Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Daytime drowsiness and other sleep related symptoms such as attention and concentration difficulties, blurred vision and slurred speech were evaluated using seven point rating scales in 51 drug free depressed patients and an age and sex matched control group. Degrees of depression and anxiety were quantified using the Beck Depression Inventory and State Trait Anxiety Inventory respectively. Daytime drowsiness and sleep related symptoms were seen to be significantly higher in the index group. Both depression and anxiety scores significantly correlated with daytime drowsiness.
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PMID:Daytime sleepiness in depression. 719 12

Though most of ectopic pinealoma occurs in the midline of cerebral base, only ten cases of frontal subcortical germinomas were reported in Japan as far as we know in literature. The patient, 20 year-old male, was admitted to our hospital because of blurred vision of the right eye and somnolence. Neurological examination on admission revealed bilateral choked discs and impaired visual acuity of both eyes with visual field defect of the right eye. A large deep bifrontal tumor was noted by cerebral angiography and pneumoventriculography done at the time of ventricular drainage. After subtotal removal of left frontal tumor and bifrontal V-P shunt, he came alert. No abnormality of posterior part of third ventricle was noted on the post-operative pneumonencephalogram. As the microscopic examination revealed that the tumor was germinoma of two-cell pattern, Co60 with a total dose of 5,900 rads was irradiated to the rest of the tumor. Brain scan with Tc99m 6 months after the surgery showed the disappearance of the tumor and CT scan 3 years later confirmed no recurrence of the tumor. Fine structure of the tumor was also presented and discussed.
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PMID:[A case of large germinoma in bilateral frontal region (author's transl)]. 739 99

Numerous clinical reports and several controlled clinical trials have confirmed that vigabatrin is both effective and well-tolerated as an add-on treatment for patients with drug-resistant epilepsy. This report presents the results of a study of 40 patients (22 women and 18 men), aged 19-60 years (mean 37 years), with partial seizures (with or without secondary generalization) and receiving carbamazepine, 600-1800 mg/day. Vigabatrin was given as first add-on drug at a dose of 2-3 g/day for an average of 6 months, in order to assess the clinical response before considering other anti-epilepsy drugs. There was a significant decrease in seizure frequency, from a median of 13 seizures/month at baseline, to 3 seizures/month during the last month on vigabatrin (p < 0.01). Seven patients became seizure-free (17.5%). The most common adverse events experienced during the study were drowsiness, diplopia/blurred vision, and were already present before vigabatrin treatment. In conclusion, vigabatrin is effective as a first add-on therapy for partial epilepsy, refractory to carbamazepine monotherapy, and appears to be a worthy clinical alternative to other drug combinations.
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PMID:Vigabatrin as first add-on treatment in carbamazepine-resistant epilepsy patients. 749 89

A 71-year-old male with a null cell pituitary macroadenoma was given peripituitary region radiotherapy (4,346 Gy units) over a 1-month-period and 6 weeks later developed the rapid onset of blurred vision, diplopia, ataxia, incoordination, cranial nerve palsy, somnolence, and respiratory distress. His fixed neurologic deficits required ventilatory support, feeding tube placement, and chronic hospitalization until his death 1 year later. At autopsy, necrotic foci with dystrophic axonal calcification were found throughout the brainstem, associated with mild focal vascular hyalinization but without fibrinoid necrosis, telangiectasias or large vessel abnormalities. This unusual case of fatal "early delayed" radiation injury is compared to previous literature cases.
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PMID:Necrotizing brainstem leukoencephalopathy six weeks following radiotherapy. 760 98

The efficacy of valproic acid in the treatment of intractable chronic daily headache, unresponsive to traditional prophylactic medications, was examined prospectively in 16 patients. Dosage of the medication was adjusted to maintain serum valproic acid levels between 50 and 100 micrograms/mL, provided there were no significant side effects at that level. Valproic acid prophylaxis was of some benefit in only 2 of 16 patients. One of these two patients discontinued therapy due to side effects. Eight of the 16 patients reported side effects which included nausea, diarrhea, anorexia, lethargy, sleepiness, confusion, blurred vision, and decreased libido. In conclusion, valproic acid was not effective in controlling chronic daily headache in the majority of patients in whom conventional therapy had failed, and 50% of patients reported side effects. There is a significant disparity in the reported efficacy of this drug in treating chronic daily headache. This disparity is most likely due to the poorly-defined nature of this variety of headache. It is, therefore, recommended that more stringent definition of this disorder be developed before therapeutic regimens are evaluated.
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PMID:Valproic acid treatment of chronic daily headache. 853 Feb 78

Due to the age-associated increase in morbidity, many elderly subjects are in need of multiple drug treatment. Multimedications, however, carry a high risk for adverse drug reactions (ADR) and drug-drug interactions (DDI). This risk is especially increased in very old patients since age and morbidity lead to significant changes in body composition and organ functions. Nonetheless, representative and specific information on cumulative risks for adverse effects of multimedications in the aged is not yet available. We used data of the ongoing, population-based Berlin Aging Study (N = 516; age range 70-103 years) to evaluate the cumulative potential for ADR and DDI in a subgroup of participants taking five or more drugs (N = 221; 44.4% of the parent population [estimated]; mean age 85.2 +/- 8.3 years). Computerized algorithms were used to screen all medications for potential ADR and DDI based on standardized information which was derived from the German Physician's Desk Reference and a frequently used textbook on ADR and DDI. As expected, the analyses revealed a significant potential for adverse effects of multimedications. Cumulative totals of 12,221 different potential ADR (54.9 per subject) and 1016 different potential DDI (4.6 per subject) were identified. With regard to ADR, the most prevalent ADR-risks were for gastrointestinal upset (99%), headache (96%), postural hypotension (95%), and vertigo (94%). With respect to these risks, the minimum mean number of potentially offending drugs was 2.3, the maximum was 4.5 per subject. Additionally, 89% were at risk for drowsiness, 87% for blurred vision and 67% for confusion. Altogether, diuretics, digitalis and calcium antagonists accounted for 46% of ADR-risks. With regard to DDI, 85% had at least one drug-combination potentially leading to enhanced drug action, 52% had at least one combination potentially leading to reduced action. Most frequently involved in potential DDI were calcium antagonists (20%), digoxin (18%), and thiazides (17%). Most prevalent specific risks due to DDI were postural hypotension (48%), glycoside intoxication (26%), toxic CNS-effects (22%) and hypokalemia (19%). In conclusion, risks for ADR and DDI should be considered carefully and regularly monitored in elderly patients on multimedications. Stopping unnecessary medications, especially with regard to diuretics, digitalis and calcium antagonists, will lead to a marked reduction of the cumulative risks associated with multimedications in old age.
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PMID:[Potential side-effects and interactions in multiple medication in elderly patients: methodology and results of the Berlin Study of Aging]. 858 61

Current antidepressants achieve similar efficacy, with 60% to 80% of patients responding adequately. Clinical response is gradual, and differential response factors are difficult to discern. However, side effect profiles and toxicity vary substantially, so the choice of medication depends primarily on tolerability and safety. Dry mouth is prevalent with tricyclic antidepressants (TCAs), whereas nausea occurs more frequently with a serotonin selective reuptake inhibitor (SSRI). Long-term unwanted effects tend not to be a major problem, with a dropout rate of approximately 5% due to side effects. The relationship between suicidality and antidepressants remains under debate. Many TCAs are highly toxic in overdose whereas the SSRIs appear much safer. Nefazodone is a unique antidepressant with demonstrated efficacy. It is different from other antidepressants because of its two actions in the serotonin system, moderate serotonin selective reuptake blocking properties and direct 5-HT2 antagonism, which also can enhance 5-HT1 neurotransmission. The 5-HT2 antagonist properties may limit serotonin-mediated effects and, as a result, nefazodone may be more anxiolytic than other antidepressants. Nefazodone also moderately inhibits norepinephrine reuptake and blocks alpha 1-adrenergic receptors. The data base on the safety of nefazodone currently comprises approximately 3,500 patients from all research trials, which include controlled trials that allow comparisons of nefazodone treatment with several hundred patients taking TCAs or SSRIs and nearly 900 patients receiving placebo. The most frequent adverse experiences with nefazodone as compared with placebo treatment are nausea (21% vs. 14%), somnolence (19% vs. 13%), dry mouth (19% vs. 13%), dizziness (12% vs. 6%), constipation (11% vs. 7%), asthenia (11% vs. 6%), light-headedness (10% vs. 4%), and amblyopia (blurred vision; 6% vs. 3%). Approximately 12% of nefazodone-treated patients dropped out because of adverse experiences, as compared with 7.4% on placebo, 10.4% on SSRIs, but 21.8% on imipramine after short-term exposure in placebo-controlled trials. Long-term safety data include nearly 1,300 patients; nefazodone was well tolerated. Nefazodone was evaluated in normal subjects by the author and was found to produce less impairment than imipramine and was less likely to interact with alcohol. In summary, nefazodone has a favorable adverse-event profile as compared with the TCAs and a rather different one from the SSRIs. It appears to be safe and well tolerated after both acute and long-term use.
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PMID:Tolerability and safety: essentials in antidepressant pharmacotherapy. 862 62

The chemistry, pharmacology, pharmacokinetics, and clinical efficacy of nefazodone hydrochloride, a new antidepressant, are described. Nefazodone enhances serotonin (5-hydroxytryptamine [5-HT]) synaptic transmission by acting as an antagonist at 5-HT2 receptors and by inhibiting the reuptake of 5-HT. These two mechanisms combined may enhance 5-HT1A-mediated transmission. In addition, nefazodone weakly inhibits the reuptake of norepinephrine. Nefazodone is a structural analogue of trazodone but is pharmacologically distinct. In placebo-controlled trials, nefazodone was as effective as imipramine for the treatment of major depression and produced clinical benefits in patients with depression-related anxiety and sleep disturbances. More than 2000 patients have received nefazodone in clinical trials. The most commonly reported adverse drug reactions (ADRs) are asthenia, somnolence, dry mouth, nausea, constipation, dizziness, lightheadedness, confusion, abnormal vision, and blurred vision. The incidence of sexual-dysfunction ADRs may be less than that reported for other antidepressants. Nefazodone does not inhibit rapid-eye movement sleep. Nefazodone, an inhibitor of the hepatic P-450 isoenzyme CYP3A4, may increase concentrations of drugs metabolized by this isoenzyme, such as terfenadine, astemizole, triazolam, alprazolam, and midazolam. Caution should be exercised in administering nefazodone hydrochloride with triazolobenzodiazepines, and coadministration with terfenadine or astemizole is contra-indicated. The dosage should start at 100 mg twice daily and then be increased, depending on occurrence of ADRs and the patient's clinical response, to 300-600 mg daily. In elderly or debilitated patients, the initial dosage should be half the usual dosage. Nefazodone hydrochloride is as effective as other available antidepressants and may cause fewer ADRs.
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PMID:Nefazodone: a new antidepressant. 889 78

Most of the modern non-sedating H1 receptor antagonists (antihistamines) penetrate the brain poorly, allowing the use of doses large enough to counteract allergic processes in peripheral tissues without important central effects. The antihistamines reviewed here are acrivastine, astemizole, cetirizine, ebastine, fexofenadine, loratadine, mizolastine, and terfenadine. However, these drugs are not entirely free from central effects, and there are at least quantitative differences between them. Although psychomotor and sleep studies in healthy subjects in the laboratory may predict that an antihistamine does not cause drowsiness, the safety margin can be narrow enough to cause a central sedating effect during actual treatment. This might result from a patient's individual sensitivity, disease-induced sedation, or drug dosages that are for various reasons relatively or absolutely larger (patient's weight, poor response, reduced drug clearance, interactions). Mild to even moderate sedation is not necessarily a major nuisance, particularly if stimulants need be added to the regimen (e.g. in perennial rhinitis). Furthermore, patients can adjust doses themselves if needed. Sedating antihistamines are not needed for long-term itching, because glucocorticoids are indicated and more effective. It is wise to restrict or avoid using antihistamines (astemizole, terfenadine) that can cause cardiac dysrhythmias, because even severe cardiotoxicity can occur in certain pharmacokinetic drug-drug interactions. Histamine H1 receptor antagonists (antihistamines) are used in the treatment of allergic disorders. The therapeutic effects of most of the older antihistamines were associated with sedating effects on the central nervous system (CNS) and antimuscarinic effects causing dry mouth and blurred vision. Non-specific "quinidine-like" or local anaesthetic actions often led to cardiotoxicity in animals and man. Although such adverse effects varied from drug to drug, there was some degree of sedation with all old antihistamines. Non-sedating antihistamines have become available during the past 15 years. Some of them also have antiserotonin or other actions that oppose allergic inflammation, and they are not entirely free from sedative effects either. In small to moderate "clinical" concentrations they are competitive H1 receptor antagonists, although large concentrations of some of them exert non-competitive blockade. Daytime drowsiness and weakness are seldom really important, and they restrict patients' activities less than the old antihistamines. Some new antihistamines share with old antihistamines quinidine-like effects on the cardiac conducting tissues, and clinically significant interactions have raised the question of drug safety. This prodysrhythmic effect has also been briefly mentioned in comparisons of non-sedative H1 antihistamines.
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PMID:Variations among non-sedating antihistamines: are there real differences? 1033 1

Detrusor instability, or urinary incontinence, is common in elderly patients, particularly elderly women. The clinical symptoms of overactive, or unstable, urinary bladder include urge urinary incontinence, urgency, and frequency. Mixed urinary incontinence, which comprises urge urinary incontinence and stress incontinence, is manifested by increased intraabdominal pressure on coughing or sneezing. The detrusor muscle of the bladder is under the control of the parasympathetic, or muscarinic, nervous system. The drug of choice in this condition is oxybutynin chloride, which has the ability to block acetylcholine released from parasympathetic nerves in the urinary bladder, preventing contractions of the muscle and exerting a direct spasmolytic effect on the bladder. A new extended-release oral tablet formulation, OROS oxybutynin, uses osmotic pressure to deliver the drug at a controlled rate over approximately 24 hours. It resembles a conventional tablet but has a two-part core consisting of a drug layer and below it, a "push" layer containing osmotically active components, the whole surrounded by a semipermeable membrane with a laser-drilled opening in the drug side. Water in the gastrointestinal tract enters the tablet and mixes with the drug to form a suspension. The "push" layer expands and pushes the suspended drug out of the orifice and into the gastrointestinal tract for eventual absorption. Pharmacokinetic studies have indicated a slow rise in mean plasma concentration of the isomer R-oxybutynin for 4 to 6 hours after a single dose of OROS oxybutynin, followed by maintenance of steady concentrations for up to 24 hours, minimizing the fluctuations between peak and trough associated with TID dosing of 5-mg immediate-release oxybutynin tablets. Efficacy and safety studies comparing the extended-release with the immediate-release formulation of oxybutynin demonstrated equivalent efficacy in patients with overactive urinary bladder. The adverse-event profile of oxybutynin is similar to that of a typical anticholinergic agent such as atropine--dry mouth, constipation, somnolence, blurred vision, headache, and gastrointestinal pain--although in 2 clinical studies, the incidence of dry mouth was less with the extended-release formulation. Once-daily dosing with OROS oxybutynin appears to be well tolerated and effective, as well as convenient, for the treatment of overactive bladder, particularly for elderly patients using multiple medications.
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PMID:An extended-release formulation of oxybutynin chloride for the treatment of overactive urinary bladder. 1036 30


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