmacol 2001; 11: 32732. Melkersson K. Clozapine and olanzapine, but not conventional antipsychotics, increase insulin release in vitro. Eur Neuropsychopharmacol 2004; 14: 1159. Melkersson KI, Dahl M-L. Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs 2004; 64: 70123. Nakadate T, Kubota K, Nakaki T, Kato R. Effect of chlorpromazine on insulin release in mice: comparison between in vivo and in vitro. Jpn J Pharmacol 1982; 32: 9503. Olefsky JM. Insulin resistance. In: Porte D, Sherwin RS, editors. Diabetes Mellitus. Stamford, CT: Appleton and Lange; 1997. p.513 52. 20 Prakash C, Kamel A, Gummerus J, Wilner K. Metabolism and excretion of a new antipsychotic drug, ziprasidone, in humans. Drug Metab Dispos 1997; 25: 86372. Seeger TF, Seymour PA, Schmidt AW, Zorn SH, Schulz DW, Lebel LA, et al. Xiprasidone CP-88, 059 ; : a new antipsychotic with combined dopamine and serotonin receptor antagonist activity. J Pharmacol Exp Ther 1995; 275: 10113. Sussman KE, Pollard HB, Leitner JW, Nesher R, Adler J, Cerasi E. Differential control of insulin secretion and somatostatin-receptor recruitment in isolated pancreatic islets. Biochem J 1983; 214: 22530. Sutton R, Peters M, McShane P, Gray DW, Morris PJ. Isolation of rat pancreatic islets by ductal injection of collagenase. Transplantation 1986; 42: 68991. Taylor DM, McAskill R. Atypical antipsychotics and weight gain a systematic review. Acta Psychiatr Scand 2000; 101: 41632. Woods SC, Kaiyala K, Porte D, Schwartz MW. Food intake and energy balance. In: Porte D, Sherwin RS, editors. Diabetes Mellitus. Stamford, CT: Appleton and Lange; 1997. p.17592. 26 Yazici KM, Erbas T, Yazici AH. The effect of clozapine on glucose metabolism. Exp Clin Endocrinol Diabetes 1998; 106: 4757. HVPA Pharmacy and Therapeutics Committee "Bottom Line" on Ranexa: o Ranexa is an expensive agent with limited clinical benefit. o Significant safety concerns with QTc-prolongation and drug interactions. Derived products such as monoclonal antibodies ; from other countries. This interaction can provide a useful means of disseminating good practice developed within the UK. But there is also a need to ensure that the international nature of research is not used to introduce double standards. We note the position statement by the Wellcome Trust, which, as a general rule, we endorse: `International research supported by the Trust is expected to be carried out in the spirit of the UK legislation as well as being compliant with all local legislation and ethical review procedures.' 52 15.89 Further to the requirement implied in this statement, some members of the Working Party would like to see formal provisions in place which ensure that research and testing, both nationally and internationally, are always carried out in accordance with the least-severe protocols, in order to minimise harm to animals used in research. They would also welcome the introduction of regulations that would prevent UK researchers from importing or outsourcing research or research products that it would not be possible to obtain in the UK. Since the extent to which this may be occurring is uncertain, they would like to recommend that Ministers request the APC to undertake a systematic study to clarify the matter, exploring perhaps also whether a system of certification or voluntary codes of conduct would be suitable devices to ensure that UK-based researchers adhere to the same standards abroad as in the UK. From their point of view, whenever UK researchers are involved in international collaborations they should seek to adopt protocols that meet the highest international standards of best practice. As a minimum they should meet UK requirements, which in most cases are likely to be stricter than those of other countries. The group would also like to recommend that multinational companies that undertake part of their research in the UK should enforce a single global policy on animal care and welfare that meets the highest international standards of best practice. 15.90 However, other members of the group, while welcoming the aspiration behind such proposals, have reservations about their appropriateness and feasibility. They argue that because of the differences in regulatory systems it would be very complicated to ensure that research facilities abroad, or products sourced from outside of the UK met with Home Office approval. If such approval could not be attained, there would be a risk that research and testing facilities in the UK would be disadvantaged, since the exchange of products such as antisera, passaged tumours or GM lines is crucial to collaboration in fundamental research. Accordingly, they do not see a need to recommend that the APC be asked to undertake a study to advance the debate. Similarly they point out that practical problems may prevent multinational companies from implementing a single harmonised policy on animal care and welfare, both in the medium and long term. 15.91 Members also briefly discussed, but were not able to agree on, the question of whether UKbased research might be driven abroad because of the current, or likely future, regulatory provisions and practice. During our fact-finding meetings and discussions we heard conflicting evidence about this possibility. Some researchers observed that several research projects, and some laboratories, have been moved abroad while others, more frequently pharmaceutical companies, consider that the attractiveness of scientific talent in the UK generally outweighs any regulatory burdens. A range of views was represented among members of the Working Party, with some agreeing with the evidence presented during the fact-finding meetings, and others disagreeing. The latter group found arguments. If the applicant is taking one of these drugs for the reason stated, he she is not eligible for coverage. This list is a reference guide for prequalifying cases; it is not intended to be an exhaustive, all-inclusive list. Drug name Procrit Prolixin Prostigmin Rebetron Regonol Revia Requip Retrovir Ridaura Rilutek Risperdal Roferon-A Roxicet Saquinavir Selegiline Serentil Seroquel Sinemet Solganal Sparine Stadol Stelazine Symmetrel Synapton Tacrine Talwin Taractan Tasmar Tensilon Thioridazine Thiothixene Thorazine Tindal Tolcapone Tramadol Trichlorfon Trifluoperazine Trilafon Ultracet Ultram Vicodin Zeldoz Zidovudine Ziiprasidone Zyprexa Alternate name for same drug Erythropoietin Fluphenazine Neostigmine N A N Auranofin Riluzole Risperidone Recombinant, rlFN-A N A N A Eldepryl Mesoridazine Quetiapine Carbidopa, Levodopa Gold therapy N A N Trifluoperazine HCl Amantadine N A N Pentazocine N A Tolcapone Edrophonium Mellaril Navane Chlorpromazine N A Tasmar Ultram N A Stelazine Perphenazine Tramadol Tramadol N A N Olanzapine Condition for which drug is most commonly used Renal failure; anemia of chronic disease Mental health Myasthenia gravis Hepatitis C Myasthenia gravis Alcohol abuse Parkinson's disease HIV Rheumatoid arthritis ALS Mental health AIDS, cancer, hepatitis, leukemia Pain control HIV Dementia, Parkinson's disease Mental health Mental health Parkinson's disease Rheumatoid arthritis Mental health Pain control Mental health Parkinson's disease Dementia Dementia Pain control Mental health Parkinson's disease Myasthenia gravis Mental health Mental health Mental health Mental health Parkinson's disease Narcotic pain control Dementia Mental health Mental health Pain control Narcotic pain control Narcotic pain control Mental health HIV Mental health Mental health.
Been reported. Hummer et al.37 reported that after 1 year of treatment, 36% of patients treated with clozapine had gained 10% of their initial body weight. Seven patients continued to gain weight, reaching a maximum gain of 30% of their initial body weight. Clozapine-induced weight gain does not appear to plateau early in treatment, and it has been shown to continue for 30 weeks. Olanzapine, with a similar chemical structure, has also been associated with significant weight gain. In prospective, double-blind studies, olanzapine has led to nearly twice the weight gain of risperidone.38 This weight gain is not apparently related to dose and can persist for up to 1 year.39 Weight gain for risperidone and quetiapine appears to be intermediate among the antipsychotic medications. Weight gain is reported to be lower than that seen with olanzapine and clozapine but greater than that seen with conventional drugs. Weight gain associated with risperidone and quetiapine does appear to correlate with dose. Ziprasiddone is associated with little weight gain, even after 1 year of treatment. Average weight gain associated with aripiprazole after 1 year of treatment was ~ 2 kg. Among the atypical antipsychotics, the relative tendency to cause weight gain is as follows: clozapine olanzapine risperidone quetiapine ziprasidone aripiprazole.40 The mechanism of antipsychoticsinduced weight gain is undetermined, but several neurotransmitter systems have been implicated. Initially, there was speculation that histamine receptor blockage was responsible for the conventional antipsychotic-induced weight gain. Affinity for histamine receptors does correlate with medication-induced weight gain41 and is supported by empirical data. Olanzapine, with the highest affinity for histaminic receptors, is also associated with high rates of weight gain. Conversely, ziprasidone and aripiprazole, associated with lower risks of weight gain, have lower affinities for histamine receptors and duloxetine. Which has been shown to independently prolong the QTc interval, or by their additive synergistic effects Kornick et al., 2003 ; . Considering the known risk factors for arrhythmia, we propose the following recommendations for ECG monitoring of patients receiving methadone therapy. They are not meant to be exhaustive or binding, as no formula can substitute a judgment in each individual case. A screening ECG prior to initiation of therapy Repeat after 24 h of initiation of therapy When a steady state is achieved, after 4 days of therapy When the dose is significantly escalated When there is a change in patient's condition or therapy which may further increase the risk of the arrhythmia i.e., electrolyte imbalance, congestive heart failure, new medications affecting QTc or impair methadone metabolism ; Electrolytes may need to be monitored in highrisk patients In any given patient, a decision of ECG frequency should be adjusted based on the known risk for arrhythmia in that individual. It is not clear how often the ECG should be performed in an outpatient. A decision to repeat the ECG, however, depends on the patient's condition and individual circumstances; risks versus benefits need to be evaluated in critically ill patients receiving medical care at home. Goals of care are paramount in the palliative care patient. When conducting the ECG, the same lead should be used to measure the QTc interval each time, and manual measurement should be used. It is advisable to not rely on computerized readings. When prolongation of the QTc interval is observed, the presence of an additional cause hypokalemia, hypomagnesemia, addition of a QT-prolonging drug, myocardial ischemia ; should be excluded. Table 4 provides a summary of the precautions regarding use of IV methadone in palliative care patients. When discussing the risk benefit ratio of methadone with the patient and family healthcare proxy, it is important to convey a few key points. Each patient will need individual monitoring during the titration phase and any time deemed appropriate when the dose is escalated. Second, the risk of QTc prolongation and torsades de pointes is very small, but it does exist. However, the risk can be monitored with ECG. It is often reassuring to tell the patient.