- 著者
- 宮津 大輔 秋吉 正貴 山下 大貴 立石 裕樹 後藤 貴央 與田 賢作 安倍 ひろみ 田中 博和 平川 雅章 片岡 泰文 首藤 英樹
- 出版者
- 一般社団法人日本医療薬学会
- 雑誌
- 医療薬学 (ISSN:1346342X)
- 巻号頁・発行日
- vol.42, no.4, pp.271-277, 2016-04-10 (Released:2017-04-10)
- 参考文献数
- 17
Fosphenytoin (FOS) is a phosphate ester prodrug developed as an alternative to intravenous phenytoin for acute treatment of seizures. Although both FOS and phenobarbital (PB) are used for status epilepticus as second-line drugs, there is no data on their comparative efficacy and safety. We retrospectively analyzed data from children treated with FOS or PB for convulsive status epilepticus and acute exacerbation of seizures. Our aim was to compare the efficacy and safety of intravenous FOS with those of intravenous PB for convulsive status epilepticus and acute exacerbation of seizures. Seventy-seven children were included in the study: 54 received FOS, and 23 received PB. The primary end point was recurrence of seizures and drug-related adverse events. The response rate, defined as no recurrence of seizures within 24 hours after termination of seizure, was 92% (50/54) and 95% (22/23) in FOS group and in PB group, respectively. Adverse events occurred in 27% (15/54) of patients in FOS group and in 95% (22/23) of patients in PB group (P < 0.01). Although no serious adverse events occurred in patients in both FOS group and PB group, the incidence of both sedation and disturbance of consciousness were significantly higher in PB group than FOS group. From these results, FOS is recommended as second-line drugs for status epilepticus and acute exacerbation of seizures. However, the optimal serum concentration achievement rate was significantly lower in FOS group than PB group. To maintain optimal serum phenytoin levels (10 - 20 µg/mL), higher doses of FOS might be required.
- 著者
- 宮津 大輔 江田 陽一 今給 黎修 桑名 寿幸 松浦 徹 竹下 龍次 與田 賢作 秋吉 正貴 手嶋 由加 田中 博和 長郷 あかね 平川 雅章 首藤 英樹 片岡 泰文
- 出版者
- 一般社団法人日本医療薬学会
- 雑誌
- 医療薬学 (ISSN:1346342X)
- 巻号頁・発行日
- vol.43, no.1, pp.45-52, 2017-01-10 (Released:2018-01-10)
- 参考文献数
- 14
- 被引用文献数
- 2
Hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage. Nicardipine hydrochloride is a calcium channel blocker indicated for the treatment of hypertensive emergencies. However, nicardipine infusion-related phlebitis is a common and significant problem in clinical practice. The aim of this study was to survey the incidence of nicardipine infusion-related phlebitis and to identify associated risk factors for phlebitis. We conducted a retrospective observational study at Fukuoka Tokushukai medical center. A total of 79 patients who received precision continuous infusion of nicardipine were enrolled in this study. Nicardipine infusion-related phlebitis occurred in 34 (25.7%) of 132 peripheral intravenous catheters. On multivariate logistic analysis, “the dosing period over 24 hours” and “no co-infusion of saline” were significantly associated with an increased risk of nicardipine infusionrelated phlebitis. The odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of phlebitis with respect to “the dosing period over 24 hours” and “no co-infusion of saline” were 5.04 (2.012 - 12.657) and 3.36 (1.190 - 9.514), respectively. In addition, the optimal cut-off level of the dilution rate of saline was determined to be 4.23 times (sensitivity 73.5%, specificity 58.8%) based on receiver operating characteristic (ROC) analysis for predicting the occurrence of phlebitis. To minimize the risk of peripheral phlebitis, we propose that medical professionals should consider changing the infusion site every 24 hours at least and co-infusing saline diluted more than 4-5 times.
