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Depression, Anxiety, Stress, and Spirituality in Cardiovascular Disease
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Erminia Guarneri, Shyamia Stone
It has been recommended that pharmacotherapy for individuals with CVD should start with first-line selective serotonin receptor inhibitors (SSRIs) such as citalopram or sertraline.58 While effectiveness of SSRIs is similar across types, citalopram and sertraline have fewer interactions with cytochrome p450 and subsequently are less likely to cause pharmacokinetic interactions with cardiac medication.58 However, SSRIs are contraindicated when used in conjunction with other medications that lead to QT interval prolongation.77 In a review by Von Ruden78 and colleagues evaluating association between SSRIs and cardiovascular risk, it was found that of 13 studies evaluated, 5 showed decreased cardiovascular morbidity or mortality, 2 showed worsened prognosis with SSRI use, and 6 found no association. One of the few positive studies, Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART) specifically evaluated the use of sertraline as an antidepressant agent and its impact on CHF. Results ultimately found that of the 44.3% of patients with remittance of depression, there were significantly fewer cardiovascular events in comparison to the 41.4% that did not achieve remission, though the latter group was determined to have a greater severity of depression at baseline.79 Lamictal, commonly used for mood stability, now carries a black box warning for the potential of causing high-degree heart block. We recommend 7 days of arrhythmia monitoring in all patients treated with lamictal.
Seizures
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Sally Mathias, Meriem Bensalem-Owen
Carbamazepine, phenobarbital, primidone, phenytoin, valproate, and topiramate are FDA category D drugs, and should be avoided if possible. Currently levetiracetam (Keppra) and lamotrigine (Lamictal) are common choices for AED in pregnancy, but other safe choices are available as well.
Neurofeedback in an Integrative Medical Practice
Published in Hanno W. Kirk, Restoring the Brain, 2020
9-year-old boy presented with a 2-year history of generalized tonic-clonic seizures and nocturnal Rolandic seizures that occur at least weekly while on medications. EEG showed multifocal sharp-wave discharges in multiple brain areas, including mid-central, mid-parietal, right temporal, and left parietal regions. MRI showed right hippocampal sclerosis. For religious reasons, the patient’s family wanted to have him off medications, but they agreed to start medicine after an episode of status epilepticus that resulted in hospitalization about 6 months prior to presentation for neurofeedback treatment. Mother observed that medications (Trileptal and Lamictal) have caused side effects of slurred speech, tremors, poor motor coordination, decreased processing speed, and fatigue.
Orodispersible tablets for pediatric drug delivery: current challenges and recent advances
Published in Expert Opinion on Drug Delivery, 2021
Raphael Wiedey, Marcel Kokott, Jörg Breitkreutz
In several of the previously mentioned surveys, it was clearly stated that the size of the ODT is a critical characteristic and decisive for its acceptance [66,67]. Some information on this question can be drawn from the FDA approved ODTs that are currently on the market. Since the actual size of the tablets is usually not part of the published information, the dose can serve as a surrogate here. Many of the marketed ODTs have rather low doses, e.g. Risperidal M-Tab® with doses of 0.5–4 mg for patients 10 years and older. This can hardly help to estimate the maximum ODT size that can be accepted. Some products are however more interesting in this regard. Lamictal ODT® with a lowest dose of 25 mg is approved for patients 2 years and older and Orapred ODT® is a predisolon product with no age limitation for its 10 mg ODT. Nurofen Schmelztabletten® is an ibuprofen product marketed i.a. in Germany with a single dose of 200 mg, approved for patients 6 years and older. This information summed up in Table 1 can serve as a reference of what is generally possible and has been approved before.
Evaluation of the interference of lamotrigine on the analysis of synthetic cannabinoids in urine by the immunoassay method
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Hüseyin Kurku, Bilge Çetin İlhan, Ömer Kaya, Semra Aydın Akfırat
The LMG levels in the samples were measured by HPLC method. A modular system (including a gradient pump, auto sampler, column oven, and UV detector) Shimadzu LC20AT HPLC (Shimadzu, Japan) device was used in the analysis. A Shiseido Capcell C18 (5 µm * 4.6 mm * 250 mm; Shiseido, Tokyo, Japan) column was used for separation. An isocratic separation was performed using acetonitrile (75:25) and phosphate buffer (pH: 3.5) as the mobile phase. Flow rate was set to 1.2 mL/min and UV detector wavelength to 204 nm. Column temperature was 25 °C and injection volume was 20 µL. Sample preparation included 100 µL of sample, 50 µL of internal standard, 50 µL of deionized water and 200 µL of phosphate buffer (pH: 3.5) were added, mixed by vortex and transferred to the HPLC vial. Preparation of standards: LAMICTAL® 100 mg chewable/soluble tablet (100 mg LMG /250 mg tb; GlaxoSmithKline, Şişli, Turkey) [11] was dissolved in 250 mL of mobile phase and 50 mg/L standard solution was prepared by diluting 8-fold. LMG negative urine was used for the 0 standard. A 2-point calibration plot was plotted with Calibrator 0 and Calibrator 50 mg/L and urine LMG concentrations were obtained as mg/L.
Is Bioequivalence a Sufficient Measure of Equivalence?
Published in Journal of Legal Medicine, 2019
In response to concerns about BE in NTI drugs, the FDA has begun to conduct updated research to verify that generic NTIs can be substituted safely and effectively with their brand counterparts.49 For instance, the BioEquivalence in Epilepsy Patients study explored whether generic lamotrigine (an AED) would meet the average bioequivalence standards (ABE) or the revised standards when tested in patients with epilepsy who are “generic brittle” (possibly sensitive to generic switching).50 Results showed that generic lamotrigine met the ABE standards, in addition to the revised reference-scaled ABE and WSV standards, to establish BE with the brand drug (Lamictal).51 Furthermore, seizure control and tolerability were comparable between the brand and generic drugs.52