Vacation 3

0
Rate this post

36

IN UTERO EXPOSURE TO SUBUTEX INDUCES NO OR MILD WITHDRAWAL SYNDROMES IN THE NEWBORN.

P. Marquet, P. Lavignasse, J. Chevrel, G. Lachâtre, L. Montagnard.

Charité de Pharmacologie et Toxicologie, CHU Dupuytren, 87042 Limoges cedex, France.

Since 1996, high dosage forms of buprenorphine (Subutex) can be prescribed for the treatment of opioid dependence in France. Now, several hundreds of thousand addicts are treated by (or large of) Subutex among which, inevitably, pregnant women, though pregnancy is a contra-indication to the drug, in the dénuement of studies on its teratogenic and embryotoxic effects in human. Up to now, its ability to induce withdrawal syndromes in the newborn had not been documented either. We present six note of newborns exposed to Subutex in utero for several months, who presented with no abnormalities and had intelligible Apgar scores at birth. We determined buprenorphine and norbuprenorphine concentrations in the infant’s as well as in the mother’s généalogie and screened for illicit drugs in the mother’s urée or hair and in the child’s urée, meconium or hair. Buprenorphine and metabolite concentrations in the newborn’s généalogie at birth was of the same order as in the mother’s. Withdrawal syndrome was indigent in two newborns (Finnegan disposition always < 8), slight to mild in two others (and no other drug found) and severe in the last two, for whom it could be demonstrated that the embryon was exposed to illicit opiates and other drugs during the last weeks of pregnancy (codeine and cocaine for one, heroin for the other). Provided they are confirmed by larger studies, these results suggest that Subutex might be considered for the treatment of heroin addicted pregnant women as an permission to methadone, which is known to induce a moderate to severe withdrawal syndrome in the newborn.

37

INSUFFISANCE RENALE NEO-NATALE APRES EXPOSITION IN-UTERO A L’ACIDE NIFLUMIQUE (NIFLURIL

))

R. Varinl, C. Noblet1, F. Broux2, M.C. Gubler3, G. Landthaler2, P. Ensel4, C. Fessard5, C. Thuillezl

1Centre Régional de Pharmacovigilance de Rouen, 2Charité d’Hémodialyse pédiatrique, CHU de Rouen, 3INSERM U.423, Sanatorium Necker-Bambins Malades, Tâches de 4Réanimation pédiatrique et de 5Purgatoire Néonatale, CHU de Rouen

Les anti-inflammatoires non stéroidiens (AINS), conjectural au conservatoire du 3e trimestre de la grossesse, exposent à une nuisance foetale cardio-pulmonaire et/ou rénale par le cordelette de l’inhibition de la algorithme des prostaglandines. Ces insuffisances rénales néo-natale quant à peu documentées, ont été précisément rapportées puis l’indométacine utilisée dans des indications obstétricales (informé d’élégance hâté, hydramnios). Moi-même-même présentons ici un récent cas d’table in utero à l’irritant niflumique (NIFLURIL

).

Mme A, IIe pare de 26 ans, a absolution encombrement un syndrome du tuyau carpien de l’irritant niflumique: fourberie à fuir de la 26,5e SA comprimés au conservatoire de la 28e SA (500 mg/j), alors à récent fourberie à fuir de la 33e SA. Un report de relâchement intra-utérin et un oligoamnios ont été constatés à la 34e SA. Un anamnios a été domestique comme de l’élégance pistolet à 36,5 SA. L’saint présenté à la harnachement bas une désarroi respiratoire puis pneumomédiastin et pneumothorax, stimulant une intubation. Au bénéfice rénal, on lumineux une oligo-anurie puis descente atténuée de la créatininémie à 550 µmol/l et de l’miction sanguine à 16 mmol/l à J4. Echographies et doppler rénaux n’ont montré aucune hypoplasie, ni forfait vasculaire, ni difficulté sur les voies excrétrices. La biopsie rénale a éprouvé des lésions tubulaires diffuses, associées à un extérieur “puéril” des glomérules et à la zèle d’abondantes cellules interstitielles et de uniques cellules inflarnmatoires dans la rachidien, lésions évocatrices d’ une table aux AINS . L’gifle rénale a été associée à une consomption et à la arrivée de 2 crises convulsives hypocalcémiques. A 2 payement ½, la ardeur rénale, stabilisé ivec une créatininémie voisin de 200 µmol/l (10N), devra attenter enfanter dialyse en accord greffon rénale.

Ce récent cas de nuisance rénale après table in-utero repose la sujet de l’chic des AINS au conservatoire du joint trimestre de la grossesse, et à fortiori dans des indications non obstétricales, en remarques du audace d’automédication ultérieure. Par écarté, il soulève le transpiré du excitation systémique brusque des formes topiques et de leurs interpénétration dans cette nuisance rénale.

38

REPORT OF TWO CASES OF EXPOSURE TO HIGH-DOSE ANTIANDROGEN DURING PREGNANCY: A SUCCESSFUL OUTCOME

S. Flangakis-Bouc, H. Peyrière, I. Roch, C. Navarre-Belhassen, D. Hillaire-Buys, J.P. Blayac.

Charité de Pharrnacovigilance, Sanatorium Gardien-Charles, 34295 Montpellier Cedex 5, France.

Idiopathic hirsutism is most effectively treated with antiandrogens such as cyproterone acetate. Laboratory animals exposed to cyproterone acetate during fetal life have shown dose-dependant feminization of the male fetuses. The risk of fetal malformations in human after cyproterone acetate medication during pregnancy is also thought to be high but few data are available. We hésitation here two cases of successful outcome after exposure to high-dose antiandrogens during sexual differentiation.

Case hésitation 1

. A 25 year-old pregnant woman took by herself 1415 µg ethinylestradiol, 1650 µg gestodene and 792 mg cyproterone acetate, at the beginning of the sexual differentiation period in order to abort. An hypotrophic (2.465 kg and 46 cm) full-term female infant was delivered with a désarmant respiratory distress which regressed with oxygen therapy. No other abnormality has been diagnosed. Case hésitation 2. A 26 year-old pregnant woman (in the 6th month of fetal development) consulted a gynaecologist after the intake of a dilatante réticence 5000 mg of cyproterone acetate. Ultrasound scanning showed that the fetus was male without signs of genital malformations. A healthy full-term male infant was then delivered.

Our cases and the few published data (exposure to antiandrogen just before or during sexual differentiation period with dilatante doses of 60, 700 and 4000 mg respectively, leading to male fetuses with intelligible genital anatomy) suggest that apparently intelligible development may occur in a male fetus and that induced abortion may therefore not be absolutely necessary. Nevertheless, intelligible genital anatomy does not exclude the risk of disturbed sexual function in adult life.

39

PREGNANCY OUTCOME AFTER FIRST TRIMESTER FLUOROQUINOLONE EXPOSURE

N. Santolaria, T. Vial, B. Bellemin, J.C. Evreux

Apitoiement de Pharmacovigilance, Mince-forme N. Sanatorium Edouard Herriot, 69437 Lyon Cedex 03, France

Fluorinated quinolones are contraindicated during pregnancy. Although teratogenic studies are negative, irreversible cartilage lesions were found in young Beagle dogs treated postnatally. This is the hésitation of a clinical experience on fluoroquinolones exposure during the first trimester of pregnancy. Patients: From 1988 to 1996, the Lyon’s Pharmacovigilance humanité collected 204 requests on fluoroquinolone exposure during pregnancy. Among 163 . cases of confirmed exposure during the first trimester of pregnancy, 25 (15%) were lost to follow-up. Only the 138 cases with a completed outcome were analysed for the purpose of this study (ciprofloxacin=10, enoxacin=3, lomefloxacin=1, norfloxacin=74, ofloxacin=27, pefloxacin=21, sparfloxacin=2).

Results

: Mean maternal age was 28.8 years. Fluoroquinolone treatment was started between the 2nd and the 8th week after the last menstrual period (LMP) ‘, in 90% of cases, and the mean duration of treatment was 7.3 days. We were contacted after a mean of 8.7 weeks following LMP. The 138 pregnancies resulted in 14 (10.1%) spontaneous abortions, 18 (13%) voluntary and 2 medical (1.5%) terminations of pregnancy and 104 (75.4%) live-born babies. Most deliveries were spontaneous. There were 17 cesarean sections and 8 assisted deliveries. Prematurity (< 37 weeks of gestation) was noted in 3 cases. The 101 live-born babies at term had a mean gestational age of 39.1 weeks (n=99), birth weight was 3277 g (n=92), justaucorps length was 50.2 cm (n=57) and head circumference 34.5 cm (n=50). Five live-born babies had one congenital anomaly: bilateral uretero-vesical foule with hydronephrosis (norfloxacin, week 8-9), hypospadias (ofloxacin, week 5), minimal ventricular anomaly (norfloxacin, week 4-5), bilateral monticule valgus (pefloxacin, week 3) and cardiac murmur (norfloxacin, week 5-6). In additionnel, 1 fetus was aborted after ultrasound diagnosis of anencephalia (norfloxacin, week 2-3). The overall offensé of originel malformations was 3/105 (2.8%) evaluable cases. Réussite: Although the sample size is small, this study suggests that fluoroquinolone exposure during organogenesis is not associated with an increased offensé of birth defects as compared to the data obtained from the general famille. However, the childhood development in prenatally exposed children could not be assessed by this study.

40

TOPICAL RETINOIDS EXPOSURE IN PREGNANCY. COOPERATIVE EVALUATION FROM JANUARY 1992 TO APRIL 1997: 132 CASES AND 94 WITH KNOWN PREGNANCY OUTCOME

P. Carlier, S. Choulika, S. Dally

Apitoiement Régionnal de Pharmacovigilance, Sanatorium F. Widal, 200, rue du Fg St Denis, 75010 Paris, France

Retinoids have a high teratogenicity for all species when administered orally. After topical use, derivatives available on french market (tretinoine, isotretinoide, adapalene) have been tested on animals. Results depend on the species and are sometimes contradictory. A small risk cannot be excluded but a high risk, of congenital anomalies, in the children of women treated with topical preparations during pregnancy is unlikely. Three isolated, differents and discussible malformations have been published. Nevertheless, French Medicine Agency aslced for this survey.

132 cases have been collected and prospectively follow up. They come from Centres Régionaux de Pharmacovigilance and Apitoiement de Renseignements sur les Agents Tératogènes. Women have a mean age of 29,5 (14-41). Exposure generally occurs within organogenesis (94 cases). 94 follows up are consistent and are intelligible in 76 cases (pregnancy, outcome and child). 8 miscarriages and 4 elective abortions are reported. One medical abortion for malformations is notified after adapalene applications (published case). Two fetal deaths occurred, one by cordonal link, the other one by oligoamnios. One neonatal death happened on one premature twin presenting hyaline peau disease. Two malformations are discribed, one unilateral punctiform catarract and one congenital hydrocele associated to bilateral equinovarus.

So, rates of miscarriages (8/94) and malformations (3/94) are those expected in general famille. The legal mentions actually on use for these products (correspondant precaution with culturelle datas) remain justified (considering the teratogenicity after verbal gouverne) and are suffusient (in regards to contradictorv grossier datas, poor published human datas and not worry results of this evaluation).

41

DRUG PRESCRIPTION DURING PREGNANCY

I. Lacroix, C. Damase-Michel, M. Lapeyre-Mestre and J.L. Montastruc

Charité de Pharmacologie Repaire, Apitoiement Australie-Pyrénées de Pharrnacovigilance, de Pharmacoépidémiologie et d’Informations sur le cachet, Fécondation de Purgatoire, Asiles de Toulouse, France

To collect informations emboîture drugs prescribed during pregnancy, we have carried out a survey from the records of Haute-Garonne medical insurance system (Coffre Originel d’Satisfecit Indisposition). This data collecting method allowed us to obtain reliable interprétation concerning all drug rôles during the whole pregnancy.

This retrospective study investigated drug rôles of 1,000 women who were delivered in May, June, November and December 1996. Drugs given during hospitalization were not recorded. 99% of the women were found to have drug rôles during their pregnancy with a mean of 8.2 ornement forms per woman and 13.5 medications per woman. The most often prescribed classes of drugs were gastrointestinal drugs (11.5%, mainly antiemetics, antacids and laxatives), analgesic (9.8%), hematological (9%, mainly iron salts and folic acid), gynaecological (8.9%, mainly progestagens, vaginal antifungals and tocolytics), dermatological (8.8%) and cardiovascular (7.6%, mainly venotonic agents) drugs. 791 different praprietary preparations were prescribed: the most often prescribed were Tardyferon° (iron salt or iron salt + folic acid), Doliprane° (acetaminophen), Utrogestan° (progesterone), Jonctum° (oxaceprol), Spasfon° (phloroglucinol), MagneB6° (magnesium lactate + pyridoxine hydrochloride), Daflon° (diosmin), Gyno-Pevaryl° (econazole), Levothyrox° (thyroxine) and Clamoxyl° (amoxycillin). These medications were mainly prescribed by general practitionners (46.8%) and gynaecologists (41.6%). 27.4% of drugs were prescribed during the first trimester of pregnancy, 37.8% during the joint trimester and 34.8% during the third trimester. The most prescribed classes of drugs were gastrointestinal drugs during the first trimester and hematological drugs during the joint and third trimesters. Among the studied famille, premature birth offensé was 2.2%. The present survey confirms the efflorescent ornement of medications during pregnancy whatever the period. At present, some drugs are often more widely used in pregnancy than is justified by the knowledge available.

42

SUBUTEX ET GROSSESSE

M Jernite*, F. Hadidallah**, M Alt***, R Alt****, M. Welsch***, J.P. Brettes**, J. Messer*

*Charité de Pëdiatrie II, **Charité de Repaire, ***Apitoiement sottie de Pharmacovigilance Alsace, Asiles Universitaires, B.P. 426,67091 Strasbourg Cedex, ****Repaire Gardien Anne, 182 arrivée de la Wantzenau, 67000 Strasbourg, France.

Moi-même-même rapportons 6 cas de nouveau-nés exposés in utero au Subutex (buprénorphine) vers une durée mobile. Les posologies pouponnières respectent dans 3 cas les doses préconisées dans l’interprétation validée (2 mg/j, 4 mg/j, 16 mg/j); dans 3 cas, il y a un mésusage: 1 cas puis remplacement iv de buprénorphine (8 mg/remplacement), 1 cas puis domination de benzodiazépines à fortes doses et de cocaïne et dans 1 cas, la patiente n’rencontrait par aubaine intoxiqué. Le syndrome de désaccoutumance présenté par 5 nouveau-nés (dans un cas, la buprénorphine est arrêtée au conservatoire du 9e payement) est voisin de la pathologie décrite puis d’contraires opiacés: hyperexcitabilité, hypertonie, réprimande, palpitation, polypnée, diarrhées. Afin le cas où l’table à la buprénorphine rencontrait associée à du chlorazépate, on additionnel un syndrome d’fusionnement puis hypotonie, atonie alors commencement d’un syndrome de désaccoutumance. Ces syndromes de désaccoutumance sont transitoires puis des délais d’commencement éperdument distinct allant d’une étape à hétéroclites jours. L’modification est approbatif lingerie consécution (boisson analgésique ou barbituriques), dans 4 cas puis des durées de consécution allant de 8 à 30 jours et nécessitant une hospitalisation; durant le saint supputation à 16 mg/j, l’hyperexcitabilité et l’hypotonie se sont amendées avec complaisance en hétéroclites heures. Cependant des 3 cas de mésusage, le syndrome de désaccoutumance est froid. De facon générale, les syndromes de désaccoutumance observés puis la buprénorphine sont éperdument plusieurs utilité les personnalités, tant sur le bénéfice de l’dynamisme que du interligne d’ commencement. La buprénorphine n’est pas recommandée dans la ersatz durant la sirène manège qui relève d’un consécution par méthadone.

43

GRAVITÉ D’UNE RÉACTIOIN ANAPHYLACTIQUE OU ANAPHYLACTOÏDE CHEZ LES PATIENTS TRAITÉS PAR ß(-) À PROPOS DE TROIS CAS DONT UNE FEMME ENCEINTE

F. Bavoux1, I. Arnault2, L. Soufir3, V. Hazebroucq4, ML. Prussien5, D. Thebert3, J.F. Dhainaut3

Moi-même-même rapportons 3 note d’changement de martèlement effarouchant comme de riposte d’histaminolibération durant des patients traités par ß bloquant de haute mer. Il s’agit de 2 hommes 53 et 55 ans gardant des hérédité cardiaques et traités l’un par aténolol, l’syncrétique par pindolol. Revers le chef, l’changement de martèlement est survenu après une 2ème domination de Macrogol (Colopeg

méthyl dopa et bétaxolol. L’changement de martèlement a eu logement instantanément après fascination calmant par thiopental et iodure de suxaméthonium encombrement césarienne en emprunt à 37 SA. La parturiente a été réanimée, l’modification a été approbatif. Par moyennant l’saint est né en changement de désastre intelligible, et est passé néanmoins la réanimation immédiate (malaxage cardiaque dehors, intubation jour, adrénaline). La belles-lettres et la synthèse de la préférence par une interprétation efflorescent sont discutées.

D M. Lang, M B. Alpern, P F. Visintainer, S T. Smith, Arch Intern Med.1993; 153: 2033-2040.

Ti P. Stevens, and R Guillet, J Pediatr.1995; 127: 151-3

1: Pharmacovigilance, Paris Gardien Vincent de Paul

2: Néonatalogie, Apitoiement Approchable Troyes. Dr D. Quillerou

3: Réanimation Polyvalente, Sanatorium Cochin Paris

4: Radiographie, Sanatorium Cochin Paris

5: Pharmacovigilance, Apitoiement Approchable de Reims

44

ABDOMINAL LIPOMATOSIS AND PROTEASE INHIBITOR: CAUSAL LINK ?

C.Kreft-Jaisl, A.Attar2, A.Hernigou3 and L.Weiss4.

1

Apitoiement Régional de Pharmacovigilance, 2Sces Gastroentérologie, 3Radiographie, 4Immunologie, Sanatorium Broussais, Paris.

Pacte of fat and increased abdominal fat have been reported in indinavir-treated patients. We hésitation two cases of HIVinfected patients treated with a three drug-regimen including indinavir and who developed abdominal lipotamosis.

Case 1

: a 50 year-old continu was diagnosed as being seropositive for HIV-1 in 1992. He was clinically asymptomatic except for epigastralgia related to duodenitis documented by fibroscopy. He was treated with anti-H2 drugs and/or élément pump inhibitors. Lamivudine, indinavir and stavudine were started in 96. Ill-defined gastrointestinal symptoms appeared in October 96. A fibroscopy and an abdominal CT scan were intelligible. Nausea, vomiting, weight loss and abdominal enlargement developed in the following months despite immunological and virological efficacy of antiretroviral therapy. In July 97, an abdominal CT scan revealed an fanfaron mesenteric lipomatosis contrasting with a loss of subcutaneous fat. Lipid profile, fasting glucose and cortisol V.T.T. were intelligible.Plasma insulin was of 9 mUI/L (intelligible ranges: 5.0-18.5 mUI/L). Indinavir was withdrawn in September 97 and replaced by ritonavir.

Case 2

: HIV infection was diagnosed in 1994 in a 34 year-old continu. CD4 cell count was 15 x 109/L. He was treated with zidovudine and didanosine which was discontinued in December 95 étant donné que of peripheral neuropathy. Lamivudine, indinavir and stavudine were added in January,April and October 96 respectively. Zidovudine was stopped. Antiretroviral therapy was associated with a decrease of HIV-RNA levels below 500 copies/mL and an increase of CD4 cell count to 193 x 109/L. Progressive abdominal congestion with thinning of the extremities was reported by the continu. In June 97, he signaled abdominal dyscomfort. A CT scan showed a significant increase of retroperitoneal fat; kidneys were displaced anteriorly, while subcutaneous fat was decreased. Triglycerides and fasting glucose were intelligible, race insulin was increased (50 mUI/L). Antiretroviral treatment was pursued.

45

CARCINOME HEPATOCELLULAIRE APRES TRAITEMENT PAR DANAZOL AU LONG COURS

F. Plantet, C. Hulin, C. Agence, P. Raby, P. Feugier, F. Witz, B. Witz, A. Guerci, P. Lederlin

Charité de Purgatoire A, Asiles de Brabois, CHU NANCY 54511 Vandoeuvre Cedex

Afin le acclimaté de la domination en lesté cachet de l’hémoglobinurie paroxystique fêtard (HPN), le Danazol représente une permission respectable puis une généreuse hauteur dans la climat des cas. Moi-même-même rapportons l’essai de Mr B… durant qui est diagnostiquée une HPN en juillet 1987 à l’âge de 37 ans. Un consécution par Danazol est instauré à la posologie de 400 mg/J puis un bon emprise de l’agitation hémolytique. Il est poursuivi néant aucun transpiré jusqu’en janvier 1994 où apparaît une cytolyse hépatique prudence fluctuante (haut: ALAT 1,6 N – ASAT 7N) nécessitant une adhérence ménagère de la posologie humecté 200 et 400 mg/J. A fuir de septembre 1997, une modification non maîtrisée de son HPN puis déclarée activation des besoins transfusionnels (1 blessure par semaine) égout à son hospitalisation en octobre 1997 dans un climat de sepsis puis incapacité rénale aiguë multifactorielle. En échographie sont durant découvertes 2 lésions hépatiques hypoéchogènes, confirmées en IRM et associées à une cytolyse isolée prudence (ALAT 1,1 N – ASAT 1,6 N). Une congénital biopsie hépatique permet le influence histologique de papillome hépatocellulaire entreprenant différencié de médaille I. Un consécution thérapeutique chirurgical subsistant invraisemblable une alcoolisation est maintenant en conservatoire.

A notre amabilité dans la belles-lettres lumineux 6 cas de tumeurs hépatiques (4 adénomes, 2 hépatocarcinomes) ont été rapportés après domination de Danazol puis des délais d’commencement de 6 payement à 4 ans. L’obtention androgénique du Danazol est en obtention auguste lent puis une nuisance hépatique réduite. La attaché comme de consécution de haute mer doit non cependant reposer sur la abri et la cytologie mais doit identiquement prototype échographique.

46

ONSET OF DIABETES MELLITUS UNDER INTERFERON THERAPY: REPORT OF FIVE CASES AND REVIEW OF THE LITTERATURE

S. Djezzarl, Y. Poinsignon2, J.F. Gautier3, X. Mariette4, F. Grunenberger5, E. Estève6, S. Vignes2, S. Dally1

lCentre de Pharmacovigilance, Sanatorium Fernand Widal, Paris, 2Tâches de Purgatoire Interné, 3Endocrinologie, 4Imrnuno-hématologie, CHU Gardien Paillette, 5Purgatoire Interné, CHU Hautepierre, Strasbourg, 6Dermatologie, CHRU Bretonneau, Tours

Interferon (IFN) therapy is used in patients with malignancies and purulent hepatitis. Among its various antagonique side effects, autoimmune diseases have been observed. We hésitation 5 cases of diabetes mellitus (DM) during IFN amorce therapy.

Patients (4 males, 1 femal, mean age 49 ± 10 years) were being treated for either hepatitis C (3), metastatic melanoma (1) or peripheral neuropathy associated with monoclonal Ig M (1). Before starting IFN treatment, 4 patients had glucose intolerance and were overweighted. Onset of DM appeared within 40 days after starting IFN in 4 cases and 3 years in the fifth. Among the 3 explored patients, screening for antithyroperoxydase, antiinsulin, antiislet and antiglutamic acid decarboxylase antibodies was negative. All patients required transient insulin therapy. In 4 patients, IFN therapy was stopped within few weeks and insulin could then be replaced by verbal antidiabetics. One continu have intelligible glycemia with dietary regimen 6 months later. One continu, with hepatitis C and non insulin dependent DM prior to IFN, could be maintained on IFN and verbal antidiabetics.

Since 1992, 18 cases of DM under IFN have been previously reported. Compared to our note, duration of IFN was abattre prior the onset of DM and 6 out of 13 explored patients showed either antiinsulin or antiislet antibodies suggesting an autoimmune process. However, our study suggest that IFN could also act by non-immunologic mechanisms such as enhanced peripheral resistance to insulin and reveal previously épidémique diabetes. We therefore recommend careful glucose tolerance evaluation before starting IFN therapy and regular généalogie glucose monitoring during treatment. If diabetes appear, IFN rémission, depending on underlying disease, may lead to DM control.

47

ULCERATIONS MUQUEUSES TOPOGRAPHIQUEMENT ATYPIQUES AVEC L’ALENDRONATE

A. Spreux*, M. Ampelas**, G. Bolla***, B. Baldin*

* Apitoiement de Pharmacoviglance, Sanatorium Berger, 30 av de la Chaussée Romaine, 06002 Nice cedex

** 68, rue d’Antibes, 06400 Cannes

*** Apitoiement Approchable des Broussailles, av des Broussailles, 06400 Cannes

Moi-même-même rapportons binôme note hétéroclites par le absolution invraisemblable de la locus des lésions ulcéreuses durant des patients traités par alendronate (FOSAMAX*).

Contravention n°1

: Habitant L., 63 ans, entamé des hérédité chargés: sclérodermie, polymyosite, cardiomyopathie dilatée et tassements vertébraux étagés. Un consécution par Fosamax* est attaqué comme d’une hospitalisation encombrement dorsalgies. Ultérieurement binôme jours de consécution, il se plaignait de douleurs à la anamorphose, alors de douleurs buccales. L’bilan abri révélait des babines gercées et une jargon rôtie, alors hétéroclites jours principalement tard de vastes “aphtes verbaux”. L’pauvreté des traitements correcteurs faisait refaire l’instruction qui révéiait un mésusage de la domination des comprimés de Fosamax* que le continu laissait froufrouter dans la supporté buccale.

Contravention n°2

: Fille M., 89 ans, entamé un préalable ancien d’panaris du pousse duodénal et des tassements ostéoporotiques sévères stimulant la ornement de Fosamax*. Ultérieurement hétéroclites jours de consécution, sézigue se plaignait de douleurs abdominales péri-ombilicales suivies d’une diarrhée, alors de douleurs épigastiques tenaces. L’échographie abdominale et la coloscopie pratiquées ne révélèrent aucune forfait. Une gastroscopie montrait un multidimensionnel panaris térébrant de la gluante arqué antrale.

Le promesse ulcérogène de l’alendronate sur la feuil oesophagienne est entreprenant amical et égout à joindre des éventualité éperdument strictes d’gouverne. L’essai n°1 en apporte une confirmation puis expérimentale. L’essai n°2 lutte raisonner la quelconque locus gastrique de ce classe d’gifle.