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The Ingestion Pathway
Published in Antonietta Morena Gatti, Stefano Montanari, Advances in Nanopathology From Vaccines to Food, 2021
Antonietta Morena Gatti, Stefano Montanari
Paradoxical effects are very well known by pharmacologists and toxicologists. A paradoxical effect or paradoxical reaction is the result of the administration of a medical drug, opposite to the effect which would normally be expected – for example, pain caused by a pain relief medication, suicidal compulsions from anti-depressants or the so-called Eagle effect [5-9].a
Extrapulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
A 6-month regimen is recommended for initial treatment of all patients with drug-susceptible TB lymphadenitis.36 This recommendation is based on both observational and randomized studies, the latter of which compared treatment outcomes of 6 versus 9 months of therapy.154–159 For example, in a randomized trial comparing a three times weekly, 6-month standard four-drug regimen with the same regimen administered for 9 months, there was no difference in treatment failure or recurrence at 5 years.159 It is important to note that response to treatment may be slow and affected lymph nodes may enlarge and new nodes can appear during or after therapy without any evidence of bacteriological relapse.154,156,157,160 These “paradoxical” reactions have been reported to occur in up to 23% of HIV-uninfected patients.161,162 In HIV-infected patients, paradoxical reactions are often associated with initiation of antiretroviral therapy.163,164 Spontaneous resolution occurs in most patients. Anti-inflammatory medications such as nonsteroidal agents and corticosteroids have been used to treat milder paradoxical reactions.
Central nervous system depressants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Controversy exists about whether benzodiazepine use alone can result in disinhibited or impulsive behaviour (ibid.). Nonetheless, paradoxical reactions including increased seizures in epileptic people (Riss et al., 2008), increased anxiety, acute excitement and hyperactivity, aggression, suicidal behaviour, and criminal acts, such as assaults and rape, have been reported (Rosenbaum et al., 1984). Depending on the patient sample, estimates of incidence range from 1 per cent to 20 per cent (Dietch and Jennings, 1988); high-risk groups include recreational abusers, individuals with borderline personality disorder or impulse control disorders, patients with alcohol problems, children and elderly people, and patients on high-dose regimes. In these groups, impulse control and alcohol problems are the most important risk factors, and the combination of a benzodiazepine and alcohol is particularly prone to lead to paradoxical reactions.
The impact of anti-seizure medications on electroencephalogram (EEG) results
Published in Expert Review of Neurotherapeutics, 2023
Gianluca Dini, Giovanni Battista Dell’Isola, Elisabetta Mencaroni, Pietro Ferrara, Giuseppe Di Cara, Pasquale Striano, Alberto Verrotti
ASMs may paradoxically worsen seizure frequency or induce new seizure types in some patients with epilepsy. Although the paradoxical ability of ASMs to increase seizures has been recognized for decades, the underlying mechanisms are poorly understood. Drug-induced exacerbation of seizures is, in many cases, an idiosyncratic reaction. Paradoxical reaction has been reported with CBZ, benzodiazepines, and VGB [58]. In some patients, a paradoxical increase in seizure frequency represents a manifestation of drug intoxication. For example, CBZ overdose can worsen seizures [59]; LTG in high doses can cause myoclonic status [60]. In other situations, an inappropriate choice of the ASM can induce worsening trough a purely pharmacodynamic mechanism. For example, CBZ can both aggravate and induce new seizure types when used for the treatment of absence seizures, juvenile myoclonic epilepsy, and other idiopathic generalized epilepsies [58]. LTG has been reported to aggravate seizures in Dravet syndrome. In general, a seizure-inducing effect of ASMs has to be considered when a seizure increase is observed soon after the initiation of therapy and a decrease of seizures is seen with tapering of the dosage.
What are the challenges in the pharmacotherapeutic management of male genital tuberculosis?
Published in Expert Opinion on Pharmacotherapy, 2023
Aditya Prakash Sharma, Rajeev Kumar
Assessment of response to pharmacotherapy is also difficult for genital TB. A paradoxical reaction which is a clinical or radiological worsening of the preexisting tubercular lesions or development of new lesions in patients started on ATT after an initial favorable response may also occur. This is a part of immune reconstitution inflammatory syndrome (IRIS) and is more common in patients with concomitant HIV. A clinical examination may be fallacious for response assessment since changes such as an enlarged testis, thickened epididymis, beaded vas deferens, or hard prostate may persist even after successful treatment. A corollary can be drawn from data available on TB lymphadenitis where in a prospective study, re-biopsy in 23 of the 36 patients with post-treatment lymphadenopathy revealed granulomas in 52.2%, positive acid-fast bacilli stain in 17.4%, and positive TB-PCR in 47.8%, but all samples were sterile (no microbiological recurrence) [18]. Most patients improved without further treatment, and it may become difficult to differentiate a paradoxical reaction from an inadequate response to treatment.
Spotlight on the treatment armamentarium of concomitant psoriasis and inflammatory bowel disease: a systematic review
Published in Journal of Dermatological Treatment, 2022
Claudio Conforti, Caterina Dianzani, Iris Zalaudek, Michele Cicala, Paolo Persichetti, Roberta Giuffrida, Silviu-Horia Morariu, Nicoleta Neagu
However, paradoxical reactions folowing TNF inhibitors treatment have been increasingly reported. Paradoxical reactions during treatment with a biologic agent can be defined as the appearance or exacerbation of a pathological condition that usually responds to this class of drug, while treating a patient for another condition, which usually remains under control (33). Paradoxical psoriasis (PXPS) reactions have been reported after TNF inhibitors treatment (21,25,34–38) especially in the pediatric population (39–41), the majority of which resolved with Ustekinumab treatment. On the other hand, there is a case of Infliximab-induced pustular psoriasis described by Zheng et al. which resolved without biological therapy discontinuation and with topical corticosteroids (33). Similar rates were found among patients treated with either Adalimumab or Infliximab in a 676 patients retrospective study: 34 PXPS cases and 38 cases, respectively (42).