MEDICATION ALERT BULLETIN 05.2025
1. REMINDER ON CONTRAINDICATIONS FOR THE USE OF ACE INHIBITORS (ACEI) AND ANGIOTENSIN RECEPTOR BLOCKERS (ARB) DURING PREGNANCY: INFORMATION FROM THE NEW ZEALAND MEDICINES AND MEDICAL DEVICES SAFETY AUTHORITY (MEDSAFE)
Risks of Using ACEi/ ARB
First-line medications for treating hypertension in adult patients include ACEi (e.g., enalapril, lisinopril, perindopril, quinapril, ramipril) and ARB (e.g., candesartan, losartan, telmisartan). However, these medications are contraindicated during pregnancy. The use of these medications during pregnancy is associated with toxicity to the fetus and newborn, including skull defects, reduced amniotic fluid volume, hypotension, hyperkalemia, renal failure, and stillbirth.
Recommendations for Prescribing ACEi/ ARB to Patients of Reproductive Age
– Before starting treatment with ACEi/ ARB medications, the physician should ask the patient if they are pregnant or planning to become pregnant.
– Inform the patient about the risks of ACEi/ ARB medications to the fetus and remind the patient to see a doctor immediately upon becoming pregnant. If the patient plans to become pregnant, consider switching to alternative antihypertensive medications before conception.
– If the patient becomes pregnant during treatmentby ACEi/ARB medications, it is necessary to discontinue the medication and replace it with another appropriate antihypertensive drug.
Source: https://magazine.canhgiacduoc.org.vn/Magazine/Details/311
2. ANTIBIOTIC-RELATED INFLAMMATORY BOWEL SYNDROME: INFORMATION FROM HEALTH CANADA
Drug-induced inflammatory bowel syndrome is an allergic reaction, with typical symptoms including prolonged vomiting (occurring within 1-4 hours after taking the medication), primarily reported in children using medications containing amoxicillin. Other symptoms may include abdominal pain, fatigue, diarrhea, hypotension, or increased neutrophils. In severe cases, drug-induced inflammatory bowel syndrome may progress to shock.
Patients are advised to discontinue the use of amoxicillin-containing medications and immediately inform healthcare personnel if they experience symptoms of drug-related inflammatory bowel syndrome, as this may be a sign of a serious allergic reaction.
The risk of developing inflammatory bowel syndrome will be updated in the product information sheets for amoxicillin-containing medications in Canada. This information will be updated in the sections Warning and Precautions, Adverse Effects in the product information for amoxicillin-containing medications.circulating in Canada.
Source: https://magazine.canhgiacduoc.org.vn/Magazine/Details/311
3. INTERSTITIAL LUNG DISEASE DUE TO MEDICATION: INFORMATION FROM MEDSAFE
At the meeting in September 2024, the Medicines Adverse Reactions Committee (MARC) of the New Zealand Medicines and Medical Devices Safety Authority (Medsafe) reviewed a report of an unspecified pneumonia case related to methotrexate. In this bulletin, Medsafe reiterated the risk of interstitial lung disease when using methotrexate and other medications.
Medications Causing Interstitial Lung Disease
Interstitial lung disease is a term that refers to a group of conditions that cause inflammation or fibrosis of the lung parenchyma. These lesions impair the lungs’ ability to exchange gases and can lead to respiratory failure or death.
Interstitial lung disease is the most common adverse drug reaction affecting the lungs. Some medications that may cause interstitial lung disease include nitrofurantoin, methotrexate, amiodarone, leflunomide, chemotherapy agents, and some biologics (Table 1). Medsafe has recorded reports of hundreds of medications capable of causing interstitial lung disease.
Table 1. Examples of Medications Associated with Interstitial Lung Disease
| Medication | Characteristics |
|---|---|
| Methotrexate | Acute/chronic interstitial pneumonia and pulmonary fibrosis may occur and progress rapidly |
| Amiodarone | Pulmonary fibrosis and/or pneumonia are reported reactions. Patients recover if the medication is stopped early |
Monitoring Drug-Induced Interstitial Lung Disease
The onset symptoms of interstitial lung disease are nonspecific, including cough, shortness of breath, and fatigue. The diagnosis of interstitial lung disease is based on clinical signs, imaging, and histopathology. Clinically, drugs can be a cause of interstitial lung disease when patients present with new respiratory symptoms or worsening symptoms during drug therapy.
Risk Factors for Drug-Induced Interstitial Lung Disease:
– Age (children and the elderly are at higher risk of adverse reactions).
– Underlying pulmonary conditions.
– Drug interactions: concurrent use of drugs that may cause interstitial lung disease.
Management of Interstitial Pneumonitis
When using drugs that have the potential to cause interstitial lung disease, close monitoring of the patient’s respiratory function is necessary. Late detection of interstitial lung disease increases the risk of irreversible lung damage and even death. Healthcare professionals should refer to drug usage guidelines and related treatment protocols to take appropriate management measures.
Upon detecting a patient with drug-induced interstitial lung disease, it is essential to discontinue the drug immediately and treat with corticosteroids. Early recognition and treatment can improve the patient’s prognosis.patients about the risk of interstitial lung disease: Patients using medications that may cause interstitial lung disease should be informed about this risk. Patients are advised to seek medical attention immediately when symptoms such as cough, chest pain, shortness of breath, fever, or chills appear. Explain to patients that early detection and treatment are crucial to reduce the risk of irreversible lung damage.
Source: https://magazine.canhgiacduoc.org.vn/Magazine/Details/311
4. ANSM: THE IMPORTANCE OF RATIONAL USE OF FLUOROQUINOLONE ANTIBIOTICS
Recommendations for healthcare professionals:
– Only prescribe this class of antibiotics when indicated, while informing the patient about the benefits, potential risks, and guiding them on how to manage adverse drug reactions. Do not use fluoroquinolones in cases where alternative antibiotic classes can be chosen.
– Fluoroquinolones should not be prescribed in:
+ The treatment of non-serious infections or infections that may resolve on their own.
+ The prevention of traveler’s diarrhea or recurrent lower urinary tract infections.
+ The treatment of infections not caused by bacteria, such as non-bacterial chronic prostatitis.
+ The treatment of infectionsmild to moderate bacteria (uncomplicated cystitis, acute exacerbation of chronic bronchitis, chronic obstructive pulmonary disease (COPD), acute bacterial sinusitis, and acute otitis media), except in cases where commonly recommended antibiotics are no longer appropriate.
+ Patients with a history of serious adverse reactions to quinolone/fluoroquinolone antibiotics.
Note: Avoid concurrent use of corticosteroids with fluoroquinolone antibiotics as it significantly increases the risk of adverse tendon reactions.
Source: http://canhgiacduoc.org.vn/CanhGiacDuoc/DiemTin/5628/ANSM-Tam-quan-trong-su-dung-khang-sinh-fluoroquinolon-hop-ly.htm
5. MEDSAFE: NOTE ON SOME MEDICATIONS THAT CAUSE INCREASED SWEATING
Drug-induced hyperhidrosis
Hyperhidrosis is a condition of excessive and uncontrolled sweating. This condition can be classified as: primary, of unknown cause (idiopathic), or secondary due to underlying conditions, medications, or other causes.
Drug-induced hyperhidrosis is the most common secondary cause. This condition can affect any part of the body, may appear unilaterally, asymmetrically, or systemically. If left untreated, hyperhidrosis cancan lead to issues such as skin infections, causing patients to feel embarrassed when communicating, reducing self-confidence, and affecting the patient’s mental health.
Mechanism
The mechanism of increased sweating is related to the body’s temperature regulation activities in the hypothalamus, the thermoregulation center in the spinal cord, sympathetic ganglia, and the neural connections to the eccrine sweat glands. Acetylcholine is an important neurotransmitter in the process of body temperature regulation and sweating. Some medications can affect these pathways, enhancing acetylcholine transmission, thereby increasing sweating.
Table 1 lists some medications that may cause increased sweating along with their mechanisms.
Table 1: Drug groups/medications related to hyperhidrosis and mechanisms (incomplete list)
| Drug Group | Specific Medications | Mechanism |
| Opioids | Codeine
Fentanyl Morphine |
Histamine release leading to increased acetylcholine secretion |
| Medications affecting endocrine function
– Glucocorticoids – Thyroid medications |
Dexamethasone
Hydrocortisone Prednisone Levothyroxine |
Release of various hormones affecting the feedback regulation cycle |
Management
When suspecting that medication is the cause of increased sweating in patients, doctors may consider reducing the dose or switching to a long-acting formulation. Additionally, both pharmacological and non-pharmacological measures (e.g., topical antiperspirants) can be applied to reduce the severity of symptoms. If the sweating condition becomes severe and outweighs the therapeutic benefits of the medication, the drug causing the symptoms should be discontinued and replaced with another medication less likely to cause increased sweating.
Source: http://canhgiacduoc.org.vn/CanhGiacDuoc/DiemTin/5609/Medsafe-luu-y-mot-so-thuoc-gay-tang-tiet-mo-hoi.htm
Leave a reply