wikidoc - User contributions [en]

Ergoloid mesylate

2015-04-29T14:27:17Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Ergoloid mesylate
|aOrAn=a
|drugClass=Central Nervous System Agent
|indicationType=treatment
|indication=Alzheimer's disease - dementia
|adverseReactions=nausea and gastric disturbances


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
A proportion of individuals over sixty who manifest signs and symptoms of an idiopathic decline in mental capacity (i.e., cognitive and interpersonal skills, mood, self-care, apparent motivation) can experience some symptomatic relief upon treatment with ergoloid mesylates preparations. The identity of the specific trait(s) or condition(s), if any, which would usefully predict a response to ergoloid mesylates therapy is not known. It appears, however, that those individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (i.e., primary progressive dementia, Alzheimer's dementia, senile onset, multi-infarct dementia).

Before prescribing ergoloid mesylates, the physician should exclude the possibility that the patient's signs and symptoms arise from a potentially reversible and treatable condition. Particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Ergoloid mesylates preparations are not indicated in the treatment of acute or chronic psychosis, regardless of etiology (see CONTRAINDICATIONS).

The decision to use ergoloid mesylates in the treatment of an individual with a symptomatic decline in mental capacity of unknown etiology should be continually reviewed since the presenting clinical picture may subsequently evolve sufficiently to allow a specific diagnosis and a specific alternative treatment. In addition, continued clinical evaluation is required to determine whether any initial benefit conferred by ergoloid mesylates therapy persists with time.

The efficacy of ergoloid mesylates was evaluated using a special rating scale known as the SCAG (Sandoz Clinical Assessment-Geriatric). The specific items on this scale on which modest but statistically significant changes were observed at the end of twelve weeks include: mental alertness, confusion, recent memory, orientation, emotional lability, self-care, depression, anxiety/fears, cooperation, sociability, appetite, dizziness, fatigue, bothersome(ness), and an overall impression of clinical status.

====Dosage====
1 mg three times a day.

Alleviation of symptoms is usually gradual and results may not be observed for 3–4 weeks.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=There is limited information regarding FDA-Labeled Use of {{PAGENAME}} in pediatric patients.




|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* Ergoloid mesylates preparations are contraindicated in individuals who have previously shown hypersensitivity to the drug. Ergoloid mesylates preparations are also contraindicated in patients who have psychosis, acute or chronic, regardless of etiology.


|warnings=====Precautions====

* Practitioners are advised that because the target symptoms are of unknown etiology, careful diagnosis should be attempted before prescribing ergoloid mesylates preparations.




|clinicalTrials=Ergoloid mesylates preparations have not been found to produce serious side effects. Transient nausea and gastric disturbances have been reported. Ergoloid mesylates preparations do not possess the vasoconstrictor properties of the natural ergot alkaloids.
|postmarketing=There is limited information regarding Postmarketing Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|drugInteractions=
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* Oral
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=There is limited information regarding Overdose of {{PAGENAME}} in the drug label.




|drugBox={{Drugbox2
| Verifiedfields = changed
| verifiedrevid = 477511114
| image = Ergot wiki.png
| type = combo
| component1 = Dihydroergocristine
| class1 = [[Ergot]] [[alkaloid]]
| component2 = Dihydroergocornine
| class2 = Ergot alkaloid
| component3 = alpha-Dihydroergocryptine
| class3 = Ergot alkaloid
| component4 = beta-Dihydroergocryptine
| class4 = Ergot alkaloid


| tradename =
| pregnancy_category = Contraindicated
| legal_status = Rx-only
| routes_of_administration = Oral, parenteral


| bioavailability = 25%
| protein_bound = 98–99%
| metabolism = 50%
| elimination_half-life = 3.5 hours


| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 8067-24-1
| ATC_prefix = C04
| ATC_suffix = AE01
| ATC_supplemental =
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = NA
| PubChem =
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB01049
| ChEBI_Ref = {{ebicite|changed|EBI}}
| ChEBI = 59756
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL =
| synonyms = Co-dergocrine, dihydroergotoxine


}}


|mechAction=* There is no specific evidence which clearly establishes the mechanism by which ergoloid mesylates preparations produce mental effects, nor is there conclusive evidence that the drug particularly affects cerebral arteriosclerosis or cerebrovascular insufficiency.


|structure=* Each tablet for oral use contains ergoloid mesylates USP; a mixture of the methanesulfonate salt of the following hydrogenated alkaloids:

: [[File:Ergot str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

Inactive ingredients for oral tablets are: butylated hydroxyanisol, hydrogenated vegetable oil, lactose, mannitol, polyvinyl pyrrollidone, corn starch, stearic acid and talc.


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=Pharmacokinetic studies have been performed in normal volunteers with the help of radiolabelled drug as well as employing a specific radioimmunoassay technique. From the urinary excretion quotient of orally and intravenously administered tritium-labelled ergoloid mesylates the absorption of ergoloid was calculated to be 25%. Following oral administration, peak levels of 0.5 ngEq/mL/mg were achieved within 1.5–3 hr. Bioavailability studies with the specific radioimmunoassay confirm that ergoloid is rapidly absorbed from the gastrointestinal tract, with mean peak levels of 0.05–0.13 ng/mL/mg (with extremes of 0.03 and 0.18 ng/mL/mg) achieved within 0.6–1.3 hr (with extremes of 0.4 and 2.8 hr). The finding of lower peak levels of ergoloid compared to the total drug-metabolite composite is consistent with a considerable first pass liver metabolism, with less than 50% of the therapeutic moiety reaching the systemic circulation. The elimination of radioactivity, representing ergoloid plus metabolites bearing the radiolabel, was biphasic with half-lives of 4 and 13 hr. The mean half-life of unchanged ergoloid in plasma is about 2.6–5.1 hr; after 3 half-lives ergoloid plasma levels are less than 10% of radioactivity levels, and by 24 hr no ergoloid is detectable.

Bioequivalence studies were performed comparing ergoloid mesylates oral tablets (administered orally) with ergoloid mesylates sublingual tablets (administered sublingually). The oral tablet and sublingual tablet were shown to be bioequivalent.


|nonClinToxic=There is limited information regarding Nonclinical Toxicology of {{PAGENAME}} in the drug label.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* NDC:68151-2780-0 in a PACKAGE of 1 TABLETS
|storage=Store at 20° to 25°C (68° to 77°F)
DISPENSE IN TIGHT, LIGHT-RESISTANT CONTAINER.
|packLabel=====ERGOLOID MESYLATES 1 MG TAB====
: [[File:Ergot PDP.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

====Ingredients and Appearance====
: [[File:Ergot I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ERGOLOID MESYLATES®<ref>{{Cite web | title = Dihydroergocornine mesylate, dihydroergocristine mesylate, dihydro-.alpha.-ergocryptine mesylate, and dihydro-.beta.-ergocryptine mesylate tablet | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1344cf98-7d79-4ab4-9a63-2e632d9afbd4}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

File:Ergot wiki.png

2015-04-29T14:22:53Z

Rabin Bista:

Ergoloid mesylate

2015-04-29T14:16:05Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Ergoloid mesylate
|aOrAn=a
|drugClass=Central Nervous System Agent
|indicationType=treatment
|indication=Alzheimer's disease - dementia
|adverseReactions=nausea and gastric disturbances


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
A proportion of individuals over sixty who manifest signs and symptoms of an idiopathic decline in mental capacity (i.e., cognitive and interpersonal skills, mood, self-care, apparent motivation) can experience some symptomatic relief upon treatment with ergoloid mesylates preparations. The identity of the specific trait(s) or condition(s), if any, which would usefully predict a response to ergoloid mesylates therapy is not known. It appears, however, that those individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (i.e., primary progressive dementia, Alzheimer's dementia, senile onset, multi-infarct dementia).

Before prescribing ergoloid mesylates, the physician should exclude the possibility that the patient's signs and symptoms arise from a potentially reversible and treatable condition. Particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Ergoloid mesylates preparations are not indicated in the treatment of acute or chronic psychosis, regardless of etiology (see CONTRAINDICATIONS).

The decision to use ergoloid mesylates in the treatment of an individual with a symptomatic decline in mental capacity of unknown etiology should be continually reviewed since the presenting clinical picture may subsequently evolve sufficiently to allow a specific diagnosis and a specific alternative treatment. In addition, continued clinical evaluation is required to determine whether any initial benefit conferred by ergoloid mesylates therapy persists with time.

The efficacy of ergoloid mesylates was evaluated using a special rating scale known as the SCAG (Sandoz Clinical Assessment-Geriatric). The specific items on this scale on which modest but statistically significant changes were observed at the end of twelve weeks include: mental alertness, confusion, recent memory, orientation, emotional lability, self-care, depression, anxiety/fears, cooperation, sociability, appetite, dizziness, fatigue, bothersome(ness), and an overall impression of clinical status.

====Dosage====
1 mg three times a day.

Alleviation of symptoms is usually gradual and results may not be observed for 3–4 weeks.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=There is limited information regarding FDA-Labeled Use of {{PAGENAME}} in pediatric patients.




|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* Ergoloid mesylates preparations are contraindicated in individuals who have previously shown hypersensitivity to the drug. Ergoloid mesylates preparations are also contraindicated in patients who have psychosis, acute or chronic, regardless of etiology.


|warnings=====Precautions====

* Practitioners are advised that because the target symptoms are of unknown etiology, careful diagnosis should be attempted before prescribing ergoloid mesylates preparations.




|clinicalTrials=Ergoloid mesylates preparations have not been found to produce serious side effects. Transient nausea and gastric disturbances have been reported. Ergoloid mesylates preparations do not possess the vasoconstrictor properties of the natural ergot alkaloids.
|postmarketing=There is limited information regarding Postmarketing Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|drugInteractions=
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* Oral
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=There is limited information regarding Overdose of {{PAGENAME}} in the drug label.




|drugBox=
|mechAction=* There is no specific evidence which clearly establishes the mechanism by which ergoloid mesylates preparations produce mental effects, nor is there conclusive evidence that the drug particularly affects cerebral arteriosclerosis or cerebrovascular insufficiency.


|structure=* Each tablet for oral use contains ergoloid mesylates USP; a mixture of the methanesulfonate salt of the following hydrogenated alkaloids:

: [[File:Ergot str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

Inactive ingredients for oral tablets are: butylated hydroxyanisol, hydrogenated vegetable oil, lactose, mannitol, polyvinyl pyrrollidone, corn starch, stearic acid and talc.


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=Pharmacokinetic studies have been performed in normal volunteers with the help of radiolabelled drug as well as employing a specific radioimmunoassay technique. From the urinary excretion quotient of orally and intravenously administered tritium-labelled ergoloid mesylates the absorption of ergoloid was calculated to be 25%. Following oral administration, peak levels of 0.5 ngEq/mL/mg were achieved within 1.5–3 hr. Bioavailability studies with the specific radioimmunoassay confirm that ergoloid is rapidly absorbed from the gastrointestinal tract, with mean peak levels of 0.05–0.13 ng/mL/mg (with extremes of 0.03 and 0.18 ng/mL/mg) achieved within 0.6–1.3 hr (with extremes of 0.4 and 2.8 hr). The finding of lower peak levels of ergoloid compared to the total drug-metabolite composite is consistent with a considerable first pass liver metabolism, with less than 50% of the therapeutic moiety reaching the systemic circulation. The elimination of radioactivity, representing ergoloid plus metabolites bearing the radiolabel, was biphasic with half-lives of 4 and 13 hr. The mean half-life of unchanged ergoloid in plasma is about 2.6–5.1 hr; after 3 half-lives ergoloid plasma levels are less than 10% of radioactivity levels, and by 24 hr no ergoloid is detectable.

Bioequivalence studies were performed comparing ergoloid mesylates oral tablets (administered orally) with ergoloid mesylates sublingual tablets (administered sublingually). The oral tablet and sublingual tablet were shown to be bioequivalent.


|nonClinToxic=There is limited information regarding Nonclinical Toxicology of {{PAGENAME}} in the drug label.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* NDC:68151-2780-0 in a PACKAGE of 1 TABLETS
|storage=Store at 20° to 25°C (68° to 77°F)
DISPENSE IN TIGHT, LIGHT-RESISTANT CONTAINER.
|packLabel=====ERGOLOID MESYLATES 1 MG TAB====
: [[File:Ergot PDP.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

====Ingredients and Appearance====
: [[File:Ergot I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ERGOLOID MESYLATES®<ref>{{Cite web | title = Dihydroergocornine mesylate, dihydroergocristine mesylate, dihydro-.alpha.-ergocryptine mesylate, and dihydro-.beta.-ergocryptine mesylate tablet | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1344cf98-7d79-4ab4-9a63-2e632d9afbd4}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

Ergoloid mesylate

2015-04-29T14:14:00Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Ergoloid mesylate
|aOrAn=a
|drugClass=Central Nervous System Agent
|indicationType=treatment
|indication=Alzheimer's disease - dementia
|adverseReactions=nausea and gastric disturbances


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
A proportion of individuals over sixty who manifest signs and symptoms of an idiopathic decline in mental capacity (i.e., cognitive and interpersonal skills, mood, self-care, apparent motivation) can experience some symptomatic relief upon treatment with ergoloid mesylates preparations. The identity of the specific trait(s) or condition(s), if any, which would usefully predict a response to ergoloid mesylates therapy is not known. It appears, however, that those individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (i.e., primary progressive dementia, Alzheimer's dementia, senile onset, multi-infarct dementia).

Before prescribing ergoloid mesylates, the physician should exclude the possibility that the patient's signs and symptoms arise from a potentially reversible and treatable condition. Particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Ergoloid mesylates preparations are not indicated in the treatment of acute or chronic psychosis, regardless of etiology (see CONTRAINDICATIONS).

The decision to use ergoloid mesylates in the treatment of an individual with a symptomatic decline in mental capacity of unknown etiology should be continually reviewed since the presenting clinical picture may subsequently evolve sufficiently to allow a specific diagnosis and a specific alternative treatment. In addition, continued clinical evaluation is required to determine whether any initial benefit conferred by ergoloid mesylates therapy persists with time.

The efficacy of ergoloid mesylates was evaluated using a special rating scale known as the SCAG (Sandoz Clinical Assessment-Geriatric). The specific items on this scale on which modest but statistically significant changes were observed at the end of twelve weeks include: mental alertness, confusion, recent memory, orientation, emotional lability, self-care, depression, anxiety/fears, cooperation, sociability, appetite, dizziness, fatigue, bothersome(ness), and an overall impression of clinical status.

====Dosage====
1 mg three times a day.

Alleviation of symptoms is usually gradual and results may not be observed for 3–4 weeks.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=There is limited information regarding FDA-Labeled Use of {{PAGENAME}} in pediatric patients.




|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* Ergoloid mesylates preparations are contraindicated in individuals who have previously shown hypersensitivity to the drug. Ergoloid mesylates preparations are also contraindicated in patients who have psychosis, acute or chronic, regardless of etiology.


|warnings=====Precautions====

* Practitioners are advised that because the target symptoms are of unknown etiology, careful diagnosis should be attempted before prescribing ergoloid mesylates preparations.




|clinicalTrials=Ergoloid mesylates preparations have not been found to produce serious side effects. Transient nausea and gastric disturbances have been reported. Ergoloid mesylates preparations do not possess the vasoconstrictor properties of the natural ergot alkaloids.
|postmarketing=There is limited information regarding Postmarketing Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|drugInteractions=
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* Oral
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=There is limited information regarding Overdose of {{PAGENAME}} in the drug label.




|drugBox=
|mechAction=* There is no specific evidence which clearly establishes the mechanism by which ergoloid mesylates preparations produce mental effects, nor is there conclusive evidence that the drug particularly affects cerebral arteriosclerosis or cerebrovascular insufficiency.


|structure=* Each tablet for oral use contains ergoloid mesylates USP; a mixture of the methanesulfonate salt of the following hydrogenated alkaloids:

: [[File:Ergot str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

Inactive ingredients for oral tablets are: butylated hydroxyanisol, hydrogenated vegetable oil, lactose, mannitol, polyvinyl pyrrollidone, corn starch, stearic acid and talc.


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=Pharmacokinetic studies have been performed in normal volunteers with the help of radiolabelled drug as well as employing a specific radioimmunoassay technique. From the urinary excretion quotient of orally and intravenously administered tritium-labelled ergoloid mesylates the absorption of ergoloid was calculated to be 25%. Following oral administration, peak levels of 0.5 ngEq/mL/mg were achieved within 1.5–3 hr. Bioavailability studies with the specific radioimmunoassay confirm that ergoloid is rapidly absorbed from the gastrointestinal tract, with mean peak levels of 0.05–0.13 ng/mL/mg (with extremes of 0.03 and 0.18 ng/mL/mg) achieved within 0.6–1.3 hr (with extremes of 0.4 and 2.8 hr). The finding of lower peak levels of ergoloid compared to the total drug-metabolite composite is consistent with a considerable first pass liver metabolism, with less than 50% of the therapeutic moiety reaching the systemic circulation. The elimination of radioactivity, representing ergoloid plus metabolites bearing the radiolabel, was biphasic with half-lives of 4 and 13 hr. The mean half-life of unchanged ergoloid in plasma is about 2.6–5.1 hr; after 3 half-lives ergoloid plasma levels are less than 10% of radioactivity levels, and by 24 hr no ergoloid is detectable.

Bioequivalence studies were performed comparing ergoloid mesylates oral tablets (administered orally) with ergoloid mesylates sublingual tablets (administered sublingually). The oral tablet and sublingual tablet were shown to be bioequivalent.


|nonClinToxic=There is limited information regarding Nonclinical Toxicology of {{PAGENAME}} in the drug label.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* NDC:68151-2780-0 in a PACKAGE of 1 TABLETS
|storage=Store at 20° to 25°C (68° to 77°F)
DISPENSE IN TIGHT, LIGHT-RESISTANT CONTAINER.

|packLabel=====ERGOLOID MESYLATES 1 MG TAB====
: [[File:Ergot PDP.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

====Ingredients and Appearance====
: [[File:Ergot I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>


|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>


|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

File:Ergot I n A.png

2015-04-29T14:11:38Z

Rabin Bista:

File:Ergot PDP.png

2015-04-29T14:11:23Z

Rabin Bista:

File:Ergot str.png

2015-04-29T14:05:00Z

Rabin Bista:

Ergoloid mesylate

2015-04-28T20:42:03Z

Rabin Bista:

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|genericName=Ergoloid mesylate
|aOrAn=a
|drugClass=Central Nervous System Agent
|indicationType=treatment
|indication=Alzheimer's disease - dementia
|adverseReactions=nausea and gastric disturbances


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* Content




|fdaLIADAdult=====Indications====
A proportion of individuals over sixty who manifest signs and symptoms of an idiopathic decline in mental capacity (i.e., cognitive and interpersonal skills, mood, self-care, apparent motivation) can experience some symptomatic relief upon treatment with ergoloid mesylates preparations. The identity of the specific trait(s) or condition(s), if any, which would usefully predict a response to ergoloid mesylates therapy is not known. It appears, however, that those individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (i.e., primary progressive dementia, Alzheimer's dementia, senile onset, multi-infarct dementia).

Before prescribing ergoloid mesylates, the physician should exclude the possibility that the patient's signs and symptoms arise from a potentially reversible and treatable condition. Particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Ergoloid mesylates preparations are not indicated in the treatment of acute or chronic psychosis, regardless of etiology (see CONTRAINDICATIONS).

The decision to use ergoloid mesylates in the treatment of an individual with a symptomatic decline in mental capacity of unknown etiology should be continually reviewed since the presenting clinical picture may subsequently evolve sufficiently to allow a specific diagnosis and a specific alternative treatment. In addition, continued clinical evaluation is required to determine whether any initial benefit conferred by ergoloid mesylates therapy persists with time.

The efficacy of ergoloid mesylates was evaluated using a special rating scale known as the SCAG (Sandoz Clinical Assessment-Geriatric). The specific items on this scale on which modest but statistically significant changes were observed at the end of twelve weeks include: mental alertness, confusion, recent memory, orientation, emotional lability, self-care, depression, anxiety/fears, cooperation, sociability, appetite, dizziness, fatigue, bothersome(ness), and an overall impression of clinical status.

====Dosage====
1 mg three times a day.

Alleviation of symptoms is usually gradual and results may not be observed for 3–4 weeks.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=There is limited information regarding FDA-Labeled Use of {{PAGENAME}} in pediatric patients.




|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* Ergoloid mesylates preparations are contraindicated in individuals who have previously shown hypersensitivity to the drug. Ergoloid mesylates preparations are also contraindicated in patients who have psychosis, acute or chronic, regardless of etiology.


|warnings=====Precautions====

* Practitioners are advised that because the target symptoms are of unknown etiology, careful diagnosis should be attempted before prescribing ergoloid mesylates preparations.




|clinicalTrials=Ergoloid mesylates preparations have not been found to produce serious side effects. Transient nausea and gastric disturbances have been reported. Ergoloid mesylates preparations do not possess the vasoconstrictor properties of the natural ergot alkaloids.
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[[Category:Drug]]

Ergoloid mesylate

2015-04-28T20:37:23Z

Rabin Bista:

{{DrugProjectFormSinglePage
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|indication=Alzheimer's disease - dementia
|adverseReactions=nausea and gastric disturbances


|blackBoxWarningTitle=ConditionName: 
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* Content




|fdaLIADAdult=====Indications====
A proportion of individuals over sixty who manifest signs and symptoms of an idiopathic decline in mental capacity (i.e., cognitive and interpersonal skills, mood, self-care, apparent motivation) can experience some symptomatic relief upon treatment with ergoloid mesylates preparations. The identity of the specific trait(s) or condition(s), if any, which would usefully predict a response to ergoloid mesylates therapy is not known. It appears, however, that those individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (i.e., primary progressive dementia, Alzheimer's dementia, senile onset, multi-infarct dementia).

Before prescribing ergoloid mesylates, the physician should exclude the possibility that the patient's signs and symptoms arise from a potentially reversible and treatable condition. Particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Ergoloid mesylates preparations are not indicated in the treatment of acute or chronic psychosis, regardless of etiology (see CONTRAINDICATIONS).

The decision to use ergoloid mesylates in the treatment of an individual with a symptomatic decline in mental capacity of unknown etiology should be continually reviewed since the presenting clinical picture may subsequently evolve sufficiently to allow a specific diagnosis and a specific alternative treatment. In addition, continued clinical evaluation is required to determine whether any initial benefit conferred by ergoloid mesylates therapy persists with time.

The efficacy of ergoloid mesylates was evaluated using a special rating scale known as the SCAG (Sandoz Clinical Assessment-Geriatric). The specific items on this scale on which modest but statistically significant changes were observed at the end of twelve weeks include: mental alertness, confusion, recent memory, orientation, emotional lability, self-care, depression, anxiety/fears, cooperation, sociability, appetite, dizziness, fatigue, bothersome(ness), and an overall impression of clinical status.

====Dosage====
1 mg three times a day.

Alleviation of symptoms is usually gradual and results may not be observed for 3–4 weeks.
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[[Category:Drug]]

Ergoloid mesylate

2015-04-28T20:15:08Z

Rabin Bista: Created page with "{{DrugProjectFormSinglePage |aOrAn=a |indicationType=treatment |hasBlackBoxWarning=Yes |adverseReactions= |blackBoxWarningTitle=<span style="color:#FF0..."

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[[Category:Drug]]

Interferon alfa-2a

2015-04-28T19:56:13Z

Rabin Bista:

{{DrugProjectFormSinglePage
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|genericName=Interferon alfa-2a
|aOrAn=a
|drugClass=antiviral
|indicationType=treatment
|indication=RECURRENT VIRAL INFECTIONS
|adverseReactions=[[Melena|black stools]], [[chills]], [[cough]], [[fever]], [[irritability]]


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 




|fdaLIADAdult=====Indications====
* RECURRENT VIRAL INFECTIONS

====Directions====
* Take 15 minutes before meals.
* Adults and children 12 years and older : 20 drops twice a day in a little water. Hold in the mouth for about 30 seconds then swallow.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=====Indications====
RECURRENT VIRAL INFECTIONS

====Directions====
* Children between 12 years and 6 years of age: 10 drops twice a day in a little water. Hold in the mouth for about 30 seconds then swallow.
* Children under 6 years: 5 drops twice a day in a glass of water.
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|warnings=* Stop use and ask doctor if symptoms worsen or persist more than 3 days




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|postmarketing=[[Melena|black stools]], [[chills]], [[cough]], [[fever]], [[irritability]]
|drugInteractions=


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|administration=* [[Oral]]

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: INTERFERON ALFA-2A 4C
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: [[File:Inter PDP.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

====Ingredients and Appearance====
: [[File:Inter I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


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|brandNames=* GUNA-INF ALPHA®<ref>{{Cite web | title = Interferon alfa-2a | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f96495b5-1ffe-432c-adcf-b2db9cfd1405}}</ref>


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[[Category:Drug]]

Interferon alfa-2a

2015-04-28T19:52:19Z

Rabin Bista:

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|genericName=Interferon alfa-2a
|aOrAn=a
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|blackBoxWarningTitle=ConditionName: 
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|fdaLIADAdult=====Indications====
* RECURRENT VIRAL INFECTIONS

====Directions====
Take 15 minutes before meals.
Adults and children 12 years and older 20 drops twice a day in a little water. Hold in the mouth for about 30 seconds then swallow.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=====Indications====
RECURRENT VIRAL INFECTIONS

====Directions====
Children between 12 years and 6 years of age 10 drops twice a day in a little water. Hold in the mouth for about 30 seconds then swallow.
Children under 6 years 5 drops twice a day in a glass of water.
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|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=


|warnings=* Stop use and ask doctor if symptoms worsen or persist more than 3 days




|clinicalTrials=There is limited information regarding Clinical Trial Experience of {{PAGENAME}} in the drug label.

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|administration=* Oral

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INTERFERON ALFA-2A 4C
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|howSupplied=*
|packLabel=PRINCIPAL DISPLAY PANEL
: [[File:Inter PDP.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]

====Ingredients and Appearance====
: [[File:Inter I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* GUNA-INF ALPHA®<ref>{{Cite web | title = Interferon alfa-2a | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f96495b5-1ffe-432c-adcf-b2db9cfd1405}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

File:Inter I n A.png

2015-04-28T19:49:02Z

Rabin Bista:

File:Inter PDP.png

2015-04-28T19:48:43Z

Rabin Bista:

Interferon alfa-2a

2015-04-28T19:32:22Z

Rabin Bista:

Iothalamate Sodium I 125

2015-04-28T19:25:10Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Iothalamate Sodium I 125
|aOrAn=a
|drugClass=[[Diagnosis|Diagnostic Agent]]
|indicationType=diagnosis
|indication=[[renal disease]] by evaluation of [[glomerular filtration]]
|adverseReactions=[[Hyperpyrexia]]


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 




|fdaLIADAdult=====Indications====
* GLOFIL®-125 (Sodium Iothalamate I-125 Injection) is indicated for evaluation of [[glomerular filtration]] in the diagnosis or monitoring of patients with [[renal disease]].

====Dosage====
* The suggested dose range employed in the average patient (70 kg) is as follows:
: Continuous intravenous infusion: 20 to 100 μCi (0.74-3.7 megabecquerels) (Sigman, et al (1) method).
: Single intravenous injection: 10 to 30 μCi (0.37-1.11 megabecquerels) (Cohen, et al (2) method).
: The patient dose should be measured by a suitable radioactivity calibration system immediately prior to administration.

Technique
Continuous intravenous infusion

Sigman (1) method

I. Preparation:

* Adequate [[diuresis]] (a urine flow exceeding 3 mL/min.) is established, preferably by an oral water load of 1,500 mL two hours prior to the beginning of the clearance study.
It is not necessary to withhold breakfast or admit the patient the night before.
II. Procedure:

* After the establishment of adequate [[diuresis]], a number 14 or 16 French [[Foley catheter]] is aseptically inserted into the [[bladder]].
An [[intravenous]] infusion of Lactated Ringer’s (Hartmann’s) solution is started in each arm, one to maintain a site for injection of the GLOFIL®-125, the other to serve as a site for serial withdrawal of blood. A two-way stopcock connects the needle and intravenous tubing of each arm.
* The dose is equally divided into (1) an [[intravenous]] priming dose to be injected as is and (2) a sustaining dose to be diluted in 30 to 60 mL of isotonic sodium chloride, depending on how many collection periods are anticipated.
* The priming dose is slowly injected into one arm. This is immediately followed by infusion of the sustaining solution through the same site, usually at the rate of 0.5 mL/min., by means of an automatic pump. During this infusion, the Lactated Ringer’s solution in the same arm is discontinued, and 40 to 45 minutes are allowed for equilibration in order to reach a state of constant plasma concentration of radioactivity.
* After attaining equilibrium, consecutive 15 minute collection periods are started. From the arm opposite the injection site, 5 mL of blood (allowing duplicate plasma counting volumes) is drawn six minutes prior to the midpoint of each collection period, placed in heparinized tubes, mixed, and centrifuged. The blood samples may be obtained through the two-way stopcock after discarding the first 30 mL aspirated into the syringe. This 30 mL contains the contents of the tubing, including infusion fluid, and must be cleared in order to obtain an undiluted blood sample. If desired, this step may be eliminated and blood samples obtained by direct [[venipuncture]].
* During each collection period, total urine must be accurately collected and the volume accurately measured. Three such consecutive collection periods are sufficient for most clinical studies.
III. Clearance Calculations:

* Aliquots (1 mL each) of plasma and urine from each collection period are counted in a standard gamma-ray scintillation well detector.
* All counts are corrected for background activity.
* Glomerular filtration rate is calculated by the formula C=UV/P, in which:
: C = glomerular filtration rate in mL/min
: U= urinary concentration of radioactivity in net counts/min/mL
: V= urinary flow rate in mL/min
: P = plasma concentration of radioactivity in net counts/min/mL
* Average [[glomerular filtration rate]] (GFR) is calculated from the rates for the individual collection periods. [[GFR]] can be expressed in terms of body weight (mL/min/kg) or [[body surface area]] (mL/min/m2).
* Unilateral [[glomerular filtration rates]] can be determined by the same technique by utilizing [[ureteral]] [[catheterization]].
Single intravenous injection

Cohen (2) method:

* The method of Cohen, et al (2) requires little preparation, few and small blood samples, no bladder catheterization, and no constant intravenous infusion. It is simple to perform, rapid, and utilizes equipment which is readily available in most modern laboratories.

I. Preparation:

* Lugol's solution, 3 drops orally, three times a day, is administered for one or two days prior to the test.
* No diet or water restriction is necessary.

* Oral water load is begun one hour before starting the test. Start with 20 mL/kg and force any clear liquids (unless contraindicated) until the test is complete.
II. Procedure: Record actual times for the collection of the blood and urine samples.

* Empty the bladder and label the urine Urine control.
* Inject 10-30 μCi GLOFIL®-125 [[intravenously]]; wait 30 to 60 minutes.
* Collect the entire [[urine]] and label Urine discard.
* Draw 4 to 5 mL of [[blood]] into a heparinized syringe. Label Plasma #1.
* After another 30 to 60 minutes, collect the entire urine and label Urine #1.
* Immediately draw another [[blood]] specimen. Label Plasma #2.
* After final 30 to 60 minute wait, collect the urine. Label Urine #2.
* Draw the last blood specimen immediately. Label Plasma #3.
III. Clearance Calculations:

* Radioactivity of one mL aliquots of both [[urine]] and [[plasma]] are determined using a well-scintillation detector with a single channel pulse-height analyzer. Sufficiently reproducible counts are usually obtained with time settings of 2 minutes for urine samples and 20 minutes for the plasma samples. Calculations of the clearance rates are made by using the formula:(1)
: C = UV/P + 1.73/SA where

C = glomerular filtration rate in mL/min/1.73 m2
U = urine radioactivity in counts/min/mL
V = urine flow rate in mL/min
P= mean plasma radioactivity in counts/min/mL
SA= body surface area in m2
Radiation Dosimetry
* The estimated absorbed radiation doses to an average (70 kg) patient from an intravenous dose of 100 μCi (3.7 megabecquerels) of GLOFIL®-125 are shown in Table 4. Calculations assume that there is 1% free iodide in the preparation and that the thyroid uptake of the iodine is 25%.

[[File:Iothalamate dosage.png|none|400px]]

Visual Inspection
* Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and efficacy not established in pediatrics patients.
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* GLOFIL®-125 should not be administered via a central venous line.


|warnings=* None known

====Precautions====
=====General=====
* As in the use of any radioactive material, care should be taken to minimize radiation exposure to the patient, consistent with proper patient management, and to insure minimum radiation exposure to occupational workers.

* Radiopharmaceuticals should be used only by physicians who are qualified by training and experience in the safe use and handling of radionuclides.

* Rapid or bolus-like injections should be avoided.
|clinicalTrials=There is limited information regarding Clinical Trial Experience of {{PAGENAME}} in the drug label.


|postmarketing=* [[Hyperpyrexia]]
|drugInteractions=


|FDAPregCat=C
|useInPregnancyFDA=* Animal reproduction studies have not been conducted with GLOFIL®-125. It is also not known whether GLOFIL®-125 can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. GLOFIL®-125 should be given to a pregnant woman only if clearly needed.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=Radioiodine is excreted in human milk during lactation. It is not known whether GLOFIL®-125 is excreted in human milk. Therefore, formula feedings should be substituted for breast feedings.
|useInPed=Safety and effectiveness in children have not been established.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* [[Intravenous]]
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=There is limited information regarding Overdose of {{PAGENAME}} in the drug label.




|drugBox=
|mechAction=


|structure=* GLOFIL®-125 (Sodium Iothalamate I-125 Injection) is a sterile, nonpyrogenic aqueous injection containing approximately 1 mg sodium iothalamate per mL, and 0.9 percent benzyl alcohol as a preservative. The radioactive concentration of the material is 250-300 μCi/mL as of the calibration date. Sodium bicarbonate and hydrochloric acid are present for pH adjustment.

Physical Characteristics
* Iodine-125 decays by electron capture with a physical half-life of 60.14 days. Photons that are useful for detection are listed in Table 1.

: [[File:Iothalamate str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=* The renal clearance of sodium iothalamate in man closely approximates that of inulin. The compound is cleared by glomerular filtration without tubular secretion or reabsorption. Following infusion administration of I-125 iothalamate, the effective half-life is about 0.07 days.


|nonClinToxic======Carcinogenesis, Mutagenesis, Impairment of Fertility=====
* No long-term animal studies have been performed to evaluate carcinogenic potential, mutagenic potential, or whether this drug affects fertility in males or females.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Identity
No. 1000, GLOFIL®-125 is a clear, colorless, sterile, and nonpyrogenic solution available as a 4 mL vial. It is supplied in a concentration of approximately 1 mg/mL sodium iothalamate (range is 0.5–2.0 mg sodium iothalamate per mL), with a radioactivity concentration of 250 to 300 μCi/mL at the time of calibration. Benzyl alcohol 0.9%, is added as a preservative. Sodium bicarbonate and hydrochloric acid are added for pH adjustment. The calibration and expiration dates are shown on the label.
|storage=* Refrigerate the product upon receipt at 2°C to 8°C.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Iothalamate I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* GLOFIL-125®<ref>{{Cite web | title = Iothalamate sodium, i-125 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c07ce91-cc83-45e3-bd2b-f923a9c8286c}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}



[[Category:Drug]]

Iothalamate Sodium I 125

2015-04-28T19:10:44Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Iothalamate Sodium I 125
|aOrAn=a
|drugClass=Diagnostic Agent
|indicationType=diagnosis
|indication=renal disease by evaluation of glomerular filtration
|adverseReactions=Hyperpyrexia


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
GLOFIL®-125 (Sodium Iothalamate I-125 Injection) is indicated for evaluation of glomerular filtration in the diagnosis or monitoring of patients with renal disease.

====Dosage====
The suggested dose range employed in the average patient (70 kg) is as follows:
Continuous intravenous infusion: 20 to 100 μCi (0.74-3.7 megabecquerels) (Sigman, et al (1) method).
Single intravenous injection: 10 to 30 μCi (0.37-1.11 megabecquerels) (Cohen, et al (2) method).
The patient dose should be measured by a suitable radioactivity calibration system immediately prior to administration.
Technique
Continuous intravenous infusion

Sigman (1) method

I. Preparation:

Adequate diuresis (a urine flow exceeding 3 mL/min.) is established, preferably by an oral water load of 1,500 mL two hours prior to the beginning of the clearance study.
It is not necessary to withhold breakfast or admit the patient the night before.
II. Procedure:

After the establishment of adequate diuresis, a number 14 or 16 French Foley catheter is aseptically inserted into the bladder.
An intravenous infusion of Lactated Ringer’s (Hartmann’s) solution is started in each arm, one to maintain a site for injection of the GLOFIL®-125, the other to serve as a site for serial withdrawal of blood. A two-way stopcock connects the needle and intravenous tubing of each arm.
The dose is equally divided into (1) an intravenous priming dose to be injected as is and (2) a sustaining dose to be diluted in 30 to 60 mL of isotonic sodium chloride, depending on how many collection periods are anticipated.
The priming dose is slowly injected into one arm. This is immediately followed by infusion of the sustaining solution through the same site, usually at the rate of 0.5 mL/min., by means of an automatic pump. During this infusion, the Lactated Ringer’s solution in the same arm is discontinued, and 40 to 45 minutes are allowed for equilibration in order to reach a state of constant plasma concentration of radioactivity.
After attaining equilibrium, consecutive 15 minute collection periods are started. From the arm opposite the injection site, 5 mL of blood (allowing duplicate plasma counting volumes) is drawn six minutes prior to the midpoint of each collection period, placed in heparinized tubes, mixed, and centrifuged. The blood samples may be obtained through the two-way stopcock after discarding the first 30 mL aspirated into the syringe. This 30 mL contains the contents of the tubing, including infusion fluid, and must be cleared in order to obtain an undiluted blood sample. If desired, this step may be eliminated and blood samples obtained by direct venipuncture.
During each collection period, total urine must be accurately collected and the volume accurately measured. Three such consecutive collection periods are sufficient for most clinical studies.
III. Clearance Calculations:

Aliquots (1 mL each) of plasma and urine from each collection period are counted in a standard gamma-ray scintillation well detector.
All counts are corrected for background activity.
Glomerular filtration rate is calculated by the formula C=UV/P, in which:
C = glomerular filtration rate in mL/min
U= urinary concentration of radioactivity in net counts/min/mL
V= urinary flow rate in mL/min
P = plasma concentration of radioactivity in net counts/min/mL
Average glomerular filtration rate (GFR) is calculated from the rates for the individual collection periods. GFR can be expressed in terms of body weight (mL/min/kg) or body surface area (mL/min/m2).
Unilateral glomerular filtration rates can be determined by the same technique by utilizing ureteral catheterization.
Single intravenous injection

Cohen (2) method:

The method of Cohen, et al (2) requires little preparation, few and small blood samples, no bladder catheterization, and no constant intravenous infusion. It is simple to perform, rapid, and utilizes equipment which is readily available in most modern laboratories.

I. Preparation:

Lugol's solution, 3 drops orally, three times a day, is administered for one or two days prior to the test.
No diet or water restriction is necessary.

Oral water load is begun one hour before starting the test. Start with 20 mL/kg and force any clear liquids (unless contraindicated) until the test is complete.
II. Procedure: Record actual times for the collection of the blood and urine samples.

Empty the bladder and label the urine Urine control.
Inject 10-30 μCi GLOFIL®-125 intravenously; wait 30 to 60 minutes.
Collect the entire urine and label Urine discard.
Draw 4 to 5 mL of blood into a heparinized syringe. Label Plasma #1.
After another 30 to 60 minutes, collect the entire urine and label Urine #1.
Immediately draw another blood specimen. Label Plasma #2.
After final 30 to 60 minute wait, collect the urine. Label Urine #2.
Draw the last blood specimen immediately. Label Plasma #3.
III. Clearance Calculations:

Radioactivity of one mL aliquots of both urine and plasma are determined using a well-scintillation detector with a single channel pulse-height analyzer. Sufficiently reproducible counts are usually obtained with time settings of 2 minutes for urine samples and 20 minutes for the plasma samples. Calculations of the clearance rates are made by using the formula:(1)
C = UV/P + 1.73/SA where

C = glomerular filtration rate in mL/min/1.73 m2
U = urine radioactivity in counts/min/mL
V = urine flow rate in mL/min
P= mean plasma radioactivity in counts/min/mL
SA= body surface area in m2
Radiation Dosimetry
The estimated absorbed radiation doses to an average (70 kg) patient from an intravenous dose of 100 μCi (3.7 megabecquerels) of GLOFIL®-125 are shown in Table 4. Calculations assume that there is 1% free iodide in the preparation and that the thyroid uptake of the iodine is 25%.

[[File:Iothalamate dosage.png|none|400px]]

Visual Inspection
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and efficacy not established in pediatrics patients.
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* GLOFIL®-125 should not be administered via a central venous line.


|warnings=* None known

====Precautions====
General
As in the use of any radioactive material, care should be taken to minimize radiation exposure to the patient, consistent with proper patient management, and to insure minimum radiation exposure to occupational workers.

Radiopharmaceuticals should be used only by physicians who are qualified by training and experience in the safe use and handling of radionuclides.

Rapid or bolus-like injections should be avoided.
|clinicalTrials=There is limited information regarding Clinical Trial Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|postmarketing=Hyperpyrexia
|drugInteractions=* Drug
:* Description


|FDAPregCat=C
|useInPregnancyFDA=* Animal reproduction studies have not been conducted with GLOFIL®-125. It is also not known whether GLOFIL®-125 can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. GLOFIL®-125 should be given to a pregnant woman only if clearly needed.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=Radioiodine is excreted in human milk during lactation. It is not known whether GLOFIL®-125 is excreted in human milk. Therefore, formula feedings should be substituted for breast feedings.
|useInPed=Safety and effectiveness in children have not been established.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* Intravenous
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=There is limited information regarding Overdose of {{PAGENAME}} in the drug label.




|drugBox=
|mechAction=*


|structure=* GLOFIL®-125 (Sodium Iothalamate I-125 Injection) is a sterile, nonpyrogenic aqueous injection containing approximately 1 mg sodium iothalamate per mL, and 0.9 percent benzyl alcohol as a preservative. The radioactive concentration of the material is 250-300 μCi/mL as of the calibration date. Sodium bicarbonate and hydrochloric acid are present for pH adjustment.

Physical Characteristics
Iodine-125 decays by electron capture with a physical half-life of 60.14 days. Photons that are useful for detection are listed in Table 1.

: [[File:Iothalamate str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=The renal clearance of sodium iothalamate in man closely approximates that of inulin. The compound is cleared by glomerular filtration without tubular secretion or reabsorption. Following infusion administration of I-125 iothalamate, the effective half-life is about 0.07 days.


|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
No long-term animal studies have been performed to evaluate carcinogenic potential, mutagenic potential, or whether this drug affects fertility in males or females.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Identity
No. 1000, GLOFIL®-125 is a clear, colorless, sterile, and nonpyrogenic solution available as a 4 mL vial. It is supplied in a concentration of approximately 1 mg/mL sodium iothalamate (range is 0.5–2.0 mg sodium iothalamate per mL), with a radioactivity concentration of 250 to 300 μCi/mL at the time of calibration. Benzyl alcohol 0.9%, is added as a preservative. Sodium bicarbonate and hydrochloric acid are added for pH adjustment. The calibration and expiration dates are shown on the label.
|storage=* Refrigerate the product upon receipt at 2°C to 8°C.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Iothalamate I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* GLOFIL-125®<ref>{{Cite web | title = Iothalamate sodium, i-125 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c07ce91-cc83-45e3-bd2b-f923a9c8286c}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

File:Iothalamate I n A.png

2015-04-28T19:06:41Z

Rabin Bista:

File:Iothalamate str.png

2015-04-28T19:06:24Z

Rabin Bista:

Iothalamate Sodium I 125

2015-04-28T18:52:39Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Iothalamate Sodium I 125
|aOrAn=a
|drugClass=Diagnostic Agent
|indicationType=diagnosis
|indication=renal disease by evaluation of glomerular filtration
|adverseReactions=Hyperpyrexia


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
GLOFIL®-125 (Sodium Iothalamate I-125 Injection) is indicated for evaluation of glomerular filtration in the diagnosis or monitoring of patients with renal disease.

====Dosage====
The suggested dose range employed in the average patient (70 kg) is as follows:
Continuous intravenous infusion: 20 to 100 μCi (0.74-3.7 megabecquerels) (Sigman, et al (1) method).
Single intravenous injection: 10 to 30 μCi (0.37-1.11 megabecquerels) (Cohen, et al (2) method).
The patient dose should be measured by a suitable radioactivity calibration system immediately prior to administration.
Technique
Continuous intravenous infusion

Sigman (1) method

I. Preparation:

Adequate diuresis (a urine flow exceeding 3 mL/min.) is established, preferably by an oral water load of 1,500 mL two hours prior to the beginning of the clearance study.
It is not necessary to withhold breakfast or admit the patient the night before.
II. Procedure:

After the establishment of adequate diuresis, a number 14 or 16 French Foley catheter is aseptically inserted into the bladder.
An intravenous infusion of Lactated Ringer’s (Hartmann’s) solution is started in each arm, one to maintain a site for injection of the GLOFIL®-125, the other to serve as a site for serial withdrawal of blood. A two-way stopcock connects the needle and intravenous tubing of each arm.
The dose is equally divided into (1) an intravenous priming dose to be injected as is and (2) a sustaining dose to be diluted in 30 to 60 mL of isotonic sodium chloride, depending on how many collection periods are anticipated.
The priming dose is slowly injected into one arm. This is immediately followed by infusion of the sustaining solution through the same site, usually at the rate of 0.5 mL/min., by means of an automatic pump. During this infusion, the Lactated Ringer’s solution in the same arm is discontinued, and 40 to 45 minutes are allowed for equilibration in order to reach a state of constant plasma concentration of radioactivity.
After attaining equilibrium, consecutive 15 minute collection periods are started. From the arm opposite the injection site, 5 mL of blood (allowing duplicate plasma counting volumes) is drawn six minutes prior to the midpoint of each collection period, placed in heparinized tubes, mixed, and centrifuged. The blood samples may be obtained through the two-way stopcock after discarding the first 30 mL aspirated into the syringe. This 30 mL contains the contents of the tubing, including infusion fluid, and must be cleared in order to obtain an undiluted blood sample. If desired, this step may be eliminated and blood samples obtained by direct venipuncture.
During each collection period, total urine must be accurately collected and the volume accurately measured. Three such consecutive collection periods are sufficient for most clinical studies.
III. Clearance Calculations:

Aliquots (1 mL each) of plasma and urine from each collection period are counted in a standard gamma-ray scintillation well detector.
All counts are corrected for background activity.
Glomerular filtration rate is calculated by the formula C=UV/P, in which:
C = glomerular filtration rate in mL/min
U= urinary concentration of radioactivity in net counts/min/mL
V= urinary flow rate in mL/min
P = plasma concentration of radioactivity in net counts/min/mL
Average glomerular filtration rate (GFR) is calculated from the rates for the individual collection periods. GFR can be expressed in terms of body weight (mL/min/kg) or body surface area (mL/min/m2).
Unilateral glomerular filtration rates can be determined by the same technique by utilizing ureteral catheterization.
Single intravenous injection

Cohen (2) method:

The method of Cohen, et al (2) requires little preparation, few and small blood samples, no bladder catheterization, and no constant intravenous infusion. It is simple to perform, rapid, and utilizes equipment which is readily available in most modern laboratories.

I. Preparation:

Lugol's solution, 3 drops orally, three times a day, is administered for one or two days prior to the test.
No diet or water restriction is necessary.

Oral water load is begun one hour before starting the test. Start with 20 mL/kg and force any clear liquids (unless contraindicated) until the test is complete.
II. Procedure: Record actual times for the collection of the blood and urine samples.

Empty the bladder and label the urine Urine control.
Inject 10-30 μCi GLOFIL®-125 intravenously; wait 30 to 60 minutes.
Collect the entire urine and label Urine discard.
Draw 4 to 5 mL of blood into a heparinized syringe. Label Plasma #1.
After another 30 to 60 minutes, collect the entire urine and label Urine #1.
Immediately draw another blood specimen. Label Plasma #2.
After final 30 to 60 minute wait, collect the urine. Label Urine #2.
Draw the last blood specimen immediately. Label Plasma #3.
III. Clearance Calculations:

Radioactivity of one mL aliquots of both urine and plasma are determined using a well-scintillation detector with a single channel pulse-height analyzer. Sufficiently reproducible counts are usually obtained with time settings of 2 minutes for urine samples and 20 minutes for the plasma samples. Calculations of the clearance rates are made by using the formula:(1)
C = UV/P + 1.73/SA where

C = glomerular filtration rate in mL/min/1.73 m2
U = urine radioactivity in counts/min/mL
V = urine flow rate in mL/min
P= mean plasma radioactivity in counts/min/mL
SA= body surface area in m2
Radiation Dosimetry
The estimated absorbed radiation doses to an average (70 kg) patient from an intravenous dose of 100 μCi (3.7 megabecquerels) of GLOFIL®-125 are shown in Table 4. Calculations assume that there is 1% free iodide in the preparation and that the thyroid uptake of the iodine is 25%.

[[File:Iothalamate dosage.png|none|400px]]

Visual Inspection
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and efficacy not established in pediatrics patients.
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* Condition1


|warnings=* Description

====Precautions====

* Description




|clinicalTrials=There is limited information regarding Clinical Trial Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|postmarketing=There is limited information regarding Postmarketing Experience of {{PAGENAME}} in the drug label.

=====Body as a Whole=====

=====Cardiovascular=====

=====Digestive=====

=====Endocrine=====

=====Hematologic and Lymphatic=====

=====Metabolic and Nutritional=====

=====Musculoskeletal=====

=====Neurologic=====

=====Respiratory=====

=====Skin and Hypersensitivy Reactions=====

=====Special Senses=====

=====Urogenital=====

=====Miscellaneous=====


|drugInteractions=* Drug
:* Description


|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* Oral

* Intravenous
|monitoring=There is limited information regarding Monitoring of {{PAGENAME}} in the drug label.

* Description


|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose====Acute Overdose===

====Signs and Symptoms====

* Description

====Management====

* Description

===Chronic Overdose===

There is limited information regarding Chronic Overdose of {{PAGENAME}} in the drug label.




|drugBox=
|mechAction=*


|structure=*

: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=There is limited information regarding Pharmacokinetics of {{PAGENAME}} in the drug label.


|nonClinToxic=There is limited information regarding Nonclinical Toxicology of {{PAGENAME}} in the drug label.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=*
|packLabel=
|fdaPatientInfo=There is limited information regarding Patient Counseling Information of {{PAGENAME}} in the drug label.


|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>


|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>


|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
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[[Category:Drug]]

File:Iothalamate dosage.png

2015-04-28T18:49:45Z

Rabin Bista:

Iothalamate Sodium I 125

2015-04-28T18:36:45Z

Thrombocytopenia causes

2015-04-28T18:28:54Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Thrombocytopenia}}
{{CMG}}; {{AE}} {{Ochuko}}

==Overview==
There are two broad mechanisms for the causes of thrombocytopenia: Reduced platelet production and increased platelet destruction. Thrombocytopenia is seen in a variety of infectious and genetic disorders as well as a side effect of a large list of medications.

==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

*[[Disseminated intravascular coagulation]]
* [[HELLP syndrome]]

===Common Causes===
* [[Abruptio placentae]]<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Bone marrow suppression]] ([[chemotherapy]], [[irradiation]])
* [[coronary artery bypass surgery|Cardica bypass]]<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Alcoholism|Chronic alcohol use]]
* [[Chronic liver disease]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref>
* [[Common variable immunodeficiency]]<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Congenital|Congenital thrombocytopenia]]
* [[Connective tissue disorders]] (eg [[SLE]], [[RA]], [[antiphospholipid syndrome]])<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Disseminated intravascular coagulation]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref>
* [[GP IIb/IIIa inhibitor]]<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Hemolytic uremic syndrome]]
* [[Heparin-induced thrombocytopenia]]
* [[Immune thrombocytopenic purpura]]<ref name="pmid24397048">{{cite journal| author=Farid J, Gul N, Qureshi WU, Idris M| title=Clinical presentations in immune thrombocytopenic purpura. | journal=J Ayub Med Coll Abbottabad | year= 2012 | volume= 24 | issue= 2 | pages= 39-40 | pmid=24397048 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24397048 }} </ref>
*[[Infections]]<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref>
* [[Macrophage-activation syndrome]]<ref name="pmid23233580">{{cite journal| author=Stasi R| title=How to approach thrombocytopenia. | journal=Hematology Am Soc Hematol Educ Program | year= 2012 | volume= 2012 | issue= | pages= 191-7 | pmid=23233580 | doi=10.1182/asheducation-2012.1.191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23233580 }} </ref>
* [[Medication]]s<ref name="pmid24267279">{{cite journal| author=Greenberg EM, Kaled ES| title=Thrombocytopenia. | journal=Crit Care Nurs Clin North Am | year= 2013 | volume= 25 | issue= 4 | pages= 427-34, v | pmid=24267279 | doi=10.1016/j.ccell.2013.08.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24267279 }} </ref>
* [[Preeclampsia]]
* [[Pregnancy]]<ref name="pmid23730013">{{cite journal| author=Nisha S, Amita D, Uma S, Tripathi AK, Pushplata S| title=Prevalence and characterization of thrombocytopenia in pregnancy in Indian women. | journal=Indian J Hematol Blood Transfus | year= 2012 | volume= 28 | issue= 2 | pages= 77-81 | pmid=23730013 | doi=10.1007/s12288-011-0107-x | pmc=PMC3332269 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23730013 }} </ref>
* [[Artifact|Pseudothrombocytopenia]]
* [[Thrombotic thrombocytopenic purpura]]<ref name="pmid24396345">{{cite journal| author=Abdel Karim N, Haider S, Siegrist C, Ahmad N, Zarzour A, Ying J et al.| title=Approach to management of thrombotic thrombocytopenic purpura at university of cincinnati. | journal=Adv Hematol | year= 2013 | volume= 2013 | issue= | pages= 195746 | pmid=24396345 | doi=10.1155/2013/195746 | pmc=PMC3876823 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24396345 }} </ref>

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Disseminated intravascular coagulation]], [[endocarditis]], [[pulmonary embolism]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Strontium-89]],[[zinc]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Cholesterol embolism]], [[Elejalde syndrome]], [[Griscelli syndrome|Griscelli syndrome type 1]], [[neuroectodermal melanolysosomal disease]], [[post-transfusion purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Ado-trastuzumab emtansine]], [[albendazole]], [[alemtuzumab]], [[altretamine]], [[amiodarone]], [[Amoxicillin]], [[amphotericin B]], [[amrinone]], [[amsacrine]], [[anagrelide]], [[anazolene]], [[anti-thymocyte globulin]], [[ardeparin]], [[Asenapine maleate]], [[Aspirin]], [[azathioprine]], [[Azacitidine]], [[Aztreonam]], [[bendamustine]], [[benoxaprofen]], [[Beractant]], [[bevacizumab]], [[Boceprevir]], [[bortezomib]], [[bosutinib]], [[brentuximab vedotin]], [[cabazitaxel]], [[Cabozantinib]], [[capecitabine]], [[captopril]], [[carboplatin]], [[carfilzomib]], [[carmustine]], [[caspofungin]], [[Cefadroxil]], [[Cefepime]], [[Cefotaxime sodium]], [[Ceftazidime]], [[Cefaclor]], [[Certolizumab pegol]], [[Chlorpropamide]] , [[chlorambucil]], [[chloramphenicol]],[[clofarabine]], [[Cidofovir]], [[cilazapril]], [[cimetidine]], [[cisplatin]], [[cladribine]], [[Clemastine]], [[clofarabine]], [[Clobazam]], [[Cyclophosphamide]], [[Cytarabine]], [[cytosine arabinoside]], [[dacarbazine]], [[Dactinomycin]], [[dasatinib]], [[daunorubicin]], [[decitabine]], [[deferasirox]], [[desferrioxamine]], [[Desmopressin]], [[Dexchlorpheniramine]], [[Dexrazoxane]], [[Dextran]] [[Didanosine]], [[diflunisal]], [[docetaxel]], [[Doxorubicin Hydrochloride]], [[doxycycline]], [[Rifampin]] [[platelet|drug-induced thrombocytopenia]], [[efalizumab]], [[eflornithine]], [[Eltrombopag]], [[enoxaparin]], [[Epirubicin hydrochloride]], [[eptifibatide]], [[Eribulin]], [[Ethambutol]], [[Ethacrynic Acid]], [[etoposide]], [[everolimus]], [[febuxostat]], [[Felbamate]], [[Filgastrim]], [[flucytosine]], [[fludarabine]], [[fluorouracil]], [[fondaparinux]], [[foscarnet]], [[ganciclovir]], [[gemcitabine]], [[gemtuzumab ozogamicin]], [[glycoprotein IIb/IIIa inhibitors]], [[gold salts]], [[guanidinium]], [[Guanidine]], [[haem arginate]], [[heparin]], [[Hydrocodone bitartrate and acetaminophen]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[Hydroxyurea (patient information)]], [[ibitumomab tiuxetan]], [[ibuprofen lysine]], [[ibrutinib]], [[idarubicin]], [[ifosfamide]], [[imatinib mesylate]], [[Indinavir]], [[indomethacin]], [[integrilin]], [[interferon alpha]], [[interferon alfacon-1]], [[Imipenem-Cilastatin]],[[Interferon beta- 1a]], [[Interferon gamma]], [[interleukin 10]], [[interleukin 2]], [[irinotecan hydrochloride]], [[Isoniazid]], [[isotretinoin]], [[ixabepilone]], [[Lapatinib]],[[lenalidomide]], [[Letrozole]], [[linezolid]], [[lomustine]], [[low molecular weight heparin]]s, [[Loxapine]], [[melphalan]], [[mercaptopurine]], [[Meropenem]], [[methimazole]], [[methotrexate]], [[methyldopa]], [[methyldopate]], [[methylphenidate]], [[micafungin sodium]], [[Milnacipran hydrochloride]], [[minocycline hydrochloride]], [[miltefosine]], [[mithramycin]], [[mitomycin]], [[mitoxantrone]], [[MMR vaccine]], [[montelukast]], [[nabumetone]], [[nelarabine]], [[niacin]], [[nilotinib]], [[nitisinone]], [[Nizatidine]], [[obinutuzumab]], [[Ofatumumab]], [[Omacetaxine]], [[omacetaxine mepesuccinate]], [[Olsalazine]], [[oxaliplatin]], [[Oxaprozin]], [[oxcarbazepine]], [[Oxytetracycline]], [[paclitaxel]], [[Palbociclib]], [[panobinostat]], [[para-amino salicylic acid]], [[pazopanib]], [[Pegademase]], [[pemetrexed]], [[penicillamine]], [[pentamidine Isethionate]], [[pentostatin]], [[phenylbutazone]], [[phenytoin]], [[Pergolide]], [[Pertuzumab]], [[pixantrone]], [[Plerixafor]], [[pomalidomide]], [[ponatinib]], [[pralatrexate]], [[pramipexole]], [[procarbazine]], [[promethazine]], [[proton pump inhibitors]], [[pyrimethamine]], [[quinidine]], [[quinine]], [[Rabeprazole]], [[Radium chloride]], [[raltitrexed]], [[ranitidine]], [[regorafenib]], [[reoPro]], [[repaglinide]], [[rifampicin]], [[Ritonavir]], [[rituximab]], [[romidepsin]], [[Romiplostim]], [[ruxolitinib]], [[Siltuximab]], [[sirolimus]], [[Sodium aurothiomalate]], [[sorafenib]], [[stiripentol]], [[Streptozocin]], [[sulfasalazine]], [[sulindac]], [[sulfonamides]], [[sunitinib malate]], [[Spironolactone]], [[Tacrolimus]], [[Tamoxifen]], [[temozolomide]], [[temsirolimus]], [[teniposide]], [[thalidomide]], [[thioguanine]], [[thiotepa]], [[Thiothixene]], [[Tiagabine]], [[ticlopidine]], [[tinzaparin]], [[tirofiban]], [[tocilizumab]], [[topotecan]], [[Tolmetin]], [[Tolazamide]], [[Toremifene]], [[tositumomab iodine-131]], [[trabectedin]], [[Trimethadione]], [[trimethoprim-sulfamethoxazole]], [[tolbutamide]], [[valganciclovir]], [[valproic acid]], [[vancomycin]], [[Vinblastine]], [[Vincristine sulfate liposome]] [[vinflunine]], [[vinorelbine]], [[vorinostat]], [[ziv-aflibercept]], [[zonisamide]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Alport syndrome]], [[Arias oculootoradial syndrome]], [[Epstein's syndrome]], [[Fechtner syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[aminoaciduria|Dibasic aminoaciduria type 2]], [[liver failure]], [[Niemann-Pick disease|Niemann-Pick disease type b]], [[portal hypertension]], [[Shwachman-Diamond syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Aicardi-Goutieres syndrome]], [[Alport syndrome]], [[Chediak-Higashi disease]], [[factor H|complement factor H deficiency]], [[Elejalde syndrome]], [[Fanconi anaemia]], [[Fechtner syndrome]], [[Griscelli syndrome|Griscelli syndrome type 1]], [[holocarboxylase synthase deficiency]], [[iminodipeptiduria]], [[Jacobsen syndrome]], [[MELAS]], [[neuroectodermal melanolysosomal disease]], [[Niemann-Pick disease|Niemann-Pick disease type b]], [[Omenn syndrome]], [[Paris-Trousseau thrombocytopenia]], [[Shwachman-Diamond syndrome]], [[TAR syndrome]], [[TAR syndrome|Thrombocytopenia absent radius syndrome]], [[Von Willebrand disease|Von Willebrand disease, platelet type]], [[Wiskott-Aldrich syndrome]], [[X-linked hyperimmunoglobulin M syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Acquired pure megakaryocytic aplasia]], [[aplastic anemia]], [[Bernard-Soulier syndrome]], [[thrombocytopenia|congenital amegakaryocytic thrombocytopenia (CAMT)]], [[disseminated intravascular coagulation]], [[Epstein's syndrome]], [[familial histiocytic reticulosis]], [[Gasser syndrome]], [[GATA1|GATA1-related cytopenia]], [[Glanzmann's thrombasthenia]], [[grey platelet syndrome]], [[hemolytic uremic syndrome]], [[histiocytosis X]], [[hypersplenism]], [[idiopathic thrombocytopenic purpura]], [[Jacobsen syndrome]], [[Kasabach-Merritt syndrome]], [[May-Hegglin anomaly]], [[Moschcowitz syndrome]], [[myelodysplastic syndrome]], [[myelofibrosis]], [[neonatal alloimmune thrombocytopenia]], [[pancytopenia]], [[Paris-Trousseau thrombocytopenia]], [[paroxysmal nocturnal hemoglobinuria]], [[post-transfusion purpura]], [[pulmonary embolism]], [[TAR syndrome|radial aplasia-thrombocytopenia syndrome]], [[Sebastian platelet syndrome]], [[Shwachman-Diamond syndrome]], [[thrombotic thrombocytopenic purpura]], [[Von Willebrand disease|Von Willebrand disease, platelet type]], [[Werlhof disease]], [[Wiskott-Aldrich syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[coronary artery bypass surgery|Cardiac bypass]], [[chemotherapy]], [[intra-aortic balloon pump|intra-aortic balloon pump placement]], [[blood transfusion|massive blood transfusion]], [[radiation therapy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Congenital syphilis]], [[cytomegalovirus]], [[Dengue fever]], [[ehrlichiosis]], [[Epstein-Barr virus]], [[hantavirus]], [[hepatitis C]], [[HIV]], [[human granulocytic ehrlichiosis]], [[ehrlichiosis|human monocytotropic ehrlichiosis]], [[infections]], [[infectious mononucleosis]], [[lassa fever]], [[leptospirosis]], [[malaria]], [[measles]], [[mumps]], [[mycoplasma pneumonia]], [[relapsing fever|Oklahoma tick fever]], [[parvovirus]], [[Q fever]], [[rubella]], [[septicaemia]], [[tick-borne encephalitis]], [[toxic shock syndrome|toxic shock syndrome (staphylococcal)]], [[varicella]], [[visceral leishmaniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Arias oculootoradial syndrome]], [[cholesterol embolism]], [[TAR syndrome|radial aplasia-thrombocytopenia syndrome]], [[TAR syndrome]], [[TAR syndrome|thrombocytopenia absent radius syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Aicardi-Goutieres syndrome]], [[Jacobsen syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[aminoaciduria|Dibasic aminoaciduria type 2]], [[folate deficiency]], [[Gaucher disease]], [[holocarboxylase synthase deficiency]], [[iminodipeptiduria]], [[iron deficiency]], [[isovaleric acidaemia]], [[methylmalonic aciduria|methylmalonic aciduria type 2]], [[CD36|platelet glycoprotein 4 deficiency]], [[platelet glycoprotein Ib deficiency]], [[prolidase deficiency]], [[propionyl-CoA carboxylase deficiency]], [[sea blue histiocytosis]], [[sitosterolemia]], [[vitamin B12 deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Eclampsia]], [[HELLP syndrome]], [[pre-eclampsia]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[acute myeloid leukemia]], [[acute promyelocytic leukemia]], [[chronic lymphocytic leukaemia]], [[chronic myeloid leukaemia]], [[hairy cell leukaemia]], [[hepatosplenic T-cell lymphoma]], [[histiocytosis X]], [[Kasabach-Merritt syndrome]], [[lymphoma]], [[myeloma]], [[Non-Hodgkins lymphoma]], [[paraneoplastic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| [[Arias oculootoradial syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Alcohol]], [[arsenic trioxide]], [[ethanol]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Acute respiratory distress syndrome]], [[Niemann-Pick disease|Niemann-Pick disease type b]], [[pulmonary embolism]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Alport syndrome]], [[cholesterol embolism]], [[aminoaciduria|Dibasic aminoaciduria type 2]], [[Epstein's syndrome]], [[Fechtner syndrome]], [[hemolytic uremic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Anticardiolipin syndrome]], [[antiphospholipid syndrome]], [[autoimmune lymphoproliferative syndrome type 1]], [[autoimmune lymphoproliferative syndrome type 2]], [[factor H|complement factor H deficiency]], [[Evans syndrome]], [[immunodysregulation polyendocrinopathy and enteropathy, X-linked]], [[macrophage-activation syndrome]], [[neonatal alloimmune thrombocytopenia]], [[Omenn syndrome]], [[paraneoplastic syndrome]], [[systemic lupus erythematosus]], [[Wiskott-Aldrich syndrome]], [[X-linked hyperimmunoglobulin M syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Snakebites]]
|-
|}

===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[5-azacytidine]]
*[[Abciximab]]
*[[Aclarubicin]]
*[[Acquired pure megakaryocytic aplasia]]
*[[Actinomycin D]]
*[[Acute lymphoblastic leukemia]]
*[[Acute myeloid leukemia]]
*[[Acute promyelocytic leukemia]]
*[[Acute respiratory distress syndrome]]
*[[Ado-trastuzumab emtansine]]
*[[Aflibercept]]
*[[Aggrastat]]
*[[Aicardi-Goutieres syndrome]]
*[[Albendazole]]
*[[Alcohol]]
*[[Alemtuzumab]]
*[[Alport syndrome]]
*[[Altretamine]]
*[[Amiodarone]]
*[[Amoxicillin]]
*[[Amphotericin B]]
*[[Amrinone]]
*[[Amsacrine]]
*[[Anagrelide]]
*[[Anazolene]]
*[[Anticardiolipin syndrome]]
*[[Antiphospholipid syndrome]]
*[[Anti-thymocyte globulin]]
*[[Aplastic anemia]]
*[[Ardeparin]]
*[[Arias oculootoradial syndrome]]
*[[Arsenic trioxide]]
*[[Autoimmune lymphoproliferative syndrome type 1]]
*[[Autoimmune lymphoproliferative syndrome type 2]]
*[[Azathioprine]]
*[[Aztreonam]]
*[[Bendamustine]]
*[[Benoxaprofen]]
*[[Bernard-Soulier syndrome]]
*[[Bevacizumab]]
*[[Boceprevir]]
*[[Bortezomib]]
*[[Bosutinib]]
*[[Brentuximab vedotin]]
*[[Cabazitaxel]]
*[[Capecitabine]]
*[[Captopril]]
*[[Carboplatin]]
*[[coronary artery bypass surgery|Cardiac bypass]]
*[[Carfilzomib]]
*[[Carmustine]]
*[[Caspofungin]]
*[[Cefadroxil]]
*[[Cefepime]]
*[[Cefotaxime sodium]]
*[[Ceftazidime]]
*[[Chediak-Higashi disease]]
*[[Chemotherapy]]
*[[Chlorambucil]]
*[[Chloramphenicol]]
*[[Chlorpropamide]]
*[[Cholesterol embolism]]
*[[Chronic lymphocytic leukaemia]]
*[[Chronic myeloid leukaemia]]
*[[Cidofovir]]
*[[Cilazapril]]
*[[Cimetidine]]
*[[Cisplatin]]
*[[Cladribine]]
*[[Clofarabine]]
*[[factor H|Complement factor H deficiency]]
*[[thrombocytopenia|Congenital amegakaryocytic thrombocytopenia (CAMT)]]
*[[Cyclophosphamide]]
*[[Cytomegalovirus]]
*[[Cytarabine]]
*[[Cytosine arabinoside]]
*[[Dacarbazine]]
*[[Dasatinib]]
*[[Daunorubicin]]
*[[Decitabine]]
*[[Dengue fever]]
*[[Desferrioxamine]]
*[[Desmopressin]]
*[[aminoaciduria|Dibasic aminoaciduria type 2]]
*[[Didanosine]]
*[[Disseminated intravascular coagulation]]
*[[Docetaxel]]
*[[Doxorubicin Hydrochloride]]
*[[platelet|Drug-induced thrombocytopenia]]
{{col-break|width=33%}}
*[[Eclampsia]]
*[[Efalizumab]]
*[[Eflornithine]]
*[[Ehrlichiosis]]
*[[Elejalde syndrome]]
*[[Endocarditis]]
*[[Enoxaparin]]
*[[Epirubicin hydrochloride]]
*[[Epstein's syndrome]]
*[[Epstein-Barr virus]]
*[[Eptifibatide]]
*[[Eribulin]]
*[[Ethanol]]
*[[Etoposide]]
*[[Evans syndrome]]
*[[Everolimus]]
*[[Familial histiocytic reticulosis]]
*[[Fanconi anaemia]]
*[[Fechtner syndrome]]
*[[Filgastrim]]
*[[Flucytosine]]
*[[Fludarabine]]
*[[Fluorouracil]]
*[[Folate deficiency]]
*[[Fondaparinux]]
*[[Foscarnet]]
*[[Ganciclovir]]
*[[Gasser syndrome]]
*[[GATA1|GATA1-related cytopenia]]
*[[Gaucher disease]]
*[[Gemcitabine]]
*[[Gemtuzumab ozogamicin]]
*[[Glanzmann's thrombasthenia]]
*[[Glycoprotein IIb/IIIa inhibitors]]
*[[Gold salts]]
*[[Grey platelet syndrome]]
*[[Griscelli syndrome|Griscelli syndrome type 1]]
*[[Guanidinium]]
*[[Haem arginate]]
*[[Hairy cell leukaemia]]
*[[Hantavirus]]
*[[HELLP syndrome]]
*[[Hemolytic uremic syndrome]]
*[[Heparin]]
*[[Hepatitis C]]
*[[Hepatosplenic T-cell lymphoma]]
*[[Histiocytosis X]]
*[[HIV]]
*[[Holocarboxylase synthase deficiency]]
*[[Human granulocytic ehrlichiosis]]
*[[ehrlichiosis|Human monocytotropic ehrlichiosis]]
*[[Hydroxycarbamide]]
*[[Hydroxyurea (patient information)]]
*[[Hypersplenism]]
*[[Ibritumomab tiuxetan]]
*[[Ibrutinib]]
*[[Ibuprofen lysine]]
*[[Idarubicin]]
*[[Idiopathic thrombocytopenic purpura]]
*[[Ifosfamide]]
*[[Imatinib mesylate]]
*[[Iminodipeptiduria]]
*[[Immunodysregulation polyendocrinopathy and enteropathy, X-linked]]
*[[Indinavir]]
*[[Indomethacin]]
*[[Infections]]
*[[Infectious mononucleosis]]
*[[Infliximab]]
*[[Integrilin]]
*[[Interferon alpha]]
*[[Interferon gamma]]
*[[Interleukin 10]]
*[[Interleukin 2]]
*[[intra-aortic balloon pump|Intra-aortic balloon pump placement]]
*[[Irinotecan hydrochloride]]
*[[Iron deficiency]]
*[[Isoniazid]]
*[[Isotretinoin]]
*[[Isovaleric acidaemia]]
*[[Ixabepilone]]
*[[Jacobsen syndrome]]
*[[Kasabach-Merritt syndrome]]
*[[Lassa fever]]
*[[Lenalidomide]]
{{col-break|width=33%}}
*[[Leptospirosis]]
*[[Linezolid]]
*[[Liver failure]]
*[[Lomustine]]
*[[Low molecular weight heparin]]s
*[[Lymphoma]]
*[[Macrophage-activation syndrome]]
*[[Malaria]]
*[[Massive blood transfusion]]
*[[May-Hegglin anomaly]]
*[[Measles]]
*[[MELAS]]
*[[Melphalan]]
*[[Mercaptopurine]]
*[[Methotrexate]]
*[[Methyldopa]]
*[[Methyldopate]]
*[[methylmalonic aciduria|Methylmalonic aciduria type 2]]
*[[Methylphenidate]]
*[[Micafungin sodium]]
*[[Milnacipran hydrochloride]]
*[[Mithramycin]]
*[[Mitomycin C]]
*[[Mitoxantrone]]
*[[MMR vaccine]]
*[[Montelukast]]
*[[Moschcowitz syndrome]]
*[[Mumps]]
*[[Mycoplasma pneumonia]]
*[[Myelodysplastic syndrome]]
*[[Myelofibrosis]]
*[[Myeloma]]
*[[Nelarabine]]
*[[Neonatal alloimmune thrombocytopenia]]
*[[Neuroectodermal melanolysosomal disease]]
*[[Niacin]]
*[[Niemann-Pick disease|Niemann-Pick disease type b]]
*[[Nilotinib]]
*[[Nitisinone]]
*[[Non-Hodgkins lymphoma]]
*[[Obinutuzumab]]
*[[relapsing fever|Oklahoma tick fever]]
*[[Omacetaxine mepesuccinate]]
*[[Omenn syndrome]]
*[[Oxaliplatin]]
*[[Oxaprozin]]
*[[Paclitaxel]]
*[[Palbociclib]]
*[[Pancytopenia]]
*[[Panobinostat]]
*[[Para-amino salicylic acid]]
*[[Paraneoplastic syndrome]]
*[[Paris-Trousseau thrombocytopenia]]
*[[Paroxysmal nocturnal hemoglobinuria]]
*[[Parvovirus]]
*[[Pazopanib]]
*[[Pemetrexed]]
*[[Penicillamine]]
*[[Pentamidine]]
*[[Pentostatin]]
*[[Pergolide]]
*[[Phenylbutazone]]
*[[Phenytoin]]
*[[Pixantrone]]
*[[CD36|Platelet glycoprotein 4 deficiency]]
*[[Platelet glycoprotein Ib deficiency]]
*[[Plerixafor]]
*[[Pomalidomide]]
*[[Ponatinib]]
*[[Portal hypertension]]
*[[Post-transfusion purpura]]
*[[Pralatrexate]]
*[[Pre-eclampsia]]
*[[Procarbazine]]
*[[Prolidase deficiency]]
*[[Propionyl-CoA carboxylase deficiency]]
*[[Proton pump inhibitors]]
*[[Pulmonary embolism]]
*[[Pyrimethamine]]
*[[Q fever]]
*[[Quinidine]]
*[[Quinine]]
*[[TAR syndrome|Radial aplasia-thrombocytopenia syndrome]]
{{col-break|width=33%}}
*[[Radiation therapy]]
*[[Radium chloride]]
*[[Raltitrexed]]
*[[Ranitidine]]
*[[Regorafenib]]
*[[ReoPro]]
*[[Rifampicin]]
*[[Rituximab]]
*[[Romidepsin]]
*[[Rubella]]
*[[Ruxolitinib]]
*[[Sea blue histiocytosis]]
*[[Sebastian platelet syndrome]]
*[[Septicaemia]]
*[[Shwachman-Diamond syndrome]]
*[[Siltuximab]]
*[[Sirolimus]]
*[[Sitosterolemia]]
*[[Snakebites]]
*[[Sorafenib]]
*[[Stiripentol]]
*[[Streptozocin]]
*[[Strontium-89]]
*[[Sulfasalazine]]
*[[Sulfonamides]]
*[[Sunitinib malate]]
*[[Congenital syphilis]]
*[[Systemic lupus erythematosus]]
*[[Tacrolimus]]
*[[Tamoxifen]]
*[[TAR syndrome]]
*[[Temozolomide]]
*[[Temsirolimus]]
*[[Teniposide]]
*[[Thioguanine]]
*[[Thiotepa]]
*[[thrombocytopenia absent radius|Thrombocytopenia absent radius syndrome]]
*[[Thrombotic thrombocytopenic purpura]]
*[[Tiagabine]]
*[[Tick-borne encephalitis]]
*[[Ticlopidine]]
*[[Tinzaparin]]
*[[Tirofiban]]
*[[Topotecan]]
*[[Tositumomab iodine-131]]
*[[toxic shock syndrome|Toxic shock syndrome (staphylococcal)]]
*[[Trabectedin]]
*[[Trimethoprim-sulfamethoxazole]]
*[[Valganciclovir]]
*[[Valproic acid]]
*[[Vancomycin]]
*[[Varicella]]
*[[Vinflunine]]
*[[Vinorelbine]]
*[[Visceral leishmaniasis]]
*[[Vitamin B12 deficiency]]
*[[von Willebrand disease|Von willebrand disease, platelet type]]
*[[Vorinostat]]
*[[Werlhof disease]]
*[[Wiskott-Aldrich syndrome]]
*[[X-linked hyperimmunoglobulin M syndrome]]
*[[Zinc]]
*[[Ziv-aflibercept]]
{{col-end}}

==References==
{{Reflist|2}}

[[Category:Crowdiagnosis]]
[[Category:Hematology]]
[[Category:Blood disorders]]

{{WH}}
{{WS}}

Cirrhosis causes

2015-04-28T18:27:29Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Cirrhosis}}
{{CMG}} ; {{AE}} {{ADI}}

==Overview==
There are a wide range of causes for cirrhosis, including [[alcohol abuse]], [[genetic diseases]], cardiac causes, [[toxins]], [[viruses]], and [[malnutrition]]. The consequence to the liver is the same in all cases however, with the functioning liver tissue being replaced by non-functioning scar tissue.

== Causes ==
=== Common Causes ===
Cirrhosis has many possible causes; sometimes more than one cause is present in the same patient. In the Western World, chronic alcoholism and hepatitis C are the most common causes.
* [[Alcoholic liver disease]]
* Chronic [[hepatitis C]]
* Chronic [[hepatitis B]]
* [[Non-alcoholic fatty liver disease|Non-alcoholic steatohepatitis]] (NASH)
* [[Primary biliary cirrhosis]]
* [[Primary sclerosing cholangitis]]
* [[Autoimmune hepatitis]]
* [[Hereditary hemochromatosis]]
* [[Wilson's disease]]
* [[Alpha 1-antitrypsin deficiency]]
* [[Cardiac cirrhosis]]
* [[Galactosemia]]
* [[Glycogen storage disease type IV]]
* [[Cystic fibrosis]]
* [[Hard and soft drugs|Drug]]s or [[toxin]]s
* Certain parasitic infections (such as [[schistosomiasis]])

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac cirrhosis]], [[Right sided cardiac failure]], [[Constrictive pericarditis]], [[Cor Pulmonale]], [[Tricuspid insufficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Aflatoxin]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Keratitis-ichthyosis-deafness syndrome]], [[Addison-Gull syndrome ]], [[Reynolds syndrome ]], [[Tricho-hepato-enteric syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Amiodarone]], [[Ethanol]], [[interferon alfacon-1]], [[Isoniazid]], [[Methotrexate]], [[Methyldopa]], [[Sulfasalazine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Addison-Gull syndrome ]], [[Alpha 1-antitrypsin deficiency ]], [[Alström syndrome]], [[Autoimmune cholangiopathy]], [[Autoimmune hepatitis]], [[Bearn-Kunkel syndrome ]], [[Bile duct]] [[stricture]], [[Biliary atresia]], [[Budd-Chiari Syndrome]], [[Caroli disease]], [[Cerebrohepatorenal syndrome]], [[Ceroid storage disease]], [[Cholestasis-oedema syndrome, Norwegian type]], [[Cruveilhier-Baumgarten syndrome]], [[Congenital hepatic fibrosis]], [[Cystic fibrosis]], [[Granulomatous cirrhosis]], [[Hemochromatosis]], [[Hepatic vein thrombosis]], [[Hereditary fructose intolerance]], [[Indian familial childhood cirrhosis]], [[Non-alcoholic steatohepatitis ]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Reynolds syndrome ]], [[Tricho-hepato-enteric syndrome ]], [[Wilson disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Abetalipoproteinemia]], [[Alagille syndrome]], [[Alpers disease]], [[Alpha 1-antitrypsin deficiency ]], [[Alström syndrome]], [[Berardinelli lipodystrophy syndrome]], [[Carbohydrate deficient glycoprotein syndrome type 1a]], [[Carbohydrate-deficient glycoprotein syndrome type 1b]], [[Caroli disease]], [[Ceroid storage disease ]], [[Cholestasis-oedema syndrome, Norwegian type]], [[Congenital hepatic fibrosis]], [[Cystic fibrosis]], [[Fanconi disease]], [[Fructose-1-phosphate aldolase deficiency]], [[Galactosemia]], [[Glycogen storage disease type IV]], [[Haemosiderosis]], [[Hemochromatosis]], [[Hereditary fructose intolerance]], [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]], [[Polycystic kidney disease, autosomal recessive]], [[Porphyria cutanea tarda type 2 (familial)]], [[Sickle cell disease]], [[Tyrosinaemia type 1]], [[Wilson disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Budd-Chiari Syndrome]], [[Erythropoietic protoporphyria]], [[Fanconi disease]], [[Haemosiderosis]], [[Hepatic vein thrombosis]], [[Porphyria cutanea tarda type 2 (familial)]], [[Sickle cell disease]], [[Thalassemia]], [[Tyrosinaemia type 1]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Bile duct]] [[stricture]], [[Graft versus host disease]], [[Parenteral nutrition]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Fasciola hepatica]], [[Hepatitis B]], [[Hepatitis C]], [[Schistosoma haematobium]], [[Schistosoma japonicum]], [[Schistosoma mansoni]], [[Visceral leishmaniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Alpers disease]], [[Cerebrohepatorenal syndrome]], [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Abetalipoproteinemia]], [[Carbohydrate deficient glycoprotein syndrome type 1a]], [[Carbohydrate-deficient glycoprotein syndrome type 1b]], [[Ceroid storage disease ]], [[Cholesterol ester storage disease]], [[Fructose-1-phosphate aldolase deficiency]], [[Galactosemia]], [[Glycogen storage disease type IV]], [[Hypervitaminosis A]], [[Parenteral nutrition]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetaminophen overdose]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Cerebrohepatorenal syndrome]], [[Fanconi disease]], [[Polycystic kidney disease, autosomal recessive]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune cholangiopathy]], [[Autoimmune hepatitis]], [[Graft versus host disease]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Reynolds syndrome ]], [[Sarcoidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcoholic liver disease ]]
|-
|}

=== Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
*[[Abetalipoproteinemia]]
*[[Acetaminophen overdose]]
*[[Addison-Gull syndrome ]]
*[[Aflatoxin]]
*[[Alagille syndrome]]
*[[Alcoholic liver disease ]]
*[[Alpers disease]]
*[[Alpha 1-antitrypsin deficiency ]]
*[[Alström syndrome]]
*[[Amiodarone]]
*[[Autoimmune cholangiopathy]]
*[[Autoimmune hepatitis]]
*[[Bearn-Kunkel syndrome ]] <ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1813854/#reference-sec</ref>
*[[Berardinelli lipodystrophy syndrome]]
*[[Bile duct]] [[stricture]]
*[[Biliary atresia]]
*[[Budd-Chiari Syndrome]]
*[[Carbohydrate deficient glycoprotein syndrome type 1a]]
*[[Cardiac cirrhosis]]
*[[Caroli disease]]
*[[Cerebrohepatorenal syndrome]]
*[[Ceroid storage disease ]]
*[[Cholestasis-oedema syndrome, Norwegian type]]
*[[Cholesterol ester storage disease]]
*[[Congenital hepatic fibrosis]]
*[[Constrictive pericarditis]]
*[[Cor Pulmonale]]
*[[Cruveilhier-Baumgarten syndrome]]
*[[Cystic fibrosis]]
*[[Erythropoietic protoporphyria]]
*[[Ethanol]]
*[[Fanconi disease]] <ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2165837/</ref>
*[[Fasciola hepatica]]
*[[Fructose-1-phosphate aldolase deficiency]] <ref> http://ghr.nlm.nih.gov/condition/hereditary-fructose-intolerance</ref>
*[[Galactosemia]]
*[[Glycogen storage disease type IV]]
*[[Graft versus host disease]]
*[[Granulomatous cirrhosis]]
*[[Haemosiderosis]]
*[[Hemochromatosis]]
*[[Hepatic vein thrombosis]]
*[[Hepatitis B]]
*[[Hepatitis C]]
*[[Hereditary fructose intolerance]]
*[[Hypervitaminosis A]]
*[[Indian familial childhood cirrhosis]]
*[[Isoniazid]]
*[[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
*[[Methotrexate]]
*[[Methyldopa]]
*[[Non-alcoholic steatohepatitis ]]
*[[Parenteral nutrition]]
*[[Polycystic kidney disease, autosomal recessive]]
*[[Porphyria cutanea tarda type 2 (familial)]]
*[[Primary biliary cirrhosis]]
*[[Primary sclerosing cholangitis]]
*[[Reynolds syndrome ]] <ref> http://rarediseases.info.nih.gov/GARD/Condition/4697/Reynolds_syndrome.aspx</ref>
*[[Right sided cardiac failure]]
*[[Sarcoidosis]]
*[[Schistosomiasis]]
*[[Sickle Cell Disease]]
*[[Steatohepatitis]]
*[[Thalassemia]]
*[[Tricho-hepato-enteric syndrome ]] <ref>http://www.checkorphan.org/disease/tricho-hepato-enteric-syndrome</ref>
*[[Tricuspid insufficiency]]
*[[Tyrosinaemia type 1]]
*[[Visceral leishmaniasis]]
*[[Wilson disease]]

===Differentiating Different Causes of Cirrhosis===

{|

|-style="background:silver; color:black"

| '''Differential Diagnosis''' || '''Useful Findings'''

|-style="background:silver; color:black"

| '''Alcoholic cirrhosis''' || '''History EtOH, AST/ALT > 2'''

|-style="background:silver; color:black"

| '''Chronic Hepatits C Virus (HCV)''' || '''HCV AB'''

|-style="background:silver; color:black"

| '''Primary Biliary Cirrhosis (PBC)''' || '''Elevated alk phos, AMA+'''

|-style="background:silver; color:black"

| '''Primary sclerosing cholangitis''' || '''History inflammatory bowel disease (IBD), ANA or ASMA or P-ANCA+'''

|-style="background:silver; color:black"

| '''Autoimmune hepatitis''' || '''Hypergammaglobulinemia, ANA/ASMA +'''

|-style="background:silver; color:black"

| '''Chronic Hepatitis B Virus''' || '''HBsAg+, HBeAg may be +'''

|-style="background:silver; color:black"

| '''Hemochromatosis''' || '''Family history+, Fe/TIBC and ferritin elevated'''

|-style="background:silver; color:black"

| '''Wilson’s disease''' || '''Family history+, young age, low ceruloplasmin'''

|-style="background:silver; color:black"

| '''Alpha-1-antitrypsin (AAT) deficiency''' || '''Family history+, young age, low serum AAT'''

|}

==References==

{{reflist|2}}

{{WH}}

{{WS}}

Pancreatitis causes

2015-04-28T18:26:55Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Pancreatitis}}
{{CMG}}{{VB}}

==Overview==
Pancreatitis can be caused by a number of causes both intrinsic as well as extrinsic to pancreas. The most common causes include Alcoholism, gallstones and medications.

==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Acute pancreatitis is a life-threatening condition, especially if it progresses to necrotizing pancreatitis, and should be treated as such irrespective of the cause.

===Common Causes===
* [[Alcohol]] 30% <ref name="Yang-2008">{{Cite journal | last1 = Yang | first1 = AL. | last2 = Vadhavkar | first2 = S. | last3 = Singh | first3 = G. | last4 = Omary | first4 = MB. | title = Epidemiology of alcohol-related liver and pancreatic disease in the United States. | journal = Arch Intern Med | volume = 168 | issue = 6 | pages = 649-56 | month = Mar | year = 2008 | doi = 10.1001/archinte.168.6.649 | PMID = 18362258 }}</ref>

* [[Gallstones]] 35-40% <ref name="Forsmark-2007">{{Cite journal | last1 = Forsmark | first1 = CE. | last2 = Baillie | first2 = J. | title = AGA Institute technical review on acute pancreatitis. | journal = Gastroenterology | volume = 132 | issue = 5 | pages = 2022-44 | month = May | year = 2007 | doi = 10.1053/j.gastro.2007.03.065 | PMID = 17484894 }}</ref>

* [[Hypertriglyceridemia]] 1-4% cases <ref name="Fortson-1995">{{Cite journal | last1 = Fortson | first1 = MR. | last2 = Freedman | first2 = SN. | last3 = Webster | first3 = PD. | title = Clinical assessment of hyperlipidemic pancreatitis. | journal = Am J Gastroenterol | volume = 90 | issue = 12 | pages = 2134-9 | month = Dec | year = 1995 | doi = | PMID = 8540502 }}</ref>

* Medication such as [[mercaptopurine|5-mercaptopurine]], [[azathioprine]], [[Diphenoxylate hydrochloride and atropine sulfate]], [[5-DDI]]<ref name="Yi-2012">{{Cite journal | last1 = Yi | first1 = GC. | last2 = Yoon | first2 = KH. | last3 = Hwang | first3 = JB. | title = Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease. | journal = Pediatr Gastroenterol Hepatol Nutr | volume = 15 | issue = 4 | pages = 272-5 | month = Dec | year = 2012 | doi = 10.5223/pghn.2012.15.4.272 | PMID = 24010098 }}</ref>

* [[Pancreatic tumor]]<ref name="Köhler-1987">{{Cite journal | last1 = Köhler | first1 = H. | last2 = Lankisch | first2 = PG. | title = Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma. | journal = Pancreas | volume = 2 | issue = 1 | pages = 117-9 | month = | year = 1987 | doi = | PMID = 2437571 }}</ref>

* [[ERCP|Post-ERCP]]

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Atheroembolism ]], [[Cholesterol embolism]], [[Hemorrhagic shock ]], [[Hypotension]], [[Hypotension|Intraoperative hypotension]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[6-mercaptopurine]], [[Acetaminophen]], [[Acetaminophen and Oxycodone]], [[Alogliptin]], [[Amiodarone]], [[Arabinoside]], [[Asparaginase]], [[Asparaginase Erwinia Chrysanthemi]], [[Azathioprine]], [[olsalazine|Azodisalicylate]], [[Bexarotene]], [[Bezafibrate]], [[Bumetanide]], [[Carbimazole]], [[Chlorothiazide]], [[Cidofovir]], [[Clomiphene]], [[Clozapine]], [[Cytarabine]], [[Cytosine]], [[dabrafenib mesylate]], [[Dapsone]], [[Dexamethasone]], [[Didanosine]], [[Dapsone]], [[Doxercalciferol]], [[Enalapril]], [[Enfuvirtide]], [[Eribulin]], [[Erythromycin]], [[Estrogen]], [[Exenatide]], [[Febuxostat]], [[Frusemide]], [[Furosemide]], [[Indinavir]], [[Ifosfamide]], [[Hydrochlorothiazide]], [[interferon alfacon-1]], [[Interferon gamma]], [[Interferon alfa-2b ]], [[Isoniazid]], [[Lamivudine]], [[Linagliptin]], [[Linagliptin and Metformin hydrochloride]], [[Liraglutide]], [[Losartan]], [[Meglumine antimoniate|Meglumine]], [[Mesalamine]], [[Mesalazine]], [[Methimazole]], [[Methyldopa]], [[Methylprednisolone]], [[Metronidazole]], [[Minocycline hydrochloride]], [[Nelfinavir]], [[Nilotinib]], [[Nitrofurantoin]], [[Nivolumab]], [[Olsalazine]], [[Omeprazole]], [[Oxaliplatin]], [[Oxaprozin]], [[Oxcarbazepine]], [[Oxyphenbutazone]], [[Pegaspargase]], [[Pegylated interferon alfa-2b]], [[Pentamidine]], [[Pergolide]], [[Phenylbutazone]], [[Ponatinib]], [[Pramipexole]], [[Pravastatin]], [[Premarin]], [[Prednisone]], [[Procainamide]], [[Propofol]], [[Pyritonol]], [[ Prednisolone]], [[Repaglinide]], [[Ritonavir]], [[Saquinavir mesylate]], [[Saxagliptin hydrochloride and Metformin hydrochloride]], [[Simvastatin]], [[Sitagliptin]], [[Somatropin]],[[Stavudine]], [[Sodium stibogluconate]], [[Sorafenib]], [[Sulfamethoxazole]], [[Sulindac]], [[Sulfasalazine]] ,[[Tamoxifen]], [[Teduglutide]], [[Tetracycline]], [[Thalidomide]], [[Trimethoprim-sulfamethoxazole]], [[Valproic acid]], [[Zalcitabine]], [[methyldopa|α-methyldopa]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Alcoholism]], [[Blunt trauma]], [[Pregnancy]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[fatty liver|Acute gestational fatty liver]], [[porphyria|Acute hepatic porphyrias]], [[Acute intermittent porphyria]], [[gallbladder disease|Biliary sludge]], [[Choledochal cyst]], [[Choledocholithiasis]], [[Cholelithiasis]], [[Duodenal ulcer]], [[Gallstones]], [[Gastric ulcer]], [[Hepatitis B ]], [[Hereditary pancreatitis]], [[Gallstones|Microlithiasis]], [[Pancreas|Pancreatic cysts]], [[Pancreatic pseudocyst]], [[Porphyrias]], [[Reye syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Aminoaciduria]], [[Apolipoprotein c-ii deficiency]], [[Congenital generalized lipodystrophy type 1]], [[Congenital generalized lipodystrophy type 2]], [[Cystic fibrosis]], [[Erythropoietic protoporphyria.]], [[Familial hypertriglyceridaemia]], [[Hemochromatosis]], [[Hereditary coproporphyria]], [[Lipoprotein lipase deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[ERCP]], [[Partial pancreas resection]], Posttransplantation
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Ascariasis]], [[Aspergillus]], [[Campylobacter jejuni]], [[Coxsackievirus]], [[Cryptosporidium]], [[Cytomegalovirus]], [[Fungal infections]], [[Herpes simplex]], [[HIV]], [[Human enterovirus b]], [[Legionella]], [[Leptospira]], [[Leukocytosis]], [[Mumps]], [[Mycoplasma]], [[Salmonella]], [[Teniasis]], [[Toxoplasma]], [[Varicella zoster]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[All-trans-retinoic acid]], [[Hypercalcaemia]], [[Hypertriglyceridemia]], [[Zinc]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Cholangiocarcinoma]], [[Pancreatic cancer]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Cannabis]], [[Codeine]], [[Ethanol]], [[Thallium]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Autoimmune pancreatitis]], [[Autoimmune sclerosing pancreatitis]], [[Crohn's disease]], [[Necrotizing vascular angiitis]], [[Polyarteritis nodosa]], [[Systemic lupus erythematosus]], [[Thrombotic thrombocytopenic purpura]], [[Variegate porphyria]], [[Vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Duodenal diverticulum]], [[Ectopic pancreas]], [[Fever]], [[Hypothermia]], [[Idiopathic]], [[Pancreas divisum]], [[Penetrating trauma]], [[Stenosis of pancreatic ducts]], [[Trauma]]
|-
|}

===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[6-mercaptopurine]]

*[[Acetaminophen]]

*[[fatty liver|Acute gestational fatty liver]]

*[[porphyrias|Acute hepatic porphyrias]]

*[[Acute intermittent porphyria]]

*[[Alcoholism]]

*[[All-trans retinoic acid]]

*[[Aminoaciduria]]

*[[Amiodarone]]

*[[apolipoprotein|Apolipoprotein c-II deficiency]]

*[[cytarabine|Arabinoside]]

*[[Ascariasis]]

*[[Asparaginase]]

*[[Aspergillus]]

*[[Atheroembolism ]]

*[[Autoimmune pancreatitis]]

*[[acute pancreatitis|Autoimmune sclerosing pancreatitis]]

*[[Azathioprine]]

*[[olsalazine|Azodisalicylate]]

*[[Bexarotene]]

*[[Bezafibrate]]

*[[Gallbladder disease|Biliary sludge]]

*[[Blunt trauma]]

*[[Bumetanide]]

*[[Campylobacter jejuni]]

*[[Cannabis]]

*[[Carbimazole]]

*[[Chlorothiazide]]

*[[Cholangiocarcinoma]]

*[[Choledochal cyst]]

*[[Choledocholithiasis]]

*[[Cholelithiasis]]

*[[Cholesterol embolism]]

*[[Cidofovir]]

*[[Clomiphene]]

*[[Clozapine]]

*[[Codeine]]

*[[Cytarabine]]

*[[Lipodystrophy|Congenital generalized lipodystrophy type 1]]

*[[Lipodystrophy|Congenital generalized lipodystrophy type 2]]

*[[Coxsackievirus]]

*[[Crohn's disease]]

*[[Cryptosporidium]]

*[[Cystic fibrosis]]

*[[Cytomegalovirus]]

*[[Cytosine]]

*[[Dapsone]]

*[[Dexamethasone]]

*[[Didanosine]]

*[[Duodenal diverticulum]]

{{col-break|width=33%}}
*[[Duodenal ulcer]]

*[[Pancreas|Ectopic pancreas]]

*[[Efavirenz]]

*[[Enalapril]]

*[[Enfuvirtide]]

*[[ERCP]]

*[[Eribulin]]

*[[Erythromycin]]

*[[Porphyria|Erythropoietic protoporphyria.]]

*[[Estrogen]]

*[[Ethanol]]

*[[Exenatide]]

*[[Familial hypertriglyceridaemia]]

*[[Fever]]

*[[Frusemide]]

*[[Fungal infections]]

*[[Furosemide]]

*[[Gallstones]]

*[[Gastric ulcer]]

*[[Hemochromatosis]]

*[[Hemorrhagic shock ]]

*[[Hepatitis B ]]

*[[Hereditary coproporphyria]]

*[[Hereditary pancreatitis]]

*[[Herpes simplex]]

*[[HIV]]

*[[Human enterovirus B]]

*[[Hypercalcaemia]]

*[[Hypertriglyceridemia]]

*[[Hypotension]]

*[[Hypothermia]]

*[[Idiopathic]]

*[[Indinavir]]

*[[Ifosfamide]]

*[[Interferon gamma]]

*[[Hypotension|Intraoperative hypotension]]

*[[Isoniazid]]

*[[Janumet]] ([[sitagliptin]] and [[metformin]])

*[[Lamivudine]]

*[[Legionella]]

*[[Leptospira]]

*[[Leukocytosis]]

*[[Linagliptin]]

*[[Lipoprotein lipase deficiency]]

*[[Liraglutide]]

*[[Losartan]]

*[[Meglumine antimoniate|Meglumine]]

*[[Mesalamine]]

*[[Mesalazine]]

*[[Methimazole]]

*[[Methyldopa]]

*[[Metronidazole]]

*[[Gallstones|Microlithiasis]]

*[[Mumps]]

*[[Mycoplasma]]

{{col-break|width=33%}}
* Necrotizing vascular angiitis
*[[Nelfinavir]]
*[[Nitrofurantoin]]
*[[Mestranol]]
*[[Omeprazole]]
*[[Oxaprozin]]
*[[Oxyphenbutazone]]
*[[Pancreas divisum]]
*[[Pancreatic cancer]]
*[[Pancreas|Pancreatic cysts]]
*[[Pancreatic pseudocyst]]
*[[Pancreas|Partial pancreas resection]]
*[[Pegaspargase]]
*[[Penetrating trauma]]
*[[Pentamidine]]
*[[Pergolide]]
*[[Phenylbutazone]]
*[[Polyarteritis nodosa]]
*[[Ponatinib]]
*[[Porphyrias]]
* Post transplantation
*[[Pravastatin]]
*[[Pregnancy ]]
*[[Premarin]]
*[[Prednisone]]
*[[Procainamide]]
*[[Propofol]]
*[[Pyritonol]]
*[[Renal failure]]
*[[Reye syndrome]]
*[[Salmonella]]
*[[Saquinavir mesylate]]
*[[Simvastatin]]
*[[Sitagliptin]]
*[[Smoking]]
*[[Stavudine]]
*[[Pancreas|Stenosis of pancreatic ducts]]
*[[Sodium stibogluconate]]
*[[Sorafenib]]
*[[Sulfamethoxazole]]
*[[Sulindac]]
*[[Systemic lupus erythematosus]]
*[[Tamoxifen]]
*[[Teduglutide]]
*[[Teniasis]]
* [[Tenofovir]] disoproxil fumarate
*[[Tetracycline]]
*[[Thallium]]
*[[Thrombotic thrombocytopenic purpura]]
*[[Toxoplasma]]
*[[Trauma]]
*[[Trimethoprim-sulfamethoxazole]]
*[[Valproic acid]]
*[[Varicella zoster]]
*[[Variegate porphyria]]
*[[Vasculitis]]
*[[Zalcitabine]]
*[[Zinc]]
*[[methyldopa|α-methyldopa]]
{{col-end}}

==References==
{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:Inflammations]]
[[Category:Abdominal pain]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
[[Category:Needs causes]]
[[Category:Needs content]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Ischemic colitis causes

2015-04-28T18:26:22Z

Rabin Bista: /* Drugs */

__NOTOC__
{{Ischemic colitis}}
{{CMG}}; {{AOEIC}} {{CZ}}

==Overview==
Causes of the reduced blood flow can include changes in the systemic circulation (e.g. [[hypotension|low blood pressure]]) or local factors such as [[vasoconstriction|constriction of blood vessels]] or a [[blood clot]]. In most cases, no specific cause can be identified.<ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.</ref>

==Causes==
Ischemic colitis is often classified according to the underlying cause. Non-occlusive ischemia develops because of [[low blood pressure]] or constriction of the vessels supplying blood to the colon; occlusive ischemia indicates that a [[blood clot]] or other blockage has cut off blood flow to the [[colon]]. In most cases, no specific cause can be identified.

===Non-occlusive Ischemia===
In hemodynamically unstable patients (i.e. [[shock]] patients) the [[mesenteric]] perfusion may be compromised.

===Occlusive Ischemia===
Occlusive ischemia is due to either:

1. Obstructive atherosclerotic disease
:*[[Superior mesenteric artery]] occlusion
2. [[Thromboembolism]]:
:*Most commonly the embolism is due to [[atrial fibrillation]]
:*[[Valvular heart disease]] including [[endocarditis]]
:*[[Myocardial infarction]]
:*[[Cardiomyopathy]]

===Drugs===
*[[Alosetron]]
*[[Cilansetron]]
*[[interferon alfacon-1]]
*[[Pegylated interferon alfa-2b]]
*[[Ramosetron]]

==References==
{{Reflist|2}}

[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Respiratory failure causes

2015-04-28T18:25:37Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{CMG}}
{{Respiratory failure}}

==Causes==
===Common Causes===

*[[Azacitidine]]
*[[Codeine]]
*[[Clozapine]]
*[[Fentanyl]]
*[[Gamma-Hydroxybutyric acid]]
*[[Heroin]]
*[[Ketamine]]
*[[Lidocaine]]
*[[Labetalol]]
*[[Lorazepam]]
*[[Morphine]]
*[[Nitrazepam]]
*[[Opiate]]
*[[Oxymorphone]]
*[[Procainamide (patient information)]]
*[[Sodium thiopental]]
*[[Triazolam]]
*[[Zopiclone]]

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Atrial septal defect (ostium primum)]],
[[Ebstein anomaly]],
[[Eisenmenger syndrome]],
[[Fallot tetralogy]],
[[Pulmonary valve stenosis]],
[[Transposition of great arteries]],
[[Tricuspid valve stenosis]],
[[Ventricular septal defect]]
-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[3-Quinuclidinyl benzilate]],
[[Abrin]],
[[Aldicarb]],
[[Alpha-amanitin]],
[[Barium nitrate]],
[[Bungarotoxin]],
[[Carbon monoxide poisoning]],
[[Ceritinib]]
[[Cocaine]],
[[Cone snail]],
[[Furfural]],
[[Snakebites (Patient information)]]
|-
|-bgcolor="LightSteelBlue"
| '''Congenital'''
|bgcolor="Beige"|
[[Atrial septal defect (ostium primum)]],
[[Bland-White-Garland Syndrome]],
[[Congenital Central Hypoventilation Syndrome]],
[[Congenital diaphragmatic hernia]],
[[Fallot tetralogy]],
[[Fetal circulation, persistent]],
[[Respiratory distress syndrome (neonatal)]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect '''
|bgcolor="Beige"| [[Codeine]], [[Clozapine]], [[Crizotinib]], [[Cyclophosphamide]], [[Desmopressin]], [[Dornase Alfa]], [[Fentanyl]], [[Gamma-Hydroxybutyric acid]], [[galsulfase]], [[Heroin]], [[Idursulfase]], [[interferon alfacon-1]], [[Ixabepilone]], [[Ketamine]], [[Lidocaine]], [[Labetalol]], [[Lorazepam]], [[Morphine]], [[Nitrazepam]], [[Opiate]], [[Oxymorphone]], [[Pegylated interferon alfa-2b]], [[Pramipexole]], [[Procainamide (patient information)]], [[Rasburicase]], [[Sodium thiopental]], [[Tretinoin]], [[Triazolam]], [[Vincristine sulfate liposome]], [[Zopiclone]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|
[[Asbestosis]],
Coal worker pneumoconiosis,
[[Smoke inhalation]],
Sulfur dioxide
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Hepatic failure]],
[[Hepatopulmonary syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
[[Achondrogenesis]],
[[Acute Porphyria]],
[[Alpha 1-antitrypsin deficiency]],
[[Atelosteogenesis, type II]],
[[Becker's muscular dystrophy]],
[[Carnitine palmitoyltransferase II deficiency]],
[[Cystic fibrosis]],
[[Duchenne's Muscular Dystrophy]],
[[Familial dysautonomia]],
[[Hereditary haemorrhagic telangiectasia]],
[[Osteogenesis imperfecta]],
[[Thanatophoric dysplasia]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|
[[Acute Porphyria]],
[[Cholesterol Emboli Syndrome]],
[[Fat embolism]],
[[Sepsis]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|
[[Blood transfusion]],
[[EVAR]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Babesiosis]],
[[Botulism]],
[[Crimean-Congo hemorrhagic fever]],
[[Hantavirus Pulmonary Syndrome]],
[[Heartworm]],
[[Post-polio syndrome]],
[[Rabies]],
[[Tetanus]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
[[Kyphoscoliosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Amyotrophic Lateral Sclerosis]],
[[Meningitis]],
[[Polyrediculitis]],
[[Zellweger syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Metabolic Acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|
[[Malignant Mesothelioma]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Acetylsalicylic acid]],
[[Alcohol]],
[[Bufotenin]],
[[Clitocybe dealbata]],
[[Colchicine]],
[[Cytisine]],
[[Dicofol]],
[[Saxitoxin]],
[[Tetrodotoxin]],
[[Tick paralysis]],
[[Vinyl chloride]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|
Acute lung syndrome,
[[Acute Respiratory Distress Syndrome]],
[[Alpha 1-antitrypsin deficiency]],
[[Atelectasis]],
[[Bronchial asthma]],
[[Bronchiectasis]],
[[Bronchiolitis]],
[[Bronchiolitis obliterans]],
[[Bronchogenic carcinoma]],
[[Bronchopulmonary dysplasia]],
[[Chronic Obstructive Pulmonary Disease]],
[[Cystic adenomatoid malformation of lung]],
[[Emphysema]],
[[Eosinophilic pneumonia]],
[[Fibrosing alveolitis]],
[[Flail chest]],
[[Interstitial fibrosis]],
[[Laryngo-/Bronchospasm]],
[[Legionella pneumophila]],
[[Pleural effusion]],
[[Pneumonia]],
[[Pneumothorax]],
[[Pulmonary alveolar proteinosis]],
[[Pulmonary arterio-venous malformation]],
[[Pulmonary edema]],
[[Pulmonary embolism]],
[[Pulmonary hypertension]],
[[Pulmonary oedema]],
[[Restrictive Lung Disease]],
[[Status asthmaticus]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|
Electrolyte abnormalities
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
[[Acute motor axonal neuropathy]],
[[Anaphylaxis]],
[[Angioedema]],
[[Antiphospholipid Antibody Syndrome]],
[[Devic's disease]],
[[Guillain-Barre syndrome]],
[[Hamman-Rich Syndrome]],
[[Myasthenia Gravis]],
[[Satoyoshi syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|
[[Ebstein anomaly]],
[[Flail chest]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Aspiration]],
[[Foreign body]],
[[Malignant hyperpyrexia]],
[[Multiple organ dysfunction syndrome]],
Near-drowning,
[[Reye's syndrome]]
|-
|}

===Causes by Alphabetical Order===
*[[Desmopressin]]
*[[Ixabepilone]]

==References==
{{reflist|2}}

[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Medical emergencies]]
[[Category:Organ failure]]
[[Category:Pulmonology]]
[[Category:Causes of death]]
[[Category:Needs overview]]

{{WH}}
{{WS}}

Hamman-Rich syndrome

2015-04-28T18:24:52Z

Rabin Bista: /* Causes */

{{Infobox disease |
Name = Hamman–Rich syndrome |
ICD10 = {{ICD10|J|84|1|j|80}} |
ICD9 = {{ICD9|516.3}} |
ICDO = |
Image = Hyaline membranes - very high mag.jpg |
Caption = [[Micrograph]] of [[diffuse alveolar damage]], the histologic correlate of acute interstitial pneumonitis. [[H&E stain]]. |
OMIM = 178500 |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
DiseasesDB = 4815 |
MeshID = D011658 |
}}
__NOTOC__
{{Hamman-Rich syndrome}}
{{CMG}}

{{SK}} Acute interstitial pneumonia; Acute interstitial pneumonitis; HR syndrome

==[[Hamman-Rich syndrome overview|Overview]]==

==[[Hamman-Rich syndrome historical perspective|Historical Perspective]]==

==[[Hamman-Rich syndrome classification|Classification]]==

==[[Hamman-Rich syndrome pathophysiology|Pathophysiology]]==

==[[Hamman-Rich syndrome causes|Causes]]==

*[[interferon alfacon-1]]
*[[Interferon gamma]]
* [[Nitrofurantoin]]
*[[Panitumumab]]
*[[Sodium aurothiomalate]]

==[[Hamman-Rich syndrome differential diagnosis|Differentiating Hamman-Rich syndrome from other Diseases]]==

==[[Hamman-Rich syndrome epidemiology and demographics|Epidemiology and Demographics]]==

==[[Hamman-Rich syndrome risk factors|Risk Factors]]==

==[[Hamman-Rich syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==

==[[Hamman-Rich syndrome diagnosis|Diagnosis]]==

[[Hamman-Rich syndrome history and symptoms|History and Symptoms]] | [[Hamman-Rich syndrome physical examination|Physical Examination]] | [[Hamman-Rich syndrome laboratory findings|Laboratory Findings]] | [[Hamman-Rich syndrome electrocardiogram|Electrocardiogram]] | [[Hamman-Rich syndrome chest x ray|Chest X Ray]] | [[Hamman-Rich syndrome CT|CT]] | [[Hamman-Rich syndrome MRI|MRI]] | [[Hamman-Rich syndrome echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hamman-Rich syndrome other imaging findings|Other Imaging Findings]] | [[Hamman-Rich syndrome other diagnostic studies|Other Diagnostic Studies]]

==Treatment==

[[Hamman-Rich syndrome medical therapy|Medical Therapy]] | [[Hamman-Rich syndrome surgery|Surgery]] | [[Hamman-Rich syndrome primary prevention|Primary Prevention]] | [[Hamman-Rich syndrome secondary prevention|Secondary Prevention]] | [[Hamman-Rich syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hamman-Rich syndrome future or investigational therapies|Future or Investigational Therapies]]

==Case Studies==

[[Hamman-Rich syndrome case study one|Case #1]]

{{Respiratory pathology}}

[[Category:Pulmonology]]

Pneumonia causes

2015-04-28T18:24:16Z

Rabin Bista: /* Drug Side Effect */

__NOTOC__
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; {{AL}}
{{Pneumonia}}
==Overview==
Pneumonia can result from a variety of causes, including infection with [[bacteria]], [[viruses]], [[fungi]], [[parasites]], and chemical or physical injury to the lungs. The etiology will depend upon various factors such as age, immune status, geographical area, and comorbidities.

==Causes==
====Microbiological Etiology====
{| style="border: 0px; font-size: 85%; margin: 3px; width:700px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF; width: 250px;" | Typical Bacteria
! style="background: #4479BA; color:#FFF; width: 250px;" | Atypical Bacteria
! style="background: #4479BA; color:#FFF; width: 250px;" | Viruses
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
# ''[[Streptococcus pneumoniae]]''
# ''[[Haemophilus influenzae]]''
# ''[[Staphylococcus aureus]]''
# ''[[Escherichia coli]]''
# ''[[Klebsiella pneumoniae]]''
# ''[[Pseudomonas aeruginosa]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
# ''[[Mycoplasma pneumoniae]]''
# ''[[Chlamydophila pneumoniae]]''
# ''[[Legionella pneumophila]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
# ''[[Influenza]]''
# ''[[Parainfluenza]]''
# ''[[Respiratory syncytial virus|Respiratory syncytial virus (RSV)]]''
# ''[[Metapneumovirus]]''
# ''[[Adenovirus]]''
|}

====Most Common Etiologies for Community-Acquired Pneumonia <ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref><ref name="Wong-2013">{{Cite journal | last1 = Wong | first1 = KK. | last2 = Fistek | first2 = M. | last3 = Watkins | first3 = RR. | title = Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient. | journal = J Med Microbiol | volume = 62 | issue = Pt 4 | pages = 650-1 | month = Apr | year = 2013 | doi = 10.1099/jmm.0.053488-0 | PMID = 23242642 }}</ref><ref name="Oh-2013">{{Cite journal | last1 = Oh | first1 = YJ. | last2 = Song | first2 = SH. | last3 = Baik | first3 = SH. | last4 = Lee | first4 = HH. | last5 = Han | first5 = IM. | last6 = Oh | first6 = DH. | title = A case of fulminant community-acquired Acinetobacter baumannii pneumonia in Korea. | journal = Korean J Intern Med | volume = 28 | issue = 4 | pages = 486-90 | month = Jul | year = 2013 | doi = 10.3904/kjim.2013.28.4.486 | PMID = 23864808 }}</ref>====
{| style="border: 0px; font-size: 85%; margin: 3px; width:700px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF; width: 250px;" | Outpatient

! style="background: #4479BA; color:#FFF; width: 250px;" | Inpatient (non-ICU)

! style="background: #4479BA; color:#FFF; width: 250px;" | Inpatient (ICU)

|-
| style="padding: 5px 5px; background: #F5F5F5;" |
#[[Streptococcus pneumoniae]]
#[[Mycoplasma pneumoniae]]
#[[Haemophilus influenzae]]
#[[Chlamydophila pneumoniae]]
#[[Influenza|Influenza A and B]], [[adenovirus]], [[respiratory syncytial virus]], [[parainfluenza]]
| style="padding: 5px 5px; background: #F5F5F5;" |
#[[Streptococcus pneumoniae]]
#[[Mycoplasma pneumoniae]]
#[[Haemophilus influenzae]]
#[[Legionella]]
#[[Aspiration]]
#[[Influenza|Influenza A and B]], [[adenovirus]], [[respiratory syncytial virus]], [[parainfluenza]]
#[[Yersinia enterocolitica]]
| style="padding: 5px 5px; background: #F5F5F5;" |
#[[Streptococcus pneumoniae]]
#[[Staphylococcus aureus]]
#[[Legionella]]
#[[Gram-negative bacilli]]
#[[Haemophilus influenzae]]
#[[Acinetobacter baumannii]]
|}

==Causes by Pathogen==

:'''''[[Bacterial pneumonia|Click here for bacterial pneumonia]]''''' 
:'''''[[Viral pneumonia|Click here for viral pneumonia]]''''' 
:'''''[[Fungal pneumonia|Click here for fungal pneumonia]]''''' 

==Causes by Age==

{| style="border: 0px; font-size: 85%; margin: 3px; width:700px;" align=center
|valign=top|
|+'''Common Causes by Age Group'''
! style="background: #4479BA; color:#FFF; width: 100px;" | Pathogen
! style="background: #4479BA; color:#FFF; width: 250px;" | Neonates
! style="background: #4479BA; color:#FFF; width: 250px;" | Children
! style="background: #4479BA; color:#FFF; width: 250px;" | Adults
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Bacteria
| style="padding: 5px 5px; background: #F5F5F5;" |
# ''[[Listeria monocytogenes]]''
# ''[[Mycobacterium tuberculosis]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
# ''[[Mycoplasma pneumoniae]]''
# ''[[Chlamydophila pneumoniae]]''
# ''[[Legionella pneumophila]]''
# ''[[Chlamydia trachomatis]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Typical Bacteria'''
# ''[[Streptococcus pneumoniae]]''
# ''[[Haemophilus influenzae]]''
# ''[[Escherichia coli]]''
# ''[[Klebsiella pneumoniae]]''
# ''[[Pseudomonas aeruginosa]]''
'''Atypical Bacteria'''
# ''[[Mycoplasma pneumoniae]]''
# ''[[Chlamydophila pneumoniae]]''
# ''[[Legionella pneumophila]]''
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Virus
| style="padding: 5px 5px; background: #F5F5F5;" |
# [[Herpes simplex virus]]
# [[Adenovirus]]
# [[Mumps]]
# [[Enterovirus]]
| style="padding: 5px 5px; background: #F5F5F5;" |
# [[Respiratory syncytial virus|Respiratory syncytial virus (RSV)]]
# [[Metapneumovirus]]
# [[Adenovirus]]
# [[Parainfluenza]]
# [[Influenza]]
# [[Rhinovirus]]
| style="padding: 5px 5px; background: #F5F5F5;" |
# [[Influenza]]
# [[Parainfluenza]]
# [[Respiratory syncytial virus|Respiratory syncytial virus (RSV)]]
# [[Metapneumovirus]]
# [[Adenovirus]]
|}

* Newborn [[infant]]s, [[children]], and [[adult]]s are at risk for different spectrums of disease causing microorganisms.
* In addition, adults with [[chronic (medicine)|chronic]] illnesses, who live in certain parts of the world, who reside in [[nursing home]]s, who have recently been treated with [[antibiotic]]s, or who are [[alcoholism|alcoholics]] are at risk for unique infections.
===Infants===
====Source of Infection====
* Aerosol
* Aspiration of amniotic fluid
* Blood-borne infection across the [[placenta]]
=====Newborn=====
* Most common cause is [[Streptococcus agalactiae]] (Group B Streptococcus)
* GBS causes at least 50% of cases of CAP in the first week of life.<ref name="pmid2107797">{{cite journal| author=Webber S, Wilkinson AR, Lindsell D, Hope PL, Dobson SR, Isaacs D| title=Neonatal pneumonia. | journal=Arch Dis Child | year= 1990 | volume= 65 | issue= 2 | pages= 207-11 | pmid=2107797 | doi= | pmc=PMC1792235 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2107797 }} </ref>
* Other bacterial causes in the newborn period include ''[[Listeria monocytogenes]]'' and [[tuberculosis]]
* Viral causes like [[herpes simplex virus]] (most common) [[adenovirus]], [[mumps]], and [[enterovirus]]

===Children===
* For the most part, children older than one month are at risk for the same microorganisms as adults.
* However, children less than five years are much less likely to have pneumonia caused by ''[[mycoplasma pneumoniae]]'', ''[[chlamydophila pneumoniae]]'', or ''[[Legionella|legionella pneumophila]]''.
* In contrast, older children and teenagers are more likely to acquire ''[[mycoplasma pneumoniae]]'' and ''[[chlamydophila pneumoniae]]'' than adults.<ref name="pmid10048679">{{cite journal| author=Wubbel L, Muniz L, Ahmed A, Trujillo M, Carubelli C, McCoig C et al.| title=Etiology and treatment of community-acquired pneumonia in ambulatory children. | journal=Pediatr Infect Dis J | year= 1999 | volume= 18 | issue= 2 | pages= 98-104 | pmid=10048679 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10048679 }} </ref>
* A unique cause of CAP in this group is ''[[chlamydia trachomatis]]'', which is acquired during birth but does not cause pneumonia until 2-4 weeks later.
* Common viruses include [[respiratory syncytial virus]] (RSV), [[metapneumovirus]], [[adenovirus]], [[parainfluenza]], [[influenza]], and [[rhinovirus]].
* RSV in particular is a common source of illness and hospitalization.<ref name="pmid2177540">{{cite journal| author=Abzug MJ, Beam AC, Gyorkos EA, Levin MJ| title=Viral pneumonia in the first month of life. | journal=Pediatr Infect Dis J | year= 1990 | volume= 9 | issue= 12 | pages= 881-5 | pmid=2177540 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2177540 }} </ref>
* Fungi and parasites are not typically encountered in otherwise healthy infants, though maternally-derived [[syphilis]] can be a cause of CAP in this age group.

===Adults===
====Viruses====
* Viruses cause 20% of CAP cases.
* Common viruses are [[influenza]], [[parainfluenza]], [[respiratory syncytial virus]], [[metapneumovirus]], and [[adenovirus]].
* Less common viruses include [[varicella|chicken pox]], [[SARS]], [[H5N1|avian flu]], and [[hantavirus]].<ref name="pmid15078744.">{{cite journal| author=de Roux A, Marcos MA, Garcia E, Mensa J, Ewig S, Lode H et al.| title=Viral community-acquired pneumonia in nonimmunocompromised adults. | journal=Chest | year= 2004 | volume= 125 | issue= 4 | pages= 1343-51 | pmid=15078744. | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15078744 }} </ref>

====Atypical Organisms====
*[[Mycoplasma pneumoniae]], [[chlamydophila pneumoniae]], and [[Legionella|legionella pneumophila]] are often grouped as atypical pneumonia. Community acquired pneumonia caused by these agents present insidiously, with a non-productive cough and prominent extra-pulmonary complaints, such as myalgias and diarrhea (lack the typical pneumonia symptoms of fever, cough, and sputum).
* Mycoplasma pneumonia is often called is "walking pneumonia." It is transmitted via respiratory droplets and is common among healthy individuals in close contact with one another, such as dormitories or military barracks.
* Atypical organisms are more difficult to grow, respond to different antibiotics, and were discovered more recently than the typical bacteria discovered in the early twentieth century.

====Streptococcus Pneumoniae====
* '''Streptococcus pneumoniae''' is the most common cause of [[community acquired pneumonia]].
* Aspiration pneumonia is most commonly caused by anaerobic organisms.
* Prior to the development of antibiotics and vaccination, it was a leading cause of death.
* Traditionally, it was highly sensitive to [[penicillin]], but during the 1970s resistance to multiple antibiotics began to develop.
* Current strains of "drug resistant Streptococcus pneumoniae" or DRSP are common, accounting for twenty percent of all streptococcus pneumoniae infections.
* Adults with risk factors for DRSP including being older than 65, having exposure to children in day care, alcoholism, other severe underlying disease, or recent treatment with antibiotics should initially be treated with antibiotics effective against DRSP.<ref name="pmid14765343">{{cite journal| author=Ruhe JJ, Myers L, Mushatt D, Hasbun R| title=High-level penicillin-nonsusceptible Streptococcus pneumoniae bacteremia: identification of a low-risk subgroup. | journal=Clin Infect Dis | year= 2004 | volume= 38 | issue= 4 | pages= 508-14 | pmid=14765343 | doi=10.1086/381197 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14765343 }} </ref>

====Hemophilus Influenzae====
* Another common bacterial cause of CAP.
* First discovered in [[1892]], it was initially believed to be the cause of influenza because it commonly causes CAP in people who have suffered recent lung damage from viral pneumonia.
====Enteric Gram Negative Bacteria====
* Includes [[E.coli]] and [[K.pneumoniae]]
* Adults with risk factors for infection, which include living in a [[nursing home]], serious [[heart disease|heart]] and [[lung disease]], and recent [[antibiotic]] use should initially be treated with [[antibiotics]] effective against enteric Gram negative bacteria.

====Pseudomonas Aeruginosa====
* Uncommon cause of CAP, but it is a particularly difficult bacteria to treat.
* Individuals who are malnourished, have [[bronchiectasis]], are on [[corticosteroids]], or have recently had strong antibiotics for a week or more, should initially be treated with antibiotics effective against [[Pseudomonas aeruginosa]].<ref name="pmid8711652">{{cite journal| author=Lieberman D, Schlaeffer F, Boldur I, Lieberman D, Horowitz S, Friedman MG et al.| title=Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients. | journal=Thorax | year= 1996 | volume= 51 | issue= 2 | pages= 179-84 | pmid=8711652 | doi= | pmc=PMC473032 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8711652 }} </ref>

====Special Situations====
* Coccidioides are common in southwestern US.
* Anaerobic infection is common in alcoholics. Pneumococcal pneumonia remains the most common cause of CAP in alcoholics too.
* [[Psittacosis]] (due to [[Chlamydophila psittaci]]) should be considered in the patient with exposure to birds or bird droppings.
* [[Anaerobes]] are common in patients with poor dental hygiene, and a suspected large volume of aspiration.
* [[Streptococcus pneumoniae]], [[H.influenzae]], [[moraxella catarrhalis]], and [[legionella]] species are the common causes of community acquired pneumonia in [[COPD|chronic obstructive pulmonary disorders]] and smokers.
* [[S. pneumoniae]], gram negative bacilli, [[H.influenzae]], [[staphylococcus aureus]], anaerobes, and [[chlamydia pneumoniae]] are more common in nursing home residents.
* [[S. pneumoniae]], [[H.influenzae]], and [[mycobacterium tuberculosis]] are common pathogens in early stages of HIV, whereas, P.jiroveci, [[histoplasma]], and [[cryptococcus]] are commonly seen in late stages HIV.
* In patients with structural lung disease such as [[bronchiectasis]] and [[cystic fibrosis]], [[pseudomonas aeruginosa]], [[Burkholderia cepacia]] (pseudomonas), and [[staphylococcus aureus]] are the common pathogens involved.

==Aspiration Pneumonia Causes==
* Incompetent [[swallowing]] mechanism, such as in neurological disease (a common cause being [[cerebrovascular accident|strokes]]) or while a person is [[Drunkenness|intoxicated]].
* [[Iatrogenic]] causes such as [[general anaesthesia]] for an [[Surgery|operation]]. Patients are therefore instructed to be [[nil per os]] (NPO) for at least four hours before surgery.
* Whether aspiration pneumonia represents a true bacterial infection or a chemical inflammatory process remains the subject of significant controversy.

===Drug Side Effect===
*[[Blinatumomab]]
*[[Belimumab]]
*[[Boceprevir]]
*[[Ceritinib]]
*[[Dornase Alfa]]
*[[Enfuvirtide]]
*[[ethanolamine oleate]]
*[[Felbamate]]
*[[Iloperidone]]
*[[interferon alfacon-1]]
*[[Pegylated interferon alfa-2b]]

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]

{{WH}}
{{WS}}

Idiopathic thrombocytopenic purpura causes

2015-04-28T18:23:37Z

Rabin Bista: /* Overview */

__NOTOC__
{{ITP}}
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.

{{CMG}}

==Overview==
The cause of ITP is thought to be related to chronic infections such as [[HIV]], [[hepatitis C]] and [[H. Pylori]].

===Medicines===
[[interferon alfacon-1]]

==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Emergency medicine]]
[[Category:Blood disorders]]
[[Category:Hematology]]
[[Category:Dermatology]]
[[Category:Needs content]]
[[Category:Needs causes]]

Hypothyroidism causes

2015-04-28T18:22:54Z

Rabin Bista: /* Causes by Organ System */

{{Hypothyroidism}}
{{CMG}}

==Overview==

==Causes==
There are several distinct causes for chronic hypothyroidism.
===Common Causes===
Historically and, still, in many developing countries [[iodine deficiency]] is the most common cause of hypothyroidism world-wide. In present day developed countries, however, hypothyroidism is mostly caused by [[Hashimoto's thyroiditis]], or by a lack of the [[thyroid]] gland or a deficiency of hormones from either the hypothalamus or the pituitary.

===Less Common Causes===
*Hypothyroidism can result from postpartum [[thyroiditis]], a condition that affects about 5% of all women within a year after giving birth. The first phase is typically hyperthyroidism. Then, the thyroid either returns to normal or a woman develops hypothyroidism. Of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring life-long treatment.

*Hypothyroidism can also result from sporadic inheritance, sometimes [[autosome|autosomal]] recessive.

*Temporary hypothyroidism can be due to the [[Wolff-Chaikoff effect]].

===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Axitinib]], [[interferon alfacon-1]], [[Mitotane]], [[Nivolumab]], [[Pegylated interferon alfa-2b]], [[Pembrolizumab]], [[Pergolide]], [[Pramipexole]], [[Tiagabine]], [[Tocilizumab]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
* [[Amyloidosis]]
* Antithyroid drugs
* [[Cystinosis]]
* [[Dermatosclerosis]]
* [[Drugs]] such as [[Oxcarbazepine]]
* [[Hashimoto's Thyroiditis]]
* Head and neck surgery
* [[Hemochromatosis]]
* Iodine deficiency
* [[Neoplastic]]
* Peripheral thyroid gland disorder resistance
*[[Pergolide]]
* [[Radiation]] therapy to head neck or chest area
* Radioactive iodine therapy
* [[Reidel's Thyroiditis]]
* [[Sarcoidosis]], granulomatous disease
* [[Scleroderma]]
* Secondary hypothyroidism
* Silent [[thyroiditis]]
* Subacute [[thyroiditis]]
* Subtotal thyroidectomy
* Supprative [[thyroiditis]]
* Thyreostatic therapy
* Thyroid agenesis, dysgenesis, ectopy
*[[Tiagabine]]
* [[TSH]] (thyroid stimulating hormone) deficiency

[[Category:Needs content]]
[[Category:Thyroid disease]]
[[Category:Endocrinology]]

Hyperthyroidism causes

2015-04-28T18:21:43Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Template:Hyperthyroidism}}
{{CMG}}

==Overview==

Hyperthyroidism is the result of excess thyroid hormone production, causing an overactive metabolism and increased speed of all the body's processes.

Thyroid hormone generally controls the pace of all of the processes in the body. This pace is called one's metabolism. If there is too much thyroid hormone, every function of the body tends to speed up. The thyroid gland regulates the body temperature by secreting two hormones that control how quickly the body burns calories and energy. If the thyroid produces too much hormone, the condition is called hyperthyroidism, but if too little is produced, the result is [[hypothyroidism]].

==Causes==
Major causes in humans are:
* [[Graves disease|Graves' disease]] (the most common etiology with 70-80%)
* [[Toxic thyroid adenoma]]
* [[Toxic multinodular goitre]]

Other causes of hyperthyroxinemia (high blood levels of thyroid hormones) are not to be confused with true hyperthyroidism and include subacute and other forms of [[thyroiditis]] (inflammation) and [[struma ovarii]] (a [[teratoma]]). Thyrotoxicosis (symptoms caused by hyperthyroxinemia) can occur in both hyperthyroidism and thyroiditis. When it causes acutely increased metabolism, it is sometimes called "thyroid storm", a life-threatening event characterized by [[tachycardia]], [[hypertension]], and [[fever]].

Excess thyroid hormone from pills can also cause hyperthyroidism. [[Amiodarone]], a heart medication, can sometimes cause hyperthyroidism. Hamburger toxicosis is a condition that occurs sporadically and is associated with ground beef contaminated with thyroid hormone.

[[Postpartum thyroiditis]] occurs in about 7% of women during the year after they give birth. PPT typically has several phases, the first of which is hyperthyroidism. Many times, the hyperthyroidism corrects itself within weeks or months without any treatment necessary.

===Life Threatening Causes===

===Common Causes===

===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Axitinib]], [[interferon alfacon-1]], [[Nivolumab]], [[Pegylated interferon alfa-2b]],[[Pembrolizumab]], [[Pramipexole]], [[Sorafenib]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===

{{col-begin|width=80%}}
{{col-break|width=33%}}
* [[Pramipexole]]
*[[Sorafenib]]

{{col-break|width=33%}}
*

{{col-break|width=33%}}
*
{{col-end}}

==Citing Sources==

==References==

{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Thyroid disease]]
[[Category:Endocrinology]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Disease]]
[[Category:Mature chapter]]
[[Category:Otolaryngology]]
[[Category:Needs overview]]

Hypersensitivity

2015-04-28T18:21:12Z

Rabin Bista: /* Causes by Organ System */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = 28827 |
ICD10 = {{ICD10|T|78|4|t|66}} |
ICD9 = {{ICD9|995.3}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D006967 |
}}

{{SI}}

{{CMG}}

==Overview==
'''Hypersensitivity''' refers to undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system. Hypersensitivity reactions require a pre-sensitized (immune) state of the host. The four-group classification was expounded by [[Philip George Houthem Gell|P. H. G. Gell]] and [[Robin Coombs]] in 1963.<ref>Gell PGH, Coombs RRA, eds. Clinical Aspects of Immunology. 1st ed. Oxford, England: Blackwell; 1963.</ref>

==Comparison table==
{|Class="wikitable"
|+ Comparison of hypersensitivity types
|-
! Type !! Alternative names <ref name=Immunology195Unless> Unless else specified in boxes, then ref is: Lippincott's Illustrated Reviews: Immunology. Paperback: 384 pages. Publisher: Lippincott Williams & Wilkins; (July 1, 2007). Language: English. ISBN-10: 0781795435. ISBN-13: 978-0781795432. Page 195 </ref> !! Often mentioned disorders<ref name=Immunology195Unless/> !! Mediators<ref name=Immunology195Unless/>
|-
! 1
| [[Allergy]] ||
*[[Atopy]]
*[[Anaphylaxis]]
*[[Asthma]]
||
*[[Immunoglobulin E|IgE]]
|-
! 2
| Cytotoxic, antibody-dependent ||
*[[erythroblastosis fetalis]]
*[[Goodpasture's syndrome]]
*[[autoimmune hemolytic anemia]]
||
*[[Immunoglobulin M|IgM]] or [[Immunoglobulin G|IgG]]
*([[Complement system|Complement]])
|-
! 3
| Immune complex disease ||
*[[Serum sickness]]
*[[Arthus reaction]]
*[[Systemic lupus erythematosus|SLE]]
||
*[[Immunoglobulin G|IgG]]
*([[Complement system|Complement]])
|-
! 4
| cell-mediated ||
*[[contact dermatitis]]
*[[tuberculosis]]
*[[Chronic transplant rejection]]
||
*[[Cell-mediated immunity|Cell-mediated]]
|}

==Type 1 - immediate (or atopic, or anaphylactic) ==
{{main|Allergy}}

Type 1 hypersensitivity is an allergic reaction provoked by reexposure to a specific type of [[antigen]] referred to as an allergen.<ref>{{eMedicine|med|1101}}</ref> Exposure may be by [[ingestion]], [[inhalation]], [[injection (medicine)|injection]], or direct contact. The difference between a normal immune response and a type I hypersensitive response is that plasma cells secrete [[IgE]]. This class of antibodies binds to Fc receptors on the surface of tissue mast cells and blood basophils. Mast cells and basophils coated by IgE are "sensitized." Later exposure to the same allergen, cross-links the bound IgE on sensitized cells resulting in [[degranulation]] and the secretion of pharmacologically active mediators such as mastcell
, [[leukotriene]], and [[prostaglandin]] that act on the surrounding tissues. The principal effects of these products are [[vasodilation]] and smooth-muscle contraction.

The reaction may be either local or systemic. Symptoms vary from mild irritation to sudden death from [[Anaphylaxis|anaphylactic shock]]. Treatment usually involves [[epinephrine]], [[antihistamines]], and [[corticosteroid]]s. If the entire body gets involved, then anaphylaxis can take place; an acute, systemic reaction that can prove fatal.

Some examples:
*Allergic [[asthma]]
*Allergic [[conjunctivitis]]
*[[Allergic rhinitis]] ("hay fever")
*Anaphylaxis
*[[Angioedema]]
*[[Asparaginase Erwinia Chrysanthemi]]
*[[Urticaria]] (hives)
*[[Eosinophilia]]
*[[Penicillin]]
*[[Cephalosporin]]
*[[Lincomycin Hydrochloride]]

==Type 2 - antibody-dependent ==

In type 2 hypersensitivity, the antibodies produced by the immune response bind to antigens on the patient's own cell surfaces. The antigens recognized in this way may either be intrinsic ("self" antigen, innately part of the patient's cells) or extrinsic (absorbed onto the cells during exposure to some foreign antigen, possibly as part of infection with a pathogen). These cells are recognised by [[macrophage]]s or [[dendritic cell]]s which act as antigen presenting cells, this causes a [[B cell]] response where antibodies are produced against the foreign antigen.

An example here is the reaction to penicillin where the drug can bind to red blood cells causing them to be recognised as different, B cell proliferation will take place and antibodies to the drug are produced. [[IgG]] and [[IgM]] antibodies bind to these antigens to form complexes that activate the [[classical complement pathway|classical pathway]] of [[complement system|complement]] activation for eliminating cells presenting foreign antigens (which are usually, but not in this case, pathogens). That is, mediators of acute inflammation are generated at the site and [[Complement membrane attack complex|membrane attack complex]]es cause cell [[lysis]] and death. The reaction takes hours to a day.

Another form of type 2 hypersensitivity is called [[antibody-dependent cell-mediated cytotoxicity]] (ADCC). Here, cells exhibiting the foreign antigen are tagged with antibodies (IgG or IgM). These tagged cells are then recognised by natural killer (NK) cells and macrophages (recognised via IgG bound (via the Fc region) to the effector cell surface receptor, [[CD16]] (FcγRIII)), which in turn kill these tagged cells.

Some examples:
*Autoimmune hemolytic [[anemia]]
*[[Goodpasture's syndrome]]
*[[Pemphigus]]
*[[Pernicious anemia]] (if autoimmune)
*[[Thrombocytopenia|Immune thrombocytopenia]]
*[[Blood transfusion|Transfusion]] reactions
*[[Hashimoto's thyroiditis]]
*[[Graves disease]] (see type V below)
*[[Myasthenia gravis]] (see type V below)
*[[Rheumatic fever]]
*[[Hemolytic disease of the newborn]] (erythroblastosis fetalis)
*[[Acute transplant rejection]]

==Type 3 - immune complex ==

Type 3 hypersensitivity occurs when antigens and antibodies are present in roughly equal amounts, causing extensive cross-linking. Large immune complexes that cannot be cleared are deposited in vessel walls and induce an inflammatory response. The reaction can take hours, days, or even weeks to develop.

Some clinical examples:
*[[Rheumatoid arthritis]]
*Immune complex [[glomerulonephritis]]
*[[Serum sickness]]
*Subacute bacterial [[endocarditis]]
*Symptoms of [[malaria]]
*[[Systemic lupus erythematosus]]
*[[Arthus reaction]]
*[[Farmer's lung]] (Arthus-type reaction)
*[[Polyarteritis nodosa]]

==Type 4 - cell-mediated (delayed-type hypersensitivity, DTH) ==
{{seealso|Cell mediated immunity}}

Type 4 hypersensitivity is often called delayed type as the reaction takes two to three days to develop. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.

CD8+ [[cytotoxic T cell]]s and CD4+ [[helper T cell]]s recognise antigen in a complex with either type 1 or 2 [[major histocompatibility complex]]. The antigen-presenting cells in this case are macrophages which secrete [[IL-12]], which stimulates the proliferation of further CD4+ T cells. CD4+ T cells secrete [[IL-2]] and [[interferon]] gamma, further inducing the release of other Type 1 cytokines, thus mediating the immune response. Activated CD8+ T cells destroy target cells on contact while activated macrophages produce [[hydrolytic enzyme|hydrolytic]] [[enzyme]]s and, on presentation with certain intracellular pathogens, transform into multinucleated [[giant cell]]s.

Some clinical examples:
*[[Contact dermatitis]] ([[Toxicodendron radicans|poison ivy]] rash, for example)
*[[Atopic dermatitis]] (eczema)
*[[Temporal arteritis]]
*Symptoms of [[leprosy]]
*Symptoms of [[tuberculosis]]
*[[Mantoux test]]
*[[Coeliac disease]]
*[[Chronic transplant rejection]]

==Type 5 - stimulatory ==

This is an additional type that is sometimes (often in Britain) used as a distinction from Type 2.<ref>Rajan TV. The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation. ''Trends Immunol''. 2003 Jul;24(7):376-9. PMID 12860528</ref>

Instead of binding to cell surface components, the antibodies recognize and bind to the cell surface [[receptor (biochemistry)|receptors]], which either prevents the intended [[ligand]] binding with the receptor or mimics the effects of the ligand, thus impairing cell signalling.

Some clinical examples:
*[[Graves disease]]
*[[Myasthenia gravis]]

(There is also a type 6 hypersensitivity reaction in which natural killer cells lyse cells that have been coated in antibody and this reaction is thought to be implicated with certain autoimmune diseases, tumour rejection & parasite rejection).

==Causes==
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Ado-trastuzumab emtansine]], [[Aminohippurate]], [[Amoxicillin]], [[Aprotinin]], [[Artemether/lumefantrine]], [[Asparaginase]], [[Aspirin]], [[Azficel-T]], [[Bepotastine Besilate]], [[Bicalutamide]], [[Blinatumomab]], [[Boceprevir]], [[Butalbital]], [[Conestat alfa]], [[Cytarabine]], [[Desmopressin]], [[Dexpanthenol]], [[dibucaine]], [[Ecallantide]], [[Elosulfase alfa]], [[Epirubicin ]], [[ferumoxytol]], [[Flutemetamol F 18]], [[Fluoxymesterone]], [[gadoxetate]], [[Gallium Citrate Ga 67]], [[Goserelin]], [[hexaminolevulinate]], [[Human rabies virus immune globulin]], [[hydroxyethyl starch]], [[Hydroxyprogesterone caproate]], [[Interferon alfa-2b ]], [[interferon alfacon-1]], [[Ixabepilone]], [[Levoleucovorin]], [[Lomefloxacin hydrochloride]], [[Meropenem]], [[Metaproterenol]], [[Methylene blue]], [[Netupitant and palonosetron]], [[Oritavancin]], [[Paclitaxel]], [[Phenobarbital]], [[Piperacillin/tazobactam]], [[Rimabotulinumtoxinb]], [[Sacrosidase]], [[Sorafenib]], [[Sulfasalazine]], [[Oprelvekin]], [[Penicillin G potassium]], [[Pertuzumab]], [[Sulfacetamide]], [[Teniposide]], [[tuberculin]], [[Trimethobenzamide]], [[Vedolizumab]], [[Umeclidinium]].
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}

===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Ado-trastuzumab emtansine]]
*[[Amoxicillin]]
*[[Artemether/lumefantrine]]
*[[Boceprevir]]
*[[Cytarabine]]
*[[Desmopressin]]
*[[Ferumoxytol]]
*[[Gadoxetate]]
*[[Hexaminolevulinate]]
*[[Ixabepilone]]
*[[Lomefloxacin hydrochloride]]
*[[Oprelvekin]]
*[[Oritavancin]]
*[[Paclitaxel]]
*[[Phenobarbital]]
*[[Sorafenib]]
*[[Teniposide]]

{{col-break|width=33%}}

{{col-break|width=33%}}

{{col-end}}

== See also ==

* [[Allergy]]

==References==
<references/>

==External links==
* {{GPnotebook|-529858552}}
* {{FPnotebook|ENT46}}

{{Consequences of external causes}}

[[Category:Immune system]]
[[Category:Immune system disorders]]
[[Category:Allergology]]
[[Category:Immunology]]

[[de:Überempfindlichkeitsreaktion]]
[[no:Hypersensitivitet]]
[[pl:Nadwrażliwość]]
[[vec:Clasificaxion de Gell e Coombs]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

ST elevation myocardial infarction causes

2015-04-28T18:20:41Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{ST elevation myocardial infarction}}
{{CMG}}; {{AE}} {{Ochuko}}

==Overview==
The most common proximate cause of ST elevation myocardial infarction is plaque rupture. There are risk factors for plaque rupture and triggers of plaque rupture. A full discussion regarding the [[ST elevation myocardial infarction risk factors|chronic risk factors]] and [[ST elevation myocardial infarction triggers|acute triggers]] of ST elevation MI can be found in other chapters. While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might differ substantially from that of plaque rupture: [[cocaine]] induced STEMI would not be treated with [[beta-blocker]]s, and [[myocardial contusion]] would not be treated with an [[antithrombin]]. These conditions include the following:

==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

* [[Aortic dissection]]
* [[Carbon monoxide poisoning]]
* [[Disseminated intravascular coagulation]]
* [[Infectious endocarditis]]

===Common Causes===
*[[Plaque rupture]]

===Causes by Organ System===

{|style="width:75%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[amyloidosis]], [[anaphylactic shock]], [[aortic dissection]], [[aortic stenosis]], [[arrhythmias]], [[atherosclerosis]], [[bradyarrhythmias]], [[broken heart syndrome]], [[commotio cordis]], [[coronary artery aneurysm]], [[coronary artery dissection]], [[coronary artery vasospasm]], [[coronary heart disease]], [[coronary stent thrombosis]], [[coronary thrombosis]], [[dissecting aortic aneurysm]], [[dyslipidemia]], [[Hurler disease]] [[hypertension]], [[hypotension]], [[idiopathic hypertrophic subaortic stenosis]], [[infectious endocarditis]], [[Kawasaki disease]], [[malignant hypertension]], [[myocardial contusion]],[[plaque rupture]], [[prinzmetal angina]], [[Progesterone]], [[pseudoxanthoma elasticum]], [[stress cardiomyopathy]], [[tachyarrhythmias]], [[Takayasu arteritis]], [[Takotsubo cardiomyopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Carbon monoxide poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Kawasaki disease]], [[pseudoxanthoma elasticum]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[Aldesleukin]], [[almotriptan]], [[alvimopan]], [[Amlodipine besylate and Valsartan]], [[amphetamines]], [[anabolic steroids]], [[cocaine]], [[combined oral contraceptive pill]], [[caspofungin acetate]], [[desmopressin]], [[desogestrel and ethinyl estradiol]], [[diclofenac (patch)]], [[diflunisal]], [[disulfiram]], [[eletriptan]], [[ephedrine]], [[Estropipate]], [[erythropoietin]], [[ergonovine]], [[estramustine]], [[ethynodiol diacetate and ethinyl estradiol]], [[etravirine]], [[etonogestrel]], [[fibrinogen]],[[goserelin]], [[idarubicin hydrochloride]], [[indinavir]], [[interferon alfacon-1]], [[interferon gamma]], [[letrozole]], [[leuprolide]], [[levothyroxine]], [[marijuana]], [[beta blockers|sudden withdrawal of beta blockers]], [[meclofenamate]], [[medroxyprogesterone]], [[mefenamic acid]], [[meloxicam]], [[meropenem]], [[methoxy polyethylene glycol-epoetin beta]], [[naratriptan]], [[niacin]], [[Norgestimate and Ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol]], [[nitrates|sudden withdrawal of nitrates]], [[oxaprozin]], [[pegylated interferon alfa-2b]], [[pergolide]], [[piroxicam]], [[pramipexole]], [[ramucirumab]], [[Repaglinide and Metformin hydrochloride]], [[Rubidium Rb 82]], [[sertraline]], [[sumatriptan]], [[testosterone]], [[thalidomide]], [[tiagabine]], [[toremifene]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Thyrotoxicosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Amyloidosis]], [[diabetes mellitus]], [[pheochromocytoma]], [[thyrotoxicosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Air pollution]], [[ST elevation myocardial infarction triggers|earthquakes]], [[dust|fine particulate matter]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Hurler disease]], [[pseudoxanthoma elasticum]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Fabry's disease]], [[familial hypercholesterolemia]], [[homocystinuria]], [[Hurler disease]], [[mucopolysaccharidoses]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Disseminated intravascular coagulation]], [[hypercoagulable states]], [[polycythemia vera]], [[thrombocytosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Coronary stent thrombosis]], [[beta blockers|sudden withdrawal of beta blockers]], [[nitrates|sudden withdrawal of nitrates]], [[transluminal percutaneous coronary angioplasty]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Infectious endocarditis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Homocystinuria]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[Amyloidosis]], [[dyslipidemia]], [[electrolyte imbalance]], [[Fabry's disease]], [[familial hypercholesterolemia]], [[ST elevation myocardial infarction triggers|heavy meal]], [[homocystinuria]], [[Hurler disease]], [[mucopolysaccharidoses]], [[thiamine deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Combined oral contraceptive pill]], [[nuvaring]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Pheochromocytoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Homocystinuria]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Cocaine]], [[epinephrine|epinephrine overdose]], [[marijuana]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety]], [[bereavement]], [[broken heart syndrome]], [[Hurler disease]], [[psychological stress]], [[stress cardiomyopathy]],
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Anaphylactic shock]], [[respiratory failure]], [[upper respiratory tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Electrolyte imbalance]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Amyloidosis]], [[anaphylactic shock]], [[polyarteritis nodosa]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Sexual activity]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Electrocution]], [[myocardial contusion]], [[sports injury]], [[trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Anger]], [[electrocution]], [[exertion|physical exertion]], [[ST elevation myocardial infarction triggers|wartime bombing/missile attacks]]
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[Acute coronary syndrome]]
*[[Air pollution]] <ref name="pmid11401937">{{cite journal |author=Peters A, Dockery DW, Muller JE, Mittleman MA |title=Increased particulate air pollution and the triggering of myocardial infarction |journal=Circulation |volume=103 |issue=23 |pages=2810–5 |year=2001 |month=June |pmid=11401937 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11401937}}</ref><ref name="pmid9174559">{{cite journal |author=Peters A, Döring A, Wichmann HE, Koenig W |title=Increased plasma viscosity during an air pollution episode: a link to mortality? |journal=Lancet |volume=349 |issue=9065 |pages=1582–7 |year=1997 |month=May |pmid=9174559 |doi=10.1016/S0140-6736(97)01211-7 |url=}}</ref><ref name="pmid11440492">{{cite journal |author=Peters A, Fröhlich M, Döring A, ''et al'' |title=Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study |journal=Eur. Heart J. |volume=22 |issue=14 |pages=1198–204 |year=2001 |month=July |pmid=11440492 |doi=10.1053/euhj.2000.2483 |url=}}</ref><ref name="pmid9927345">{{cite journal |author=Pope CA3rd, Dockery DW, Kanner RE, Villegas GM, Schwartz J |title=Oxygen saturation, pulse rate, and particulate air pollution: A daily time-series panel study |journal=Am. J. Respir. Crit. Care Med. |volume=159 |issue=2 |pages=365–72 |year=1999 |month=February |pmid=9927345 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=9927345}}</ref> <ref name="pmid10568625">{{cite journal |author=Peters A, Perz S, Döring A, Stieber J, Koenig W, Wichmann HE |title=Increases in heart rate during an air pollution episode |journal=Am. J. Epidemiol. |volume=150 |issue=10 |pages=1094–8 |year=1999 |month=November |pmid=10568625 |doi= |url=http://aje.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10568625}}</ref>
*[[Amphetamines]]
*[[Amyloidosis]]
*[[Anabolic steroids]]
*[[Anaphylactic shock]]
*[[Anger]]<ref name="pmid7671353">{{cite journal |author=Mittleman MA, Maclure M, Sherwood JB, ''et al'' |title=Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators |journal=Circulation |volume=92 |issue=7 |pages=1720–5 |year=1995 |month=October |pmid=7671353 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7671353}}</ref><ref name="pmid10593637">{{cite journal |author=Möller J, Hallqvist J, Diderichsen F, Theorell T, Reuterwall C, Ahlbom A |title=Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP) |journal=Psychosom Med |volume=61 |issue=6 |pages=842–9 |year=1999 |pmid=10593637 |doi= |url=http://www.psychosomaticmedicine.org/cgi/pmidlookup?view=long&pmid=10593637}}</ref><ref name="pmid15596741">{{cite journal |author=Koton S, Tanne D, Bornstein NM, Green MS |title=Triggering risk factors for ischemic stroke: a case-crossover study |journal=Neurology |volume=63 |issue=11 |pages=2006–10 |year=2004 |month=December |pmid=15596741 |doi= |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15596741}}</ref>
*[[Anxiety]]<ref name="pmid7671353">{{cite journal |author=Mittleman MA, Maclure M, Sherwood JB, ''et al'' |title=Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators |journal=Circulation |volume=92 |issue=7 |pages=1720–5 |year=1995 |month=October |pmid=7671353 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=7671353}}</ref>
*[[Aortic dissection]]
*[[Aortic stenosis]]
*[[Arrhythmias]]
*[[Atherosclerosis]]
*[[Bereavement]]
*[[Bradyarrhythmias]]
*[[Broken heart syndrome]]
*[[Carbon monoxide poisoning]]
*[[Cocaine]] <ref name="pmid10351966">{{cite journal |author=Mittleman MA, Mintzer D, Maclure M, Tofler GH, Sherwood JB, Muller JE |title=Triggering of myocardial infarction by cocaine |journal=Circulation |volume=99 |issue=21 |pages=2737–41 |year=1999 |month=June |pmid=10351966 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10351966}}</ref>
*[[Combined oral contraceptive pill]]
*[[Commotio cordis]]
*[[Coronary artery aneurysm]]
*[[Coronary artery dissection]]
*[[Coronary artery vasospasm]]
*[[Coronary heart disease]]
*[[Coronary stent thrombosis]]
*[[Coronary thrombosis]]
*[[Desmopressin]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Diabetes mellitus]]
*[[Diflunisal]]
*[[Disulfiram]]
*[[Dissecting aortic aneurysm]]
*[[Dyslipidemia]]
*[[ST elevation myocardial infarction triggers|Earthquakes]] <ref name="pmid8651102">{{cite journal |author=Leor J, Kloner RA |title=The Northridge earthquake as a trigger for acute myocardial infarction |journal=Am. J. Cardiol. |volume=77 |issue=14 |pages=1230–2 |year=1996 |month=June |pmid=8651102 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914996001695}}</ref><ref name="pmid8552142">{{cite journal |author=Leor J, Poole WK, Kloner RA |title=Sudden cardiac death triggered by an earthquake |journal=N. Engl. J. Med. |volume=334 |issue=7 |pages=413–9 |year=1996 |month=February |pmid=8552142 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8552142&promo=ONFLNS19}}</ref><ref name="pmid10220631">{{cite journal |author=Brown DL |title=Disparate effects of the 1989 Loma Prieta and 1994 Northridge earthquakes on hospital admissions for acute myocardial infarction: importance of superimposition of triggers |journal=Am. Heart J. |volume=137 |issue=5 |pages=830–6 |year=1999 |month=May |pmid=10220631 |doi= |url=}}</ref>
*[[Electrocution]]
*[[Electrolyte imbalance]]
*[[Ephedrine]]
*[[epinephrine|Epinephrine overdose]]
*[[Erythropoietin]]
*[[Ethynodiol diacetate and ethinyl estradiol]]
*[[Etonogestrel]]
*[[Fabry's disease]]
*[[Familial hypercholesterolemia]]
*[[dust|Fine particulate matter]] <ref name="pmid10378998">{{cite journal |author=Liao D, Creason J, Shy C, Williams R, Watts R, Zweidinger R |title=Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly |journal=Environ. Health Perspect. |volume=107 |issue=7 |pages=521–5 |year=1999 |month=July |pmid=10378998 |pmc=1566669 |doi= |url=}}</ref> <ref name="pmid10539820">{{cite journal |author=Pope CA, Verrier RL, Lovett EG, ''et al'' |title=Heart rate variability associated with particulate air pollution |journal=Am. Heart J. |volume=138 |issue=5 Pt 1 |pages=890–9 |year=1999 |month=November |pmid=10539820 |doi= |url=}}</ref> <ref name="pmid10725286">{{cite journal |author=Gold DR, Litonjua A, Schwartz J, ''et al'' |title=Ambient pollution and heart rate variability |journal=Circulation |volume=101 |issue=11 |pages=1267–73 |year=2000 |month=March |pmid=10725286 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10725286}}</ref><ref name="pmid10615837">{{cite journal |author=Peters A, Liu E, Verrier RL, ''et al'' |title=Air pollution and incidence of cardiac arrhythmia |journal=Epidemiology |volume=11 |issue=1 |pages=11–7 |year=2000 |month=January |pmid=10615837 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1044-3983&volume=11&issue=1&spage=11}}</ref>
*[[ST elevation myocardial infarction triggers|Heavy meal]] <ref name="pmid15609883">{{cite journal |author=Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS |title=Heavy meals as a trigger for a first event of the acute coronary syndrome: a case-crossover study |journal=Isr. Med. Assoc. J. |volume=6 |issue=12 |pages=728–31 |year=2004 |month=December |pmid=15609883 |doi= |url=}}</ref><ref name="pmid9036757">{{cite journal |author=Vogel RA, Corretti MC, Plotnick GD |title=Effect of a single high-fat meal on endothelial function in healthy subjects |journal=Am. J. Cardiol. |volume=79 |issue=3 |pages=350–4 |year=1997 |month=February |pmid=9036757 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914996007606}}</ref>
*[[Homocystinuria]]
*[[Hurler disease]]
*[[Hypercoagulable states]]
*[[Hypertension]]
*[[Hypotension]]
*[[Idarubicin hydrochloride]]
*[[Idiopathic hypertrophic subaortic stenosis]]
*[[Indinavir]]
*[[Infectious endocarditis]]
*[[Interferon gamma]]
*[[Kawasaki disease]]
*[[Malignant hypertension]]
*[[Marijuana]] <ref name="pmid11401936">{{cite journal |author=Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE |title=Triggering myocardial infarction by marijuana |journal=Circulation |volume=103 |issue=23 |pages=2805–9 |year=2001 |month=June |pmid=11401936 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11401936}}</ref>
*[[ST elevation myocardial infarction triggers|Missile attacks]] <ref name="pmid16000653">{{cite journal |author=Allegra JR, Mostashari F, Rothman J, Milano P, Cochrane DG |title=Cardiac events in New Jersey after the September 11, 2001, terrorist attack |journal=J Urban Health |volume=82 |issue=3 |pages=358–63 |year=2005 |month=September |pmid=16000653 |doi=10.1093/jurban/jti087 |url=}}</ref><ref name="pmid1679475">{{cite journal |author=Meisel SR, Kutz I, Dayan KI, ''et al'' |title=Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians |journal=Lancet |volume=338 |issue=8768 |pages=660–1 |year=1991 |month=September |pmid=1679475 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0140-6736(91)91234-L}}</ref>
*[[Medroxyprogesterone]]
*[[Meloxicam]]
*[[Mucopolysaccharidoses]]
*[[Myocardial contusion]]
*[[Naratriptan]]
*[[Niacin]]
*[[Norgestrel and Ethinyl estradiol]]
*[[Nuvaring]]
*[[Oxaprozin]]
*[[Pergolide]]
*[[Pheochromocytoma]] <ref name="pmid22441003">{{cite journal| author=Subramanyam S, Kreisberg RA| title=Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy. | journal=Endocr Pract | year= 2012 | volume= 18 | issue= 4 | pages= e77-80 | pmid=22441003 | doi=10.4158/EP11346.CR | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22441003 }} </ref>
*[[exertion|Physical exertion]]<ref name="pmid8232457">{{cite journal |author=Willich SN, Lewis M, Löwel H, Arntz HR, Schubert F, Schröder R |title=Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group |journal=N. Engl. J. Med. |volume=329 |issue=23 |pages=1684–90 |year=1993 |month=December |pmid=8232457 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8232457&promo=ONFLNS19}}</ref><ref name="pmid9603539">{{cite journal |author=Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB |title=Prediction of coronary heart disease using risk factor categories |journal=Circulation |volume=97 |issue=18 |pages=1837–47 |year=1998 |month=May |pmid=9603539 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9603539}}</ref><ref name="pmid8232456">{{cite journal |author=Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE |title=Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators |journal=N. Engl. J. Med. |volume=329 |issue=23 |pages=1677–83 |year=1993 |month=December |pmid=8232456 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8232456&promo=ONFLNS19}}</ref><ref name="pmid10707914">{{cite journal |author=Hallqvist J, Möller J, Ahlbom A, Diderichsen F, Reuterwall C, de Faire U |title=Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study |journal=Am. J. Epidemiol. |volume=151 |issue=5 |pages=459–67 |year=2000 |month=March |pmid=10707914 |doi= |url=http://aje.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10707914}}</ref><ref name="pmid10568645">{{cite journal |author=Giri S, Thompson PD, Kiernan FJ, ''et al'' |title=Clinical and angiographic characteristics of exertion-related acute myocardial infarction |journal=JAMA |volume=282 |issue=18 |pages=1731–6 |year=1999 |month=November |pmid=10568645 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10568645}}</ref><ref name="pmid11070099">{{cite journal |author=Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE |title=Triggering of sudden death from cardiac causes by vigorous exertion |journal=N. Engl. J. Med. |volume=343 |issue=19 |pages=1355–61 |year=2000 |month=November |pmid=11070099 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11070099&promo=ONFLNS19}}</ref><ref name="pmid16551711">{{cite journal |author=Whang W, Manson JE, Hu FB, ''et al'' |title=Physical exertion, exercise, and sudden cardiac death in women |journal=JAMA |volume=295 |issue=12 |pages=1399–403 |year=2006 |month=March |pmid=16551711 |doi=10.1001/jama.295.12.1399 |url=}}</ref><ref name="pmid6472399">{{cite journal |author=Siscovick DS, Weiss NS, Fletcher RH, Lasky T |title=The incidence of primary cardiac arrest during vigorous exercise |journal=N. Engl. J. Med. |volume=311 |issue=14 |pages=874–7 |year=1984 |month=October |pmid=6472399 |doi= |url=}}</ref><ref name="pmid8232456">{{cite journal |author=Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE |title=Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators |journal=N. Engl. J. Med. |volume=329 |issue=23 |pages=1677–83 |year=1993 |month=December |pmid=8232456 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8232456&promo=ONFLNS19}}</ref><ref name="pmid8232456">{{cite journal |author=Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE |title=Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators |journal=N. Engl. J. Med. |volume=329 |issue=23 |pages=1677–83 |year=1993 |month=December |pmid=8232456 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=8232456&promo=ONFLNS19}}</ref><ref name="pmid10707914">{{cite journal |author=Hallqvist J, Möller J, Ahlbom A, Diderichsen F, Reuterwall C, de Faire U |title=Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study |journal=Am. J. Epidemiol. |volume=151 |issue=5 |pages=459–67 |year=2000 |month=March |pmid=10707914 |doi= |url=http://aje.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10707914}}</ref>
*[[Piroxicam]]
*[[Plaque rupture]]
*[[Polyarteritis nodosa]]
*[[Polycythemia vera]]
*[[Prinzmetal angina]]
*[[Pseudoxanthoma elasticum]]
*[[Psychological stress]]
*[[Ramucirumab]]
*[[Respiratory failure]]
*[[Sexual activity]] <ref name="pmid8618365">{{cite journal |author=Muller JE, Mittleman MA, Maclure M, Sherwood JB, Tofler GH |title=Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Determinants of Myocardial Infarction Onset Study Investigators |journal=JAMA |volume=275 |issue=18 |pages=1405–9 |year=1996 |month=May |pmid=8618365 |doi= |url=}}</ref><ref name="pmid11559674">{{cite journal |author=Möller J, Ahlbom A, Hulting J, ''et al'' |title=Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP) |journal=Heart |volume=86 |issue=4 |pages=387–90 |year=2001 |month=October |pmid=11559674 |pmc=1729949 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11559674}}</ref>
*[[Sports injury]] <ref name="pmid11124170">{{cite journal |author=Witte DR, Bots ML, Hoes AW, Grobbee DE |title=Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study |journal=BMJ |volume=321 |issue=7276 |pages=1552–4 |year=2000 |pmid=11124170 |pmc=27557 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=11124170}}</ref>
*[[Stress cardiomyopathy]]
*[[beta blockers|Sudden withdrawal of beta blockers]]
*[[nitrates|Sudden withdrawal of nitrates]]
*[[Sumatriptan]]
*[[Tachyarrhythmias]]
*[[Takayasu arteritis]]
*[[Takotsubo cardiomyopathy]]<ref name="pmid17483198">{{cite journal |author=Akashi YJ, Barbaro G, Sakurai T, Nakazawa K, Miyake F |title=Cardiac autonomic imbalance in patients with reversible ventricular dysfunction takotsubo cardiomyopathy |journal=QJM |volume=100 |issue=6 |pages=335–43 |year=2007 |pmid=17483198 |doi=10.1093/qjmed/hcm028}}</ref>
*[[Testosterone]]
*[[Thiamine deficiency]] <ref name="pmid16020883">{{cite journal |author=Kawano H, Koide Y, Toda G, Yano K |title=ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi |journal=Intern. Med. |volume=44 |issue=6 |pages=578–85 |year=2005 |month=June |pmid=16020883 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/internalmedicine/44.578?from=PubMed}}</ref> <ref>Hundley JM, Ashburn LL, Sebrell WH. The electrocardiogram in chronic thiamine deficiency in rats. Am J Physiol 144: 404–414, 1954. </ref>
*[[Thrombocytosis]]
*[[Thyrotoxicosis]]
*[[Tiagabine]]
*[[Transluminal percutaneous coronary angioplasty]]
*[[Trauma]]
*[[Upper respiratory tract infection]] <ref name="pmid15602021">{{cite journal |author=Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P |title=Risk of myocardial infarction and stroke after acute infection or vaccination |journal=N. Engl. J. Med. |volume=351 |issue=25 |pages=2611–8 |year=2004 |month=December |pmid=15602021 |doi=10.1056/NEJMoa041747 |url=}}</ref><ref name="Saikku-1992">{{cite journal | author=Saikku P, Leinonen M, Tenkanen L, Linnanmaki E, Ekman MR, Manninen V, Manttari M, Frick MH, Huttunen JK. | title=Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. | journal=Ann Intern Med | year=1992 | volume=116 | issue=4 | pages=273-8 | id=PMID 1733381}}</ref>
*[[ST elevation myocardial infarction triggers|Wartime bombing]]
}}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Ischemic heart diseases]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
[[Category:Crowdiagnosis]]
[[Category:Mature chapter]]

{{WH}}
{{WS}}

Supraventricular arrhythmias

2015-04-28T18:20:00Z

Rabin Bista: /* Drug Side Effect */

__NOTOC__

{{CMG}}

'''Associate Editor-In-Chief:''' {{CZ}}

==Overview==
{| class="wikitable" font-size="90%"
|- style="text-align:center;background-color:#6EB4EB;"
|+'''An overview of supraventricular tachycardias'''
|-
!
!example (lead II)
!regularity
!atrial frequency
!ventricular frequency
!origin (SVT/VT)
!p-wave
!effect of adenosine
|-
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Narrow complex (QRS<0.12)'''
|-
! [[Sinus tachycardia]]
| [[Image:sinustachy_small.svg|200px|Sinustachycardia - a normal p wave precedes every QRS complex]]
| regular
| 100-180 bpm
| 100-180 bpm
| sinus node (SVT)
| precedes every QRS complex
| gradual slowing
|-
! [[Atrial Fibrillation]]
| [[Image:afib_small.svg|200px|Atrial fibrillation - irregular rate, no p waves]]
| grossly irregular
| 400-600 bpm
| 75-175 bpm
| atria (SVT)
| absent
| slows down rate; irregularity remains
|-
! [[Atrial Flutter]]
| [[Image:aflutt_small.svg|200px|Atrial flutter - sawtooth in lead II with 2:1 block]]
| regular (sometimes alternating block)
| 250-350 bpm
| 75-150 bpm (3:1 or 2:1 block is most common)
| atria (SVT)
| negative sawtooth in lead II
| temporary reduced conduction (e.g. 4:1)
|-
! [[AVNRT]]
| [[Image:avnrt_small.svg|200px|ANVRT - rSR' in lead V1]]
| regular
| 180-250 bpm
| 180-250 bpm
| AV-node (SVT)
| in QRS complex (R')
| stops
|-
! [[Atrial tachycardia]]
| [[Image:atrialtachy_small.svg|200px|Atrial tachycardia - like sinustachycardia but the p wave has a different morphology]]
| regular
| 120-250 bpm
| 75-200 bpm
| atria
| precedes QRS, p wave differs from sinus-p
| temporary AV-block
|-
! [[AVRT|Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic]]
| [[Image:avrt_small.svg|200px|AVRT - inverted p wave behind every QRS complex]]
| regular
| 150-250 bpm
| 150-250 bpm
| circle: av-node - ventricles - bypass - atria
| RP < PR
| stops
|-
! [[AVJT|AV junctional tachycardia]]
| [[Image:avnodal_small.svg|200px|AV junctional tachycardia - no or inverted p-waves within QRS complex]]
| regular
| 60-100 bpm
| 70-130 bpm
| AV node
| RP < PR
| reduces rate
|-
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Wide complex (QRS>0.12)'''
|-
! [[Supraventricular tachycardia with block]]
| [[Image:atrial_tachy_with_LBBB_leadII.svg|200px|SVT with block - any SVT combined with LBBB or RBBB]]
| (ir)regular depending on SVT
| 100-250 bpm
| 75-200 bpm
| atria (SVT)
| absent
| temporary increased AV-block (eg 4:1)
|-
! [[AVRT|Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome]]
|
| regular
| 150-250 bpm
| 150-250 bpm
| circular: bypass - atria - av-node - ventricles
| RP < PR
| stops
|-
|}

===Supraventricular [[Ectopic Beats|ectopic beats]]===
*[[Atrial Premature Complexes]]
*[[Wandering Pacemaker]]
*[[AV-nodal complexes]]

===Also read===
*Flowchart: [[Media:narrow_tachycardia_flow.png|Approach to the Narrow Complex Tachycardia]] Adapted from <cite>ESCnarrowQRS</cite>.
*[[Introduction to Arrhythmias]]
*[[Mechanisms of Arrhythmias]]
*[[Sinus node rhythms and arrhythmias]]
*[[Junctional Tachycardias]]
*[[Ventricular Arrhythmias]]

==EKG Examples==
This is an [[electrocardiogram]] from a woman in her forties who had several operations for [[congenital heart disease]]. At the time of the [[electrocardiogram]] the patient was taking [[flecainide]] and [[metoprolol]] .

This patient was being treated for [[ventricular tachycardia]]. She was initially treated with [[amiodarone]] and then was switched to a combination of [[flecainide]] and [[metoprolol]]. She was doing well. The underlying [[congenital heart disease]] was [[Tetralogy of Fallot]]. The [[electrocardiogram]] shows a [[supraventricular rhythm]] which is probably not sinus as indicated by the negative P waves in the inferior leads. The cardiogram also shows 1 [[PVC]] and a [[right Branch block]] with a left anterior hemi-block.

[[Image:Supraventricular arrhythmia.jpg|center|800px]]

===Causes===

===Drug Side Effect===

* [[Cyclophosphamide]]
* [[interferon alfacon-1]]
*[[Ixabepilone]]
* [[Rasburicase]]

==References==
<biblio>
#ESCnarrowQRS pmid=14563598
</biblio>

[[Category:Pages to merge]]

Tachycardia causes

2015-04-28T18:19:02Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Tachycardia}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}
==Overview==
Tachycardia can be caused by a wide variety of factors. The most common cause is [[orthostatic hypotension]]. Other common causes of tachycardia include endocrine disorders, disorders involving the [[heart]], and situations which cause an excess of [[catecholamine]]s in the body such as [[fever]] and [[exercise]]. Various medications and illicit drugs can also cause tachycardia.

==Causes==

===Common Causes===
*[[Orthostatic hypotension]]
*[[Fever]]
*[[Hyperventilation]]
*[[Infection]]
*[[Endocrine disorders]]
*[[Hyperthyroidism]]

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Arrhythmogenic right ventricular dysplasia]],
[[AV Nodal Reentrant Tachycardia]],
[[AV-dissociation]],
[[Bradycardia-tachycardia syndrome]],
[[Cardiac amyloidosis]],
[[Cardiac arrhythmia]],
[[Cardiac tamponade]],
[[Cardiogenic shock]],
[[Congestive Heart Failure]],
[[Ebstein's Anomaly of the Tricuspid Valve]],
[[Inappropriate Sinus Tachycardia]],
[[Inferior vena cava syndrome]],
[[Multifocal atrial tachycardia]],
[[Nonparoxysmal Junctional Tachycardia]],
[[Paroxysmal supraventricular tachycardia]],
[[Polymorphic ventricular tachycardia]],
[[Premature ventricular contractions]],
[[Pulseless ventricular tachycardia]],
[[Torsade de pointes]],
[[Wolff-Parkinson-White syndrome]]

|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"|
[[3-Quinuclidinyl benzilate]],
[[Arsenic Poisoning]],
[[Bothrops]],
[[Caffeine]],
[[Carbon monoxide poisoning]],
[[Cardiac effects of insect bites]],
[[Hydroxyethyl starch]],
[[Mercury poisoning]],
[[Methadone withdrawl]],
[[Scombroid]]

|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|
[[Amlodipine]],
[[Amphetamine]],
[[Anticholinergic]],
[[Antipsychotic]],
[[Asenapine maleate]],
[[Atropine]],
[[Abciximab (patient information)]],
[[Beractant]],
[[Benzphetamine]],
[[Benzatropine]],
[[Biperiden]],
[[Bupropion]],
[[Caspofungin]],
[[Chlorpromazine]],
[[Cidofovir]],
[[Clemastine]],
[[Clofarabine]],
[[Clomifene]],
[[Clomipramine]],
[[Clonidine]],
[[Clozapine]],
[[Corticorelin]],
[[Cosyntropin]],
[[Daptomycin]],
[[Desflurane]],
[[Desoxyn]],
[[Diethylcathinone]],[[Diethylpropion]]
[[Diflunisal]],
[[Digoxin]],
[[Dapsone]]
[[Diltiazem]],
[[Dimenhydrinate]], [[Dimercaprol]],
[[Diphenhydramine]],
[[Dipivefrine]],
[[Disulfiram]],
[[Doxapram]],
[[Doxepin]],
[[Ephedrine]],
[[Epinephrine]],
[[Ethcathinone]],
[[Felbamate]],
[[ferumoxytol]],
[[Ferric Carboxymaltose]],
[[Flavoxate]],
[[Febuxostat]],
[[Formoterol]],
[[gadopentetate]],
[[Hydroxocobalamin]],
[[Hyoscyamine]],
[[Iloprost]],
[[Imipramine]],
[[Imipenem-Cilastatin]]
[[Indomethacin]],
[[interferon alfacon-1]]
[[Isoproterenol]],
[[Isosorbide mononitrate]],
[[laronidase]],
[[Leflunomide]],
[[Levomepromazine]],
[[Levomethamphetamine]],
[[Levosimendan]],
[[Levothyroxine]],
[[Lomotil]],
[[Maprotiline]], [[Meropenem]],
[[Methcathinone]],
[[Methylphenidate]],
[[Metoclopramide]],
[[Milnacipran hydrochloride]],
[[Minoxidil]],
[[Modafinil]],
[[Meprobamate]],
[[Motofen]],
[[Nabilone]]
[[Nalbuphine]],
[[Nalmefene]],
[[Naltrexone]],
[[Niacin]],
[[Nialamide]],
[[Nitazoxanide]],
[[Neuromuscular-blocking drugs]],
[[Olanzapine]],
[[Opioid]],
[[Oprelvekin]],
[[Oxaprozin]],
[[Oxcarbazepine]],
[[Paliperidone]],
[[Papaverine]],
[[Paregoric]],
[[Pegylated interferon alfa-2b]],
[[Pentamidine Isethionate]],
[[Pergolide]],
[[Phendimetrazine]],
[[Phentermine]],
[[Pilocarpine]],
[[Pipradrol]],
[[Pirbuterol]],
[[Pralidoxime]],
[[Procainamide (patient information)]],
[[Procyclidine hydrochloride]],
[[Promethazine]],
[[Propantheline]],
[[prednisolone]],
[[Pseudoephedrine]],
[[Rizatriptan]],
[[Sipuleucel-T]],
[[Sumatriptan]],
[[Teniposide]],
[[Terbutaline]],
[[Thalidomide]],
[[Tiagabine]],
[[Tizanidine]],
[[Trazodone]],
[[Triazolam]],
[[Trospium]],
[[Tuaminoheptane]],
[[Valdecoxib]],
[[Vardenafil]],
[[Voriconazole]],
[[Zolmitriptan]],
[[Zonisamide]],
[[Zopiclone withdrawl]]

|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|
[[Graves' Disease]],
[[Toxic multinodular goitre]]

|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Accessory pancreas]],
[[Gastroenteritis]],
[[Megacolon]],
[[Peritonitis]],
[[Retroperitoneal hematoma]],
[[Ulcerative colitis]]

|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
[[Brugada syndrome]],
[[Catecholaminergic polymorphic ventricular tachycardia]],
[[Costello syndrome]]

|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|
[[Ruptured spleen]],
[[Sickle-cell disease]]

|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|
[[Blood transfusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Clostridium Difficile]],
[[Cotton fever]],
[[Ebola]],
[[Lassa fever]],
[[Malaria]],
[[Scarlet fever]],
[[Tuberculosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Autonomic neuropathy]],
[[Dysautonomia]]

|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Adams Nance syndrome]],
[[Acute Porphyria]],
[[Beriberi Heart Disease]],
[[Betel nut]],
[[Foods containing tyramine]],
[[Hypoglycemia]],
[[Hypomagnesemia]],
[[Metabolic acidosis]]

|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
[[Aortocaval compression syndrome]],
[[Fetal distress]],
[[Omphalitis]]

|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Insulinoma]]

|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Aconitum]],
[[Benzylpiperazine]],
[[Bupropion]],
[[Cocaine]],
[[Diflunisal]],
[[Imipramine]],
[[Lomotil]],
[[Long-term effects of alcohol]],
[[Procainamide]],
[[Procyclidine hydrochloride]],
[[Xanthine]]

|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|
[[Acute Chest Syndrome]],
[[Asthma]],
[[Community-acquired pneumonia]],
[[Hemothorax]]

|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Kawasaki disease]]

|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|
[[Commotio cordis]]

|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Chronic fatigue syndrome]],
[[Dipping tobacco]],
[[Hyperthermia]],
[[Malignant hyperthermia]],
[[Pheochromocytoma]],
[[Postural orthostatic tachycardia syndrome]]
|-
|}

===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[3-Quinuclidinyl benzilate]]
*[[Abciximab (patient information)]]
*[[Accessory pancreas]]
*[[Aconitum]]
*[[Acute Chest Syndrome]]
*[[Acute Porphyria]]
*[[Adams Nance syndrome]]
*[[Alcohol Withdrawal]]
*[[Amanita phalloides]]
*[[Amlodipine]]
*[[Amphetamine]]
*[[Anticholinergic]]
*[[Antipsychotic]]
*[[Aortocaval compression syndrome]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Arsenic Poisoning]]
*[[Ashman phenomenon]]
*[[Asthma]]
*[[Atropine]]
*[[Autonomic neuropathy]]
*[[AV Nodal Reentrant Tachycardia]]
*[[AV-dissociation]]
*[[AVNRT]]
*[[Benzatropine]]
*[[Benzylpiperazine]]
*[[Beriberi Heart Disease]]
*[[Betel nut]]
*[[Biperiden]]
*[[Blood transfusion]]
*[[Bothrops]]
*[[Bradycardia-tachycardia syndrome]]
*[[Brugada syndrome]]
*[[Bupropion]]
*[[Caffeine]]
*[[Carbon monoxide poisoning]]
*[[Cardiac amyloidosis]]
*[[Cardiac arrhythmia]]
*[[Cardiac effects of insect bites]]
*[[Cardiac tamponade]]
*[[Cardiogenic shock]]
*[[Cardiovascular Effects of Cocaine]]
*[[Caspofungin]]
*[[Catecholaminergic polymorphic ventricular tachycardia]]
*[[Chlorprothixene]]
*[[Chronic fatigue syndrome]]
*[[Cidofovir]]
*[[Clofarabine]]
*[[Clomipramine]]
*[[Clonidine]]
*[[Clostridium Difficile]]
*[[Commotio cordis]]
*[[Community-acquired pneumonia]]
*[[Congestive Heart Failure]]
*[[Costello syndrome]]
*[[Cotton fever]]
*[[Daptomycin]]
*[[Desflurane]]
*[[Desoxyn]]
*[[Diethylcathinone]]
*[[Diflunisal]]
*[[Digoxin]]
*[[Diltiazem]]
*[[Dimenhydrinate]]
*[[Diphenhydramine]]
*[[Dipping tobacco]]
*[[Dosulepin hydrochloride]]
*[[Doxapram]]
*[[Doxepin]]
*[[Dysautonomia]]
*[[Ebola]]
*[[Ebstein's Anomaly of the Tricuspid Valve]]
*[[Ephedrine]]
*[[Epinephrine]]
*[[Ethcathinone]]
*[[Ferric Carboxymaltose]],
*[[Fetal distress]]
*[[Foods containing tyramine]]
*[[Gastroenteritis]]
*[[Graves' Disease]]
*[[Hemothorax]]
*[[Hydroxyethyl starch]]
*[[Hydroxocobalamin]]
*[[Hyperthermia]]
*[[Hyperthyroidism]]
{{col-break|width=33%}}
*[[Hypoglycemia]]
*[[Hypomagnesemia]]
*[[Iloprost]]
*[[Imipramine]]
*[[Inappropriate Sinus Tachycardia]]
*[[Inferior vena cava syndrome]]
*[[Insulinoma]]
*[[Isoproterenol]]
*[[Isosorbide mononitrate]]
*[[Kawasaki disease]]
*[[Laronidase]]
*[[Lassa fever]]
*[[Levomepromazine]]
*[[Levomethamphetamine]]
*[[Levosimendan]]
*[[Lomotil]]
*[[Long-term effects of alcohol]]
*[[Malaria]]
*[[Malignant hyperthermia]]
*[[Maprotiline]]
*[[Megacolon]]
*[[Mercury poisoning]]
*[[Metabolic acidosis]]
*[[Methadone withdrawl]]
*[[Methcathinone]]
*[[Methylphenidate]]
*[[Metoclopramide]]
*[[Milnacipran hydrochloride]]
*[[Minoxidil]]
*[[Modafinil]]
*[[Motofen]]
*[[Multifocal atrial tachycardia]]
*[[Nabilone]]
*[[Nalbuphine]]
*[[Nalmefene]]
*[[Neuromuscular-blocking drugs]]
*[[Niacin]]
*[[Nialamide]]
*[[Nonparoxysmal Junctional Tachycardia]]
*[[Olanzapine]]
*[[Omphalitis]]
*[[Opioid]]
*[[Oprelvekin]]
*[[Oxaprozin]]
*[[Paliperidone]]
*[[Palytoxin]]
*[[Papaverine]]
*[[Paroxysmal supraventricular tachycardia]]
*[[Pergolide]]
*[[Peritonitis]]
*[[Phentermine]]
*[[Pheochromocytoma]]
*[[Pipradrol]]
*[[Polymorphic ventricular tachycardia]]
*[[Porphyria]]
*[[Postural orthostatic tachycardia syndrome]]
*[[Pralidoxime]]
*[[Premature ventricular contractions]]
*[[Procainamide (patient information)]]
*[[Procyclidine hydrochloride]]
*[[Propantheline]]
*[[Pseudoephedrine]]
*[[Pulseless ventricular tachycardia]]
*[[Retroperitoneal hematoma]]
*[[Ruptured spleen]]
*[[Scarlet fever]]
*[[Scombroid]]
*[[Scopolamine]]
*[[Sepsis]]
*[[Serotonin syndrome]]
*[[Sick sinus syndrome]]
*[[Sickle-cell disease]]
*[[Sipuleucel-T]]
*[[Sumatriptan]]
*[[Supraventricular Tachycardias]]
*[[Teniposide]]
*[[Terbutaline]]
*[[Tiagabine]]
*[[Tizanidine]]
*[[Torsade de pointes]]
*[[Toxic multinodular goitre]]
*[[Toxidrome]]
*[[Trazodone]]
*[[Tuaminoheptane]]
*[[Tuberculosis]]
*[[Ulcerative colitis]]
*[[Vardenafil]]
*[[Voriconazole]]
*[[White coat hypertension]]
*[[Wide Complex Tachycardias]]
*[[Wolff-Parkinson-White syndrome]]
*[[Xanthine]]
*[[Zopiclone withdrawl]]
{{col-end}}

==References==
{{Reflist|2}}

[[Category:Cardiology]]
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
[[Category:Needs overview]]

{{WH}}
{{WS}}

Cardiac arrhythmia

2015-04-28T18:17:57Z

Rabin Bista: /* Drug Side Effect */

__NOTOC__
{| class="infobox" style="float:right;"
|-
| [[File:Siren.gif|30px|link=Arrhythmia resident survival guide]]|| || 
| [[Arrhythmia resident survival guide|'''Resident''' '''Survival''' '''Guide''']]
|}
{{CMG}}; {{AE}} {{Rim}}

==Overview==
Cardiac arrhythmia is any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the [[heart]]. The [[heart beat]] may be too fast or too slow, and may be regular or irregular. A heart beat that is too fast is called [[tachycardia]] and a heart beat that is too slow is called [[bradycardia]]. Although many arrhythmias are not life-threatening, some can cause [[cardiac arrest]].

==Classification of Cardiac Arrhythmia==
{{familytree/start |summary=Arrhythmia}}
{{familytree | | | | | | | | | | | | | | A01 | | | A01='''Arrhythmia'''}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| | | | | }}
{{familytree | | | | | B01 | | | | | | | B02 | | | | | | | B03 | B01= '''[[Bradyarrhythmia]]'''| B02= '''Arrhythmia with normal heart rate'''| B03= '''[[Tachyarrhythmia]]''' }}
{{familytree | | | | | |!| | | | |,|-|-|-|+|-|-|-|.| | | | |!| | | | | }}
{{familytree | | | | | |!| | | | B04 | | B05 | | B06 | | | |!| | | | | B04= '''The origin of the impulse: Atria'''| B05= '''The origin of the impulse: AV junction'''| B06= '''The origin of the impulse: Ventricles'''}}
{{familytree | | | | | |!| | | | |!| | | |!| | | |!| | | | |!| | | | | }}
{{familytree | | | | | |!| | | | B07 | | B08 | | B09 | | | |!| | | | |B07= [[Sinus arrhythmia]] [[Atrial bigeminy]]| B08=[[Accelerated junctional rhythm]] [[Junctional bigeminy]]| B09= [[Accelerated idioventricular rhythm]] [[Ventricular bigeminy]] }}
{{familytree | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | |,|-|-|-|+|-|-|-|.| | | | | | | | |,|-|-|-|-|^|-|-|-|.| }}
{{familytree | C01 | | C02 | | C03 | | | | | | | C04 | | | | | | | C05 | | C01= '''The origin of the impulse: Atria'''| C02= '''The origin of the impulse: AV junction'''| C03= '''The origin of the impulse: Ventricles'''|C04= '''[[SVT|Narrow complex tachycardia (SVT)]]'''| C05= '''[[Wide complex tachycardia]]''' }}
{{familytree | |!| | | |!| | | |!| | | | |,|-|-|-|^|-|.| | | | |,|-|+|-|.| |}}
{{familytree | D01 | | D02 | | D03 | | | D04 | | | | D05 | | | D06 |!| D07 |D01= '''Normal variant:''' [[Respiratory sinus arrhythmia]] '''[[Sinus node dysfunction]]:''' [[Sinus bradycardia]] [[Sinoatrial block]] [[Sinus arrest]] [[Sick sinus syndrome]] '''Abnormality in the atria:''' [[Low atrial focus bradycardia]] [[Atrial bigeminy]] '''[[AV block|AV node dysfunction]]:''' [[First Degree AV Block|First degree AV block]] [[Second Degree AV Block|Second degree AV block]] [[Complete or Third-Degree AV Block|Complete or third-degree AV block]]|D02= [[Junctional bradycardia|Junctional escape rhythm]] [[Junctional bigeminy]]| D03=[[Isorhythmic A-V dissociation]] [[Slow VT]] ([[idioventricular rhythm]]) [[Ventricular escape rhythm]] [[Escape capture bigeminy]]|D04= '''The origin of the impulse: Atria'''| D05= '''The origin of the impulse: AV junction'''| D06= '''The origin of the impulse: Atria or AV junction'''| D07= '''The origin of the impulse: Ventricles''' }}
{{familytree | | | | | | | | | | | | |,|-|^|-|.| | | |!| | | | |!| |!| |!| }}
{{familytree | | | | | | | | | | | | E01 | | E02 | | E03 | | | E04 |!| E05 |E01= [[Atrial fibrillation]] [[Atrial flutter]] [[Ectopic Atrial Rhythm|Ectopic atrial rhythm]] [[Multifocal Atrial Tachycardia (MAT)|Multifocal atrial tachycardia (MAT)]] [[Paroxysmal Atrial Tachycardia (PAT) with Block|Paroxysmal atrial tachycardia (PAT) with block]] [[Premature Atrial Contractions (PACs)|Premature atrial contractions (PAC)]] [[Sinus Tachycardia|Sinus tachycardia]] [[Wandering atrial pacemaker]] [[Sick sinus syndrome]]| E02= [[AVNRT]] [[AVRT]] ([[accessory pathway]]): - [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]] - [[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]|E03=[[Accelerated junctional rhythm]] [[Junctional ectopic tachycardia]]| E04= '''[[Wide complex tachycardias|SVTAC]]''' '''([[Wide complex tachycardias|SVT with aberrant conduction]]): '''[[Left Bundle Branch Block|Left bundle branch block]] [[LAHB|Left anterior hemi-block]] [[Left posterior fascicular block electrocardiogram|Lefo posterior hemi-block]] [[Right Bundle Branch Block|Right bundle branch block]] [[Trifascicular block]]| E05= [[Ventricular tachycardia]] [[Ventricular fibrillation electrocardiogram|Ventricular fibrillation]] [[Ventricular Parasystole|Ventricular parasystole]] [[Ventricular bigeminy]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | F01 | | | | F02 | F01= '''The origin of the impulse: Atria, AV junction or ventricles Presence of an [[accessory pathway]]'''| F02= '''The origin of the impulse: Pacemaker'''}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | G01 | | | | G02 | G01= '''[[Accessory pathway]]''' [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]] [[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]| G02= '''[[Paced rhythm]]''' [[Pacemaker-mediated tachycardia]] [[Runaway pacemaker syndrome]] [[Sensor induced tachycardia]]}}
{{familytree/end}}

==Cardiac Arrhythmias in Alphabetical Order==
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Accelerated idioventricular rhythm]]

*[[Accessory pathway]]

*[[Andersen–Tawil syndrome]]

*[[Artificial pacemaker]]

*[[Atrial fibrillation]]

*[[Atrial flutter]]

*[[Atrial tachycardia]]

*[[AV nodal reentrant tachycardia]]

*[[AV reentrant tachycardia]]

*[[Bradycardia]]

*[[Broad complex tachycardia]]

*[[Bundle of His]]

*[[Bundle of Kent]]

*[[Cardiac arrhythmia following heart transplantation]]

*[[Ectopic atrial rhythm]]

*[[First degree AV block]]

*[[Focal atrial tachycardia]]

*[[Heart transplantation associated arrhythmias]]

*[[Idioventricular rhythm]]
{{col-break|width=33%}}

*[[Isorhythmic A-V Dissociation]]

*[[Junctional bradycardia]]

*[[Junctional tachycardia]]

*[[Left anterior hemiblock]]

*[[Left bundle branch block]]

*[[Left posterior fascicular block]]

*[[Low atrial focus tachycardia]]

*[[Lown-Ganong-Levine syndrome]]

*[[Mahaim fibers]]

*[[Multifocal atrial tachycardia]]

*[[Pacemaker mediated tachycardia]]

*[[Paroxysmal Atrial Tachycardia (PAT) with Block]]

*[[Paroxysmal supraventricular tachycardia]]

*[[Premature atrial contraction]]

*[[Right bundle branch block]]

*[[Runaway pacemaker syndrome]]

*[[Second degree AV block]]

*[[Sensor induced tachycardia]]

*[[Sick sinus syndrome]]
{{col-break|width=33%}}

*[[Sinoatrial nodal reentry tachycardia]]

*[[Sinus arrhythmia]]

*[[Sinus bradycardia]]

*[[Sinus tachycardia]]

*[[Slow VT]]

*[[Supraventricular tachycardia]]

*[[SVT with aberrancy]]

*[[Tachycardia]]

*[[Tachycardia bradycardia syndrome]]

*[[Third degree AV block]]

*[[Trifascicular block]]

*[[Ventricular escape]]

*[[Ventricular fibrillation]]

*[[Ventricular parasystole]]

*[[Ventricular tachycardia]]

*[[Wandering atrial pacemaker]]

*[[Wide complex tachycardias]]

*[[Wolff-Parkinson-White syndrome]]
{{col-end}}
{{Smallcaps|{{PAGENAME}} developed by WikiDoc.org}}

===Causes===

===Drug Side Effect===
* [[Agalsidase beta]]
* [[Bromocriptine]]
* [[Calcium gluconate]].
* [[Caspofungin acetate]].
* [[Cefotaxime sodium]].
* [[Clomifene]].
* [[Crizotinib]].
* [[Cyclobenzaprine]].
* [[Cyclophosphamide]].
* [[Dipivefrine]]
* [[Doxorubicin Hydrochloride]].
* [[Gadoterate]]
* [[Granisetron]]
*[[Idarubicin hydrochloride]]
* [[Idursulfase]]
* [[interferon alfacon-1]]
* [[Tretinoin]].
* [[Meprobamate]]
* [[Metaproterenol]]
* [[Muromonab-CD3]]
*[[Nabilone]]
* [[Nalmefene]].
*[[Omacetaxine]]
*[[Oprelvekin]]
*[[Oxaprozin]]
* [[Oxytocin]].
* [[Pegylated interferon alfa-2b]]
* [[Pilocarpine]]
* [[Prednisolone]].
* [[Rubidium Rb 82]]
*[[Sargramostim]]
* [[Sorafenib]].
* [[Sodium phenylbutyrate]]
* Laxatives like [[sodium sulfate, potassium sulfate and magnesium sulfate]].
*[[Teniposide]]
* [[Valdecoxib]],

====Contraindicated medications====

{{MedCondContrAbs|MedCond = Cardiac arrhythmia|Cyclobenzaprine|Metaproterenol|Sumatriptan}}

==References==
{{Reflist|2}}

[[Category:Up-To-Date]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Electrophysiology]]
[[Category:Medical emergencies]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
[[Category:Arrhythmia]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Chronic hypertension causes

2015-04-28T18:17:04Z

Rabin Bista: /* Causes by Organ System */

__NOTOC__
{{Template:Hypertension}}

{{CMG}}; '''Assistant Editor-In-Chief: '''[[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]]

==Overview==
Secondary hypertension is only responsible for 5% of cases of chronic hypertension whereas [[primary hypertension]] (also known as [[essential hypertension]] where no identifiable cause is identified) is responsible for 95% of cases.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168 }} </ref> Common causes of secondary hypertension include [[obstructive sleep apnea]], [[hyperaldosteronism]], [[kidney disease]]s, excess [[catecholamine]]s, [[coarctation]] of the arota, [[cushing syndrome]] among other diseases.

{{Familytree/start}}
{{Familytree | | | A01 | | A01= '''[[Chronic hypertension]]'''}}
{{Familytree | |,|-|^|-|.| }}
{{Familytree | B01 | | B02 | B01='''[[Primary hypertension]]''' (also known as [[essential hypertension]]) (95% of the cases)| B02= '''[[Secondary hypertension]]''' (5% of the cases)}}
{{Familytree/end}}

==Primary Hypertension==
When a full evaluation yields no clear etiology for the elevated blood pressure, the latter is identified as primary hypertension. Primary or essential hypertension is considered a chronic disease requiring lifelong treatment and follow-up. If an underlying disease is identifiable as the cause, secondary hypertension is diagnosed. Secondary hypertension is a potentially curable condition in most cases.<ref name="pmid17462751">{{cite journal| author=Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA et al.| title=Secondary hypertension: current diagnosis and treatment. | journal=Int J Cardiol | year= 2008 | volume= 124 | issue= 1 | pages= 6-21 | pmid=17462751 | doi=10.1016/j.ijcard.2007.01.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17462751 }} </ref> In comparison, the prevalence of primary hypertension is significantly higher than secondary hypertension, where only 5-10% of patients have a secondary etiology<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168 }} </ref> Classically, the common age range for the presentation of primary hypertension is 30 to 55 years<ref name="pmid11509166">{{cite journal| author=Dosh SA| title=The diagnosis of essential and secondary hypertension in adults. | journal=J Fam Pract | year= 2001 | volume= 50 | issue= 8 | pages= 707-12 | pmid=11509166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11509166 }} </ref>, but age alone should never warrant a diagnosis of primary hypertension without a proper work-up.

==Secondary Hypertension==
===When to Suspect Secondary Hypertension===
It is not cost effective to evaluate all hypertensive patients for secondary hypertension. <ref name="pmid17462751">{{cite journal| author=Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA et al.| title=Secondary hypertension: current diagnosis and treatment. | journal=Int J Cardiol | year= 2008 | volume= 124 | issue= 1 | pages= 6-21 | pmid=17462751 | doi=10.1016/j.ijcard.2007.01.119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17462751 }} </ref> There are certain clinical scenarios, though, that should prompt further evaluation.

====Early Onset Hypertension Under Age 30====
Primary hypertension generally first occurs between 30 and 55 years. Onset of hypertension before puberty and before age 30 in the absence of risk factors should raise suspicion for secondary hypertension.

====Abrupt Onset of Hypertension in A Normotensive Patient====

====Rapidly Progressive Hypertension or a Hypertensive Emergency or Urgency====

====Refractory Hypertension====

<div class="mw-collapsible mw-collapsed">

===Evaluation of Secondary Hypertension===

<div class="mw-collapsible-content">

{{Familytree/start}}
{{Familytree|boxstyle=text-align: center; font-size: 90%; padding: 0px; width: 50%;| | | | | | A01 | | | | | | | | | |A01=<div style="padding: 15px;">'''''Evaluation of secondary hypertension'''''</div>}}
{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px; width: 50%; border-top: 0px;| | | | | | A01 | | | | | | | | | |A01=<div style="padding: 15px;">
'''Investigation should be limited for patients with clues suggestive of potentially correctable causes.'''

❑ Presence of clues for renovascular hypertension (most common potentially correctable cause)?<ref name="pmid16549646">{{cite journal| author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al.| title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. | journal=Circulation | year= 2006 | volume= 113 | issue= 11 | pages= e463-654 | pmid=16549646 | doi=10.1161/CIRCULATIONAHA.106.174526 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16549646 }} </ref><ref name="pmid21963765">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK et al.| title=2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 19 | pages= 2020-45 | pmid=21963765 | doi=10.1016/j.jacc.2011.08.023 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21963765 }} </ref>

: ❑ Onset of hypertension before the age of 30 years
: ❑ Onset of severe hypertension (SBP ≥180 mm Hg and/or DBP ≥120 mm Hg) after the age of 55 years
: ❑ New azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent
: ❑ Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm
: ❑ Sudden, unexplained pulmonary edema
: ❑ Accelerated hypertension (sudden and persistent worsening of previously controlled hypertension)
: ❑ Resistant hypertension (failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic)
: ❑ Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage, i.e., acute renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, and/or advanced [grade III to IV] retinopathy)
: ❑ Unexplained renal failure in the absence of proteinuria or an abnormal urine sediment
: ❑ Multivessel coronary artery disease
: ❑ Unexplained congestive heart failure
: ❑ Refractory angina
</div>}}
{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px;| | |,|-|-|-|^|-|-|-|.| | | | | |}}
{{Familytree|boxstyle=text-align: center; font-size: 90%; padding: 0px;| | A01 | | | | | | A02 |A01=<div style="padding: 10px; font-weight: bold;">YES</div>|A02=<div style="padding: 10px; font-weight: bold;">NO</div>}}
{{Familytree|boxstyle=text-align: left; font-size: 90%; padding: 0px; border-top: 0px; vertical-align: top; width: 25%;| | A01 | | | | | | A02 |A01=<div style="padding: 10px;">
❑ Perform noninvasive diagnostic studies
: ❑ Duplex ultrasonography
: ❑ Gadolinium-enhanced magnetic resonance angiography
: ❑ Computed tomographic angiography (in individuals with normal renal function)
❑ Consider catheter angiography when noninvasive studies are inconclusive</div>
|A02=<div style="padding: 10px; font-size: 85%;">
Look for findings suggestive of other identifiable causes

❑ Pheochromocytoma
: ❑ Paroxysmal pounding headache
: ❑ Palpitations
: ❑ Profound perspiration
: ❑ Pallor
: ❑ Hand tremor

❑ Hyperaldosteronism
: ❑ Unexplained hypokalemia with urinary potassium wasting

❑ Obstructive sleep apnea
: ❑ Daytime somnolence
: ❑ Snoring
: ❑ Obesity

❑ Hyperparathyroidism
: ❑ Hypercalcemia

❑ Hypothyroidism
: ❑ Elevated TSH
: ❑ Puffy face

❑ Aortic coarctation
: ❑ Diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs</div>}}
{{Family tree/end}}

</div></div>

===Common Causes of Secondary Hypertension===
Common causes of secondary hypertension are often memorized by the mnemonic ABCDE:

{| border="1" style="border-collapse:collapse; text-align:left; font-size:130%;" cellpadding="5" align="center" width="600px"
|-
|bgcolor="#67e1ff"|'''Letter'''
|bgcolor="#67e1ff"|'''Causes of Secondary Hypertension'''
|-
|bgcolor="#f3f3f3"| A
|Accuracy, Apnea, Aldosteronism
|-
|bgcolor="#f3f3f3"| B
|Bruit, Bad Kidneys
|-
|bgcolor="#f3f3f3"| C
|Catecholamines, Coarctation, Cushing’s Syndrome
|-
|bgcolor="#f3f3f3"| D
|Drugs, Diet
|-
|bgcolor="#f3f3f3"| E
|Erythropoitin, Endocrine Disorders
|}

=====Accuracy=====
An accurate assessment and re-assessment of blood pressures is an essential first step when a patient presents with high blood pressure. The accuracy of home BP measurements should be confirmed by calibrating the patient's measurement technique with that obtained in the doctor's office.

=====Apnea=====
[[Obstructive sleep apnea]] (OSA) is a respiratory disease characterized by repetitive narrowing or collapse of the upper airway during sleep<ref name="pmid18250206">{{cite journal| author=Eckert DJ, Malhotra A| title=Pathophysiology of adult obstructive sleep apnea. | journal=Proc Am Thorac Soc | year= 2008 | volume= 5 | issue= 2 | pages= 144-53 | pmid=18250206 | doi=10.1513/pats.200707-114MG | pmc=PMC2628457 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18250206 }} </ref> leading to [[apnea]], [[hypopnea]], and a nocturnal decrease in oxygen tension.<ref name="pmid8872797">{{cite journal| author=Silverberg DS, Oksenberg A| title=Essential and secondary hypertension and sleep-disordered breathing: a unifying hypothesis. | journal=J Hum Hypertens | year= 1996 | volume= 10 | issue= 6 | pages= 353-63 | pmid=8872797 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8872797 }} </ref> Symptoms and signs that might suggest OSA include daytime [[somnolence]], [[obesity]], [[snoring]], and [[morning headache]].<ref name="pmid10593319">{{cite journal| author=Victor LD| title=Obstructive sleep apnea. | journal=Am Fam Physician | year= 1999 | volume= 60 | issue= 8 | pages= 2279-86 | pmid=10593319 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10593319 }} </ref> Patients with sleep apnea also tend to have drug resistant hypertension and may retain sodium. Diagnosis is made by polysomnography. Treatment relies on maintaining airway patency at night and includes, among others, the use of continuous positive airway pressure (CPAP).

=====Aldosterone=====
Primary (hyporeninemic) and secondary (hyperreninemic) [[hyperaldosteronism]] result in excess sodium and water retention with slight [[hypernatremia]] along with excretion of [[potassium]] resulting in [[hypokalemia]] in one half of patients.<ref name="pmid9854120">{{cite journal| author=Ganguly A| title=Primary aldosteronism. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 25 | pages= 1828-34 | pmid=9854120 | doi=10.1056/NEJM199812173392507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9854120 }} </ref> Common symptoms of hyperaldosteronism include drug resistant hypertension, [[fatigue]], [[headache]], intermittent [[paralysis]], [[muscle weakness]], and [[numbness]]. The most common cause of [[primary hyperaldosteronism]] is an aldosterone-producing [[adenoma]] (an "[[aldosteronoma]]"), i.e. [[Conn’s Syndrome]]. [[Secondary hyperaldosteronism]] is due to an overactive [[RAAS]], as seen in renin-secreting tumors, [[renal artery stenosis]], [[pheochromocytoma]], and other syndromes. The diagnosis is made by measuring the ratio of plasma aldosterone to plasma renin activity.<ref name="pmid7923898">{{cite journal| author=Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC| title=High incidence of primary aldosteronism in 199 patients referred with hypertension. | journal=Clin Exp Pharmacol Physiol | year= 1994 | volume= 21 | issue= 4 | pages= 315-8 | pmid=7923898 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7923898 }} </ref> It is elevated in [[primary hyperaldosteronism]] and decreased/normal with elevated [[renin]] in [[secondary hyperaldosteronism]]. It should be noted that obesity can also cause [[aldosterone]] levels to be elevated. Treatment depends upon the underlying etiology: surgery to resect an adenoma causing [[primary hyperaldosteronism]] and [[spironolactone]], an aldosterone antagonist to treat [[secondary hyperaldosteronism]].

===== Bruit=====
[[Renovascular hypertension]] is due to decreased blood supply to the [[kidneys]] secondary to renal artery stenosis and it is the most common correctable cause of secondary hypertension. [[Atherosclerosis]] of the renal artery ([[renal artery stenosis]]) in older patients above 50 years of age<ref name="pmid12196346">{{cite journal| author=Chade AR, Rodriguez-Porcel M, Grande JP, Krier JD, Lerman A, Romero JC et al.| title=Distinct renal injury in early atherosclerosis and renovascular disease. | journal=Circulation | year= 2002 | volume= 106 | issue= 9 | pages= 1165-71 | pmid=12196346 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12196346 }} </ref> and [[fibromuscular dysplasia]] in younger patients are the most common etiologies.

According to the 2013 ACC/AHA Guidelines for the Management of PAD<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>, diagnostic work-up for renal artery stenosis is indicated in the following conditions:

====Class I Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>====
*Hypertension of any stage before the age of 30
*Stage II hypertension (severe hypertension systolic blood pressure > 180 mm Hg or diastolic blood pressure > 120 mm Hg) in patients older than 55 years. If only mild hypertension is present, then renal artery stenosis is the underlying cause in only 1% of patients <ref name="pmid3872106">{{cite journal| author=Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H| title=Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. | journal=Arch Intern Med | year= 1985 | volume= 145 | issue= 3 | pages= 424-7 | pmid=3872106 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3872106 }} </ref>, but if the blood pressure is markedly elevated, then the risk of renal artery stenosis goes up 10 to 50 fold.
*Accelerated condition of previously controlled hypertension
*[[Resistant hypertension]]
*[[Malignant hypertension]]
*New [[azotemia]] (50% rise in [[creatinine]] that is sustained) within one week after administration of an [[Angiotensin Converting Enzyme]] ([[ACE]])inhibitor or [[ARB]]
*Unexplained atrophic kidney or asymmetric kidneys that differ by > 1.5 cm. If the kidney is < 9 cm in size, there is a 75% chance that renal artery stenosis is present.
*Severe hypertension, impaired renal function, and recurrent flash [[pulmonary edema]]

====Class IIa Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>====
*Unexplained renal failure including patients starting renal replacement therapy

====Class IIb Recommendations<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>====
*Presence of multi vessel [[CAD]] and no clinical clues of ARAS or PAD
*Unexplained [[CHF]] or [[refractory angina]]

====Other Indications====
* Severe hypertension in the presence of polyvascular disease ([[coronary artery disease]] or [[peripheral arterial disease]])
* A unilateral systolic-diastolic [[abdominal bruit]]. Although a bruit is infrequent in documented renal artery stenosis (the sensitivity is only 40% percent) if it is auscultated, it is associated with a very high specificity of 99%.<ref name="pmid7563536">{{cite journal| author=Turnbull JM| title=The rational clinical examination. Is listening for abdominal bruits useful in the evaluation of hypertension? | journal=JAMA | year= 1995 | volume= 274 | issue= 16 | pages= 1299-301 | pmid=7563536 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7563536 }} </ref>
*The association of race with renal artery stenosis is not clear. Reports that it is observed more often in white patients may be due to reporting bias.<ref name="pmid2022411">{{cite journal| author=Svetkey LP, Kadir S, Dunnick NR, Smith SR, Dunham CB, Lambert M et al.| title=Similar prevalence of renovascular hypertension in selected blacks and whites. | journal=Hypertension | year= 1991 | volume= 17 | issue= 5 | pages= 678-83 | pmid=2022411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2022411 }} </ref>

Definitive diagnosis is made by magnetic resonance angiography (MRA) and renal arteriography.<ref name="pmid11416635">{{cite journal| author=Wofford MR, King DS, Wyatt SB, Jones DW| title=Secondary Hypertension: Detection and Management for the Primary Care Provider. | journal=J Clin Hypertens (Greenwich) | year= 2000 | volume= 2 | issue= 2 | pages= 124-131 | pmid=11416635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11416635 }} </ref> Other diagnostic methods include duplex ultrasound scanning<ref name="pmid22595689">{{cite journal| author=AbuRahma AF, Srivastava M, Mousa AY, Dearing DD, Hass SM, Campbell JR et al.| title=Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis. | journal=J Vasc Surg | year= 2012 | volume= 56 | issue= 4 | pages= 1052-9, 1060.e1; discussion 1059-60 | pmid=22595689 | doi=10.1016/j.jvs.2012.03.036 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22595689 }} </ref>, and captopril-augmented radio-isotopic renogram<ref name="pmid10482969">{{cite journal| author=Aitchison F, Page A| title=Diagnostic imaging of renal artery stenosis. | journal=J Hum Hypertens | year= 1999 | volume= 13 | issue= 9 | pages= 595-603 | pmid=10482969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10482969 }} </ref>. Treatment is based upon the underlying etiology.

===== Bad Kidney (Chronic Renal Failure)=====
Renal parenchymal disease blunts the kidney’s physiological ability to maintain appropriate [[blood pressure]]. Notably, [[hypertension]] is both a cause and a consequence of renal parenchymal disease; the two are closely associated and may potentiate each other.<ref name="pmid11866231">{{cite journal| author=Soergel M, Schaefer F| title=Effect of hypertension on the progression of chronic renal failure in children. | journal=Am J Hypertens | year= 2002 | volume= 15 | issue= 2 Pt 2 | pages= 53S-56S | pmid=11866231 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11866231 }} </ref> The diagnosis is made by demonstration of a decreased [[GFR]]. The mechanisms by which renal parenchymal disease leads to the development of hypertension are numerous and include activation of the local [[RAAS]], release of vasoconstrictor [[cytokines]], and inappropriate [[natriuresis]] for any given [[blood pressure]].

=====Catecholamines=====
Catecholamine excess occurs in several non-disease states, such as acute [[stress]], the administration of medications with sympathomimetic activity, and illicit drug use such as [[cocaine]] and these conditions can be ruled out by thorough history taking. [[Pheochromocytoma]], a tumor of the adrenal gland leading to excess secretion of [[epinephrine]], should be considered in young patients with the triad of intermittent hypertensive episodes causing [[headache]], [[sweating]], and [[tachycardia]]. However, [[pheochromocytoma]] in older adults or a presentation with sustained hypertension is not uncommon. Diagnostic studies to evaluate pheochromocytoma include measurement of plasma free [[metanephrines]] and urinary fractionated metanephrines. The diagnostic value of plasma and urinary catecholamines is of limited value given the very short half-life of catecholamines. Treatment is usually by surgical resection of the secreting tumor with appropriate adrenergic blockade.<ref name="pmid11903030">{{cite journal| author=Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P et al.| title=Biochemical diagnosis of pheochromocytoma: which test is best? | journal=JAMA | year= 2002 | volume= 287 | issue= 11 | pages= 1427-34 | pmid=11903030 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11903030 }} </ref>

=====Coarctation=====
[[Coarctation of the aorta]] is a [[congenital heart defect]], caused by a narrowing in a segment of the ascending or [[descending aorta]]. The diagnosis is often made in a neonate or an infant as a result of a weak femoral pulse or asymmetric brisk brachial pulses. [[Hypertension]] occurs as a result of a reduction in the effective circulation at the level of the [[kidneys]] which respond by increasing plasma volume which in turn causes hypertension in the upper extremities. Diagnosis is by [[CT angiography]], but can also be made in neonates and infants by ultrasound of the heart and the great vessels. Definitive treatment is by surgical correction and or stenting.

=====Cushing’s Syndrome=====
[[Cushing's syndrome]] is an endocrine disorder caused by prolonged exposure to high endogenous or exogenous [[cortisol]] levels. Hypertension in [[Cushing’s syndrome]] has been classically attributed to the [[mineralocorticoid]] effects of cortisol. It manifests as an absent fall of nocturnal [[blood pressure]] physiologically seen in normotensive subjects with associated disturbance in the adrenocorticotropic hormone-glucocorticoid system.<ref name="pmid3397172">{{cite journal| author=Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M et al.| title=Altered circadian blood pressure rhythm in patients with Cushing's syndrome. | journal=Hypertension | year= 1988 | volume= 12 | issue= 1 | pages= 11-9 | pmid=3397172 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3397172 }} </ref> Symptoms of Cushing's syndrome include rapid [[obesity|weight gain]], particularly of the trunk and face with sparing of the limbs ([[central obesity]]), a round face often referred to as a "[[moon face]]" along with central obesity, excess [[sweating]], [[proximal muscle weakness]], [[ecchymoses]], [[insomnia]], reduced [[libido]], [[impotence]], [[amenorrhoea]], [[infertility]] and psychological disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[clinical depression|Depression]] and [[anxiety]].<ref>{{cite book |title=The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences |last=Yudofsky |first=Stuart C. |coauthors=Robert E. Hales |edition=5th |year=2007 |publisher=American Psychiatric Pub, Inc. |isbn=1585622397 }}</ref> Although an ideal diagnostic test is not considered yet available, clinicians often assess the 24-hour urinary [[cortisol]] excretion<ref name="pmid3958132">{{cite journal| author=Contreras LN, Hane S, Tyrrell JB| title=Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations. | journal=J Clin Endocrinol Metab | year= 1986 | volume= 62 | issue= 5 | pages= 965-9 | pmid=3958132 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3958132 }} </ref>, a low-dose [[dexamethasone suppression test]]<ref name="pmid14315650">{{cite journal| author=NUGENT CA, NICHOLS T, TYLER FH| title=Diagnosis of Cushing’s Syndrome; Single Dose Dexamethasone Suppression Test. | journal=Arch Intern Med | year= 1965 | volume= 116 | issue= | pages= 172-6 | pmid=14315650 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14315650 }} </ref>, late evening serum or salivary cortisol<ref name="pmid9709931">{{cite journal| author=Raff H, Raff JL, Findling JW| title=Late-night salivary cortisol as a screening test for Cushing's syndrome. | journal=J Clin Endocrinol Metab | year= 1998 | volume= 83 | issue= 8 | pages= 2681-6 | pmid=9709931 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9709931 }} </ref>, and a [[CRH]] a following a [[dexamethasone suppression test]] to establish the diagnosis.<ref name="pmid8386285">{{cite journal| author=Yanovski JA, Cutler GB, Chrousos GP, Nieman LK| title=Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing's syndrome from pseudo-Cushing's states. | journal=JAMA | year= 1993 | volume= 269 | issue= 17 | pages= 2232-8 | pmid=8386285 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8386285 }} </ref>

=====Drugs=====
An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, [[oral contraceptive pills]], some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168 }} </ref>

=====Diet=====
In addition to the association of [[obesity]] with hypertension, the 2001 study “Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet” concluded that a high sodium diet above the recommended 100 mmol per day (2.4 g of sodium or 6 g of sodium chloride salt) is associated with hypertension. As a result, reduction of sodium levels below 100 mmol per day and following the DASH diet (rich in vegetables, fruits, with low-fat dairy products) can significantly lower BP.<ref name="pmid11136953">{{cite journal| author=Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al.| title=Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 1 | pages= 3-10 | pmid=11136953 | doi=10.1056/NEJM200101043440101 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11136953 }} </ref> Ingestion of excessive amounts of [[liquorice]] can lead to elevation in the [[blood pressure]].

=====Erythropoietin=====
Elevated erythropoietin is typically seen in [[COPD]] patients who have functional anemia due to chronic [[hypoxia]] and in hematologic disorders such as polycythemia. The pathogenesis of erythropoietin-induced hypertension includes increased hematocrit and blood viscosity, altered sensitivity to vasopressors, dysregulated vasodilatory factors, and vascular cell growth causing arterial remodeling and changes in arterial smooth musculature.<ref name="pmid10213636">{{cite journal| author=Vaziri ND| title=Mechanism of erythropoietin-induced hypertension. | journal=Am J Kidney Dis | year= 1999 | volume= 33 | issue= 5 | pages= 821-8 | pmid=10213636 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10213636 }} </ref> Diagnosis and treatment are etiology-dependent.

=====Endocrine=====
In addition to the more common endocrine causes of hypertension such as hyperaldosteronism, [[Cushing’s syndrome]], and [[pheochromocytoma]], several other endocrine changes can cause hypertension. Both hypothyroidism and hyperthyroidism can cause hypertension by volume retention and by increased cardiac output, respectively. Also, [[hyperparathyroidism]] and hypovitaminosis D can cause hypertension due to poorly understood mechanisms, where [[parathyroidectomy]] seems to significantly decrease blood pressure in patients with parathyroid disease and elevated BP.<ref name="pmid22145139">{{cite journal| author=Chopra S, Cherian D, Jacob JJ| title=The thyroid hormone, parathyroid hormone and vitamin D associated hypertension. | journal=Indian J Endocrinol Metab | year= 2011 | volume= 15 Suppl 4 | issue= | pages= S354-60 | pmid=22145139 | doi=10.4103/2230-8210.86979 | pmc=PMC3230087 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22145139 }} </ref> [[Acromegaly]] can also be a cause of hypertension.

==Causes by Organ System==

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic regurgitation]], [[aortic dissection]], acute severe vascular damage, [[adams Nance syndrome ]], [[aneurysm]], [[aortic coarctation ]], [[aortic stenosis]], [[arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly ]], [[arteriosclerosis]], [[atheroma]], [[avasthey syndrome ]], [[carotid paraganglioma ]],Congenital [[mitral stenosis ]], [[eisenmenger's Syndrome ]], [[fibromuscular dysplasia of arteries ]], [[grange syndrome ]], hemangiomatosis (familial pulmonary capillary disease), [[hypertensive heart disease ]], [[pulmonary artery agenesis ]], [[vasculitis ]], [[patent ductus arteriosus]], [[third degree AV block]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Acetaldehyde ]], [[aristolochic acid]] poisoning , [[arizona Bark Scorpion poisoning ]], [[black widow spider envenomation ]], [[cadmium poisoning]], [[cocaine]], [[ecstasy]] abuse , [[ginseng ]], [[heavy metal poisoning]], Indian [[tobacco]] poisoning, [[jimsonweed poisoning ]], [[lead poisoning]] , [[lockwood-Feingold syndrome ]], [[mustard tree poisoning ]], [[nicotine]] addiction , [[pseudoephedrine]] poisoning , [[silicosis ]], [[toxic mushrooms -- Psychedelic ]], [[lobelia]] poisoning
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[almotriptan]], [[amitriptyline]], [[Asenapine maleate]], [[Atropine]], [[Beractant]], [[Betamethasone valerate]], [[Benzphetamine]], [[Betamethasone dipropionate]], [[Butorphanol]], [[Cidofovir]], [[cocaine]], [[combined oral contraceptive pill]], [[cyclosporine]], [[caspofungin acetate]], [[desipramine]], [[Desmopressin]], [[Desogestrel and Ethinyl Estradiol]], [[Diethylpropion]], [[dihydroergotamine]], [[diflunisal]], [[Dimercaprol]], [[Dipivefrine]], [[doxepin]], [[Drospirenone and Ethinyl estradiol]], [[Eculizumab]], [[Eletriptan]], [[ephedrine]], [[ergotamine]], [[Erythropoietin]], [[Estropipate]], [[etodolac]], [[febuxostat]], [[Florbetapir F-18]], [[formoterol]], [[frovatriptan]], [[gadoterate]], [[glucocorticoid resistance ]], [[gadopentetate]], [[Hydroxocobalamin]], [[Indomethacin]], [[imipramine]], [[interferon alfacon-1]], [[isometheptene]], [[Ketorolac tromethamine]], [[Lanreotide]], [[Leuprolide]], [[Levalbuterol]], [[Medroxyprogesterone]], [[Mefenamic acid]], [[Megestrol]], [[Meloxicam]], [[Meloxicam]], [[Meropenem]], [[Metipranolol]], [[Methylene blue]], [[Methylphenidate]], [[Methylprednisolone]], [[Metoclopramide]], [[Methoxy polyethylene glycol-epoetin beta]], [[Mifepristone]], [[Milnacipran hydrochloride]], [[Mirabegron]], [[monoamine oxidase inhibitor]]s, [[Nabilone]], [[Naphazoline]] , [[nasal decongestants]], [[Naproxen and esomeprazole magnesium]], [[Norethindrone acetate and Ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol]], [[nortriptyline]], [[NSAIDs]], [[Oxaprozin]], [[Oxcarbazepine]], [[Pentamidine Isethionate]], [[Pergolide]], [[phencyclidine]], [[Phendimetrazine]], [[phenylpropanolamine]], [[Pilocarpine]], [[Piroxicam]], [[Pralidozxime]], [[protriptyline]], [[pseudoephedrine]], [[prednisolone]], [[Prednisone]], [[Ramucirumab]], [[Rasagiline]], [[Repaglinide and Metformin hydrochloride]], [[rizatriptan]], [[Rotigotine]], [[sedative dependence]], [[serotonin toxicity]], [[Sertraline]], [[Sipuleucel-T]], [[Sorafenib]], [[steroid abuse]], [[Sulindac]], [[sumatriptan]], [[Sunitinib]], [[Thalidomide]], [[Tiagabine]], [[Tocilizumab]], [[Tolmetin]], [[Travoprost]], [[Triamcinolone]], [[Valganciclovir hydrochloride]], [[zolmitriptan]], [[Zolmitriptan]], [[Zonisamide]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Nephrosis -- deafness -- urinary tract -- digital malformation ]], [[Fitzsimmons-Walson-Mellor syndrome ]]

|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Carcinoid Syndrome]], [[acromegaly ]], [[adrenal incidentaloma ]], [[alcohol-induced pseudo-Cushing syndrome ]], [[apparent mineralocorticoid excess ]], [[congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]], [[congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]], [[Conn's syndrome]], [[cushing's disease]], [[cushing's syndrome ]], [[diabetes]], Familial [[cushing syndrome ]], [[graves disease ]], [[hyperadrenalism ]], [[hyperparathyroidism ]], [[hyperpituitarism ]], [[hyperthyroidism]], [[hypothyroidism]], isolated secretion of corticosterone, isolated secretion of deoxycorticosterone, [[mineralocorticoid excess]], [[multiple endocrine neoplasia type 1]], [[myxoedema]], [[pheochromocytoma]], [[primary aldosteronism]], primary cortisol resistance, [[pseudohyperaldosteronism ]], [[pseudohypoaldosteronism ]], [[Schroeder syndrome 1 ]], [[hyperthyroidism]], [[hypoglycemia]], isolated secretion of 18-hydroxy-deoxycorticosterone, [[renin-secreting tumors]], [[dexamethasone sensitive hypertension]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Hepatorenal tyrosinemia ]], [[pancreatitis]], [[retroperitoneal Fibrosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]], [[congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]], [[cockayne syndrome ]], [[down Syndrome ]], [[Fabry's Disease ]], isolated secretion of 18-hydroxy-deoxycorticosterone, [[Pierre Robin's sequence ]], [[Senior-Loken Syndrome]], [[Turner Syndrome ]], [[Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency ]], [[Von Hippel-Lindau Disease ]], [[Werner syndrome ]], [[Williams Syndrome ]], [[Gaucher disease type 3 ]], [[mucopolysaccharidosis]] type I [[Hurler syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Anemia]], Atypical [[Hemolytic uremic syndrome]], Catastrophic [[antiphospholipid syndrome ]], Essential mixed [[cryoglobulinemia ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[hemolytic uremic syndrome ]], [[hypereosinophilic syndrome ]], [[Liddle's syndrome]], Multicentric reticulohistiocytosis , [[polycythemia ]], [[thromboembolism ]], [[thrombotic thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Poliomyelitis]], [[meningitis]], [[post streptococcal glomerulonephritis ]], [[renal tuberculosis]], [[nipah virus encephalitis ]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Acrodynia ]], [[Allain Babin Demarquez syndrome ]], [[familial osteodysplasia - Anderson type]], [[Paget's disease of bone ]], [[Grange syndrome ]], [[Faye-Petersen-Ward-Carey syndrome ]], [[oculo skeletal renal syndrome ]], [[Thieffry and Sorrell Dejerine syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Guillain-Barre Syndrome]], [[autonomic dysreflexia syndrome ]], [[Binswanger's Disease ]], Brain stem [[encephalitis]], [[central sleep apnea ]], [[choroideremia -- hypopituitarism ]], [[disequilibrium syndrome ]], [[dysautonomia ]], [[hereditary sensory and autonomic neuropathy 3 ]], [[increased intracranial pressure]], [[neurofibromatosis syndrome Type II]] , [[neurogenic hypertension ]], [[nipah virus encephalitis ]], [[obstructive sleep apnea ]], [[Sneddon Syndrome ]], [[upper spinal cord lesions]], [[Wolfram's disease]], [[meningitis]], [[polyradiculitis]], [[quadriplegia]], [[Adams Nance syndrome ]], [[glycine encephalopathy]] - classical neonatal form, [[pituitary Cancer ]], [[Fitzsimmons-Walson-Mellor syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Abdominal obesity metabolic syndrome ]], [[acute intermittent porphyria ]], [[congenital hepatic porphyria ]], [[Gaucher disease]] type 3, [[glycine encephalopathy]] - classical neonatal form, [[glycine synthase deficiency ]], [[gouty nephropathy]], [[liquorice]], [[metabolic syndrome]], [[tyrosinemia ]], [[Von Gierke disease]] IB, [[increased salt intake]], [[mucopolysaccharidosis]] type I [[Hurler syndrome]], [[Fabry's Disease ]], [[vitamin D -- adverse effects]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Eclampsia ]], [[Fowler-Christmas-Chapple syndrome ]], [[gestational hypertension]], [[HELLP syndrome ]], [[ovarian dysgenesis]], [[PCOS]], [[pregnancy toxemia /hypertension ]], twin-twin transfusion syndrome
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Endothelin]] producing tumor, [[adrenal Cancer ]], familial [[adrenal adenoma ]], [[renal Cancer ]], [[neuroblastoma ]]
[[pituitary Cancer ]], [[renin-secreting tumors]], [[rhabdoid tumor ]], [[Wilms' tumor ]], [[adrenal incidentaloma ]], familial [[renal cell carcinoma ]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| Isolated Ectopia lentis, [[oculo skeletal renal syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Amphetamine]] abuse, [[almotriptan]], [[dihydroergotamine]], [[ergotamine]], [[frovatriptan]], [[isometheptene]], [[rizatriptan]], [[sumatriptan]], [[zolmitriptan]], [[amitriptyline]], [[cyclosporine]], [[desipramine]], [[dexamethasone]] sensitive hypertension, [[doxepin]], [[ephedrine]], [[glucocorticoid resistance ]], [[imipramine]], [[nasal decongestants]], [[nortriptyline]], [[combined oral contraceptive pill]], [[phencyclidine]], [[phenylpropanolamine]], [[protriptyline]], [[serotonin toxicity]], [[steroid abuse]], [[pseudoephedrine]], [[cocaine]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anxiety]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Asphyxia ]], [[bronchopulmonary dysplasia]], [[COPD ]], [[Goodpasture syndrome ]], [[pulmonary cystic lymphangiectasis ]], [[pulmonary embolism ]], [[pulmonary fibrosis]] /[[granuloma ]], [[pulmonary veno-occlusive disease ]], pulmonary lymphangiomatosis, [[respiratory acidosis ]], [[respiratory failure ]], [[unilateral pulmonary agenesis ]], [[hyperventilation]], [[obstructive sleep apnea ]], [[Wegener's granulomatosis ]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Bartter's Syndrome]], [[dissection of the renal arteries]], [[acid-base imbalance ]], [[acute renal failure ]], [[albuminuria ]], [[analgesic nephropathy syndrome ]], autosomal dominant [[polycystic kidney disease ]], autosomal recessive [[polycystic kidney disease ]], bilateral [[renal artery stenosis ]], [[Bright's Disease ]], [[chronic kidney disease ]], [[chronic pyelonephritis]], congenital [[membranous glomerulonephritis]], [[congenital stenosis of renal artery]], congenital hydronephrosis, [[diffuse mesangial sclerosis]], familial [[renal cell carcinoma ]], [[Fitzsimmons-Walson-Mellor syndrome ]], [[glomerulonephritis ]], [[hereditary nephritis]] (X-linked), [[hypoplastic kidney]], [[IgA nephropathy ]], [[kidney arteriovenous fistula ]], [[Kimmelstiel-Wilson disease]], [[lupus nephritis ]], [[nephrocalcinosis ]], [[nephrosclerosis ]], [[nephrosis -- deafness -- urinary tract -- digital malformation ]], [[nephrotic syndrome ]], [[oculo skeletal renal syndrome ]], [[Pierson syndrome ]], Severe infantile [[polycystic kidneys]] with [[tuberous sclerosis ]], [[post streptococcal glomerulonephritis ]], [[renal artery thrombosis]], [[renal artery stenosis]], [[renal emboli]], [[renal segmental hypoplasia-induced Hypertension ]], [[renal tuberculosis]], [[Salcedo syndrome ]], [[simple kidney cysts ]], [[Thieffry and Sorrell Dejerine syndrome ]], [[urinary tract infections ]], [[urinary tract obstruction]], [[vesicoureteral reflux ]], [[Wegener's granulomatosis ]], [[Gitelman's Syndrome]], [[hepatorenal tyrosinemia ]], Atypical [[hemolytic uremic syndrome]], [[gouty nephropathy]], [[Goodpasture syndrome ]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune Vasculitis ]], [[systemic lupus erythematosus]], diffuse [[systemic sclerosis ]], [[polyarteritis nodosa ]], [[Takayasu arteritis ]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Electrical burns ]], [[head injury]], [[skull fracture ]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| Acquired total [[lipodystrophy ]], following [[kidney transplantation]], [[aging]], [[alcohol|alcohol intake]], [[alcohol withdrawal]], [[amyloidosis ]], bone cement implantation syndrome, [[brachydactyly with hypertension]], [[Carnevale-Canun-Mendoza syndrome ]], [[codeine withdrawal ]], [[collagen disease]], [[essential hypertension]], [[fever]], [[Gram's syndrome ]], [[hypothermia]], [[irradiation]], [[Kashani-Strom-Utley syndrome ]], [[lymphomatoid granulomatosis ]], [[MSBD syndrome ]], [[neuroleptic malignant syndrome ]], [[obesity]], [[physical inactivity ]], [[Selye syndrome ]], [[serotonin syndrome ]], [[shaken baby syndrome ]], [[stress-induced hypertension ]], [[type A personality]], [[Wagener syndrome ]], [[pain]], [[post-exercise]], [[transfusion of large blood volumes]], [[white coat hypertension]]
|-
|}

==Causes in Alphabetical Order==
{{MultiCol}}
* [[Abdominal obesity metabolic syndrome ]]
* [[Absence of pulmonary artery ]]
* [[Acetaldehyde ]]
* [[Acid-Base Imbalance ]]
* Acquired total [[Lipodystrophy ]]
* [[Acrodynia ]]
* [[Acromegaly ]]
* [[Acute intermittent porphyria ]]
* [[Acute renal failure ]]
* [[Acute severe vascular damage]]
* [[Adams Nance syndrome ]]
* [[Adrenal Cancer ]]
* [[Adrenal incidentaloma ]]
* After [[Kidney transplantation]]
* [[Kidney tumor]]
* [[Aging]]
* [[Albuminuria ]]
* [[Alcohol]]
* [[Alcohol withdrawal]]
* [[Alcohol-induced pseudo-Cushing syndrome ]]
* [[Allain Babin Demarquez syndrome ]]
* [[Almotriptan]]
* [[Amitriptyline]]
* [[Amphetamine]] abuse
* [[Amyloidosis ]]
* [[Analgesic nephropathy syndrome ]]
* [[Anemia]]
* [[Aneurysm]]
* [[Anxiety]]
* [[Aortic coarctation ]]
* [[Aortic regurgitation]]
* [[Aortic stenosis]]
* [[Valvular diseases|Aortic valve disease]]
* [[Apparent mineralocorticoid excess ]]
* [[Aristolochic Acid poisoning ]]
* [[Arizona Bark Scorpion poisoning ]]
* [[Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly ]]
* [[Arteriosclerosis]]
* [[Asphyxia ]]
* [[Atheroma]]
*[[Atropine]]
* Atypical [[Hemolytic uremic syndrome]]
* [[Autoimmune Vasculitis ]]
* [[Autonomic dysreflexia syndrome ]]
* Autosomal dominant [[Polycystic kidney disease ]]
* Autosomal Recessive [[Polycystic Kidney Disease ]]
* [[Avasthey syndrome ]]
* [[Bartter's Syndrome]]
*[[Betamethasone valerate]]
*[[Betamethasone dipropionate]]
* Bilateral [[Renal artery stenosis ]]
* [[Binswanger's Disease ]]
* [[Black widow spider envenomation ]]
* [[Bone cement implantation syndrome ]]
* [[Brachydactyly with hypertension]]
* Brain stem [[Encephalitis]]
* [[Bright's Disease ]]
* [[Bronchopulmonary dysplasia]]
*[[Butorphanol]]
* [[Cadmium poisoning]]
* [[Carcinoid Syndrome]]
* [[Carnevale-Canun-Mendoza syndrome ]]
* [[Carotid paraganglioma ]]
* Catastrophic [[Antiphospholipid Syndrome ]]
* [[Central sleep apnea ]]
* [[Choroideremia -- hypopituitarism ]]
* [[Chronic kidney disease ]]
* [[Chronic pyelonephritis]]
*[[Cidofovir]]
* [[Cocaine]]
* [[Cockayne syndrome ]]
* [[Codeine withdrawal ]]
* [[Collagen disease]]
* [[Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency]]
* [[Congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency]]
* [[Congenital hepatic porphyria ]]
* Congenital [[Membranous glomerulonephritis]]
* Congenital [[Mitral stenosis ]]
* [[Congenital stenosis of renal artery]]
* Congenital [[Hydronephrosis ]]
* [[Conn's syndrome]]
* [[COPD ]]
* [[Cushing's disease]]
* [[Cushing's syndrome ]]
* [[Cyclosporine]]
* [[Desipramine]]
*[[Desmopressin]]
*[[Desogestrel and Ethinyl Estradiol]]
* [[Dexamethasone sensitive hypertension]]
* [[Diabetes]]
* Diffuse [[Systemic sclerosis ]]
* [[Diffuse mesangial sclerosis]]
* [[Dihydroergotamine]]
* [[Disequilibrium syndrome ]]
* [[Aortic dissection]]
* [[Dissection of the renal arteries]]
* [[Down Syndrome ]]
* [[Doxepin]]
* [[Dysautonomia ]]
* [[Eclampsia ]]
* [[Ecstasy]] abuse
* [[Eculizumab]]
{{ColBreak}}
* [[Eisenmenger's Syndrome ]]
* [[Electrical burns ]]
* [[Endothelin]] producing tumor
* [[Ephedrine]]
* [[Ergotamine]]
* [[Essential hypertension]]
* Essential mixed [[Cryoglobulinemia ]]
* [[Fabry's Disease ]]
* Familial [[Renal cell carcinoma ]]
* Familial [[Adrenal adenoma ]]
* Familial [[Cushing syndrome ]]
* [[Faye-Petersen-Ward-Carey syndrome ]]
* [[Fever]]
* [[Fibromuscular dysplasia]] of arteries
* [[Fitzsimmons-Walson-Mellor syndrome ]]
* [[Fowler-Christmas-Chapple syndrome ]]
* [[Frovatriptan]]
* [[Gaucher disease]] type 3
* [[Gestational hypertension]]
* [[Ginseng ]]
* [[Gitelman's Syndrome]]
* [[Glomerulonephritis ]]
* [[Glucocorticoid resistance ]]
* [[Glycine encephalopathy]] - classical neonatal form
* [[Glycine synthase deficiency ]]
* [[Goodpasture syndrome ]]
* [[Gouty nephropathy]]
* [[Gram's syndrome ]]
* [[Grange syndrome ]]
* [[Graves Disease ]]
* [[Guillain-Barre Syndrome]]
* [[Head injury]]
* [[Heavy metal poisoning]]
* [[HELLP syndrome ]]
* Familial [[Hemangiomatosis]] - pulmonary capillary
* [[Familial Osteodysplasia - Anderson type]]
* [[Hemolytic uremic syndrome ]]
* [[Hepatorenal tyrosinemia ]]
* [[Hereditary nephritis]] (X-linked)
* [[Hereditary sensory and autonomic neuropathy 3 ]]
*[[Hydroxocobalamin]]
* [[Hyperadrenalism ]]
* [[Hypereosinophilic syndrome ]]
* [[Hyperparathyroidism ]]
* [[Hyperpituitarism ]]
* [[Hypertensive heart disease ]]
* [[Hyperthyroidism]]
* [[Hyperventilation]]
* [[Hypoglycemia]]
* [[Hypoplastic kidney]]
* [[Hypothermia]]
* [[Hypothyroidism]]
* [[IgA nephropathy ]]
* [[Imipramine]]
* [[Increased intracranial pressure]]
* [[Increased salt intake]]
* Indian [[Tobacco]] [[Poisoning ]]
*[[Infliximab]]
* [[Irradiation]]
* [[Isolated secretion of 18-hydroxy-deoxycorticosterone]]
* [[Isolated secretion of corticosterone]]
* [[Isolated secretion of deoxycorticosterone]]
* [[Isolated Ectopia lentis]]
* [[Isometheptene]]
* [[Jimsonweed poisoning ]]
* [[Kashani-Strom-Utley syndrome ]]
* [[Kidney arteriovenous fistula ]]
* [[Renal Cancer ]]
* [[Kimmelstiel-Wilson disease]]
* [[Lead poisoning]]
* [[Liquorice]]
* [[Liddle's syndrome]]
* [[Lobelia]] poisoning
* [[Lockwood-Feingold syndrome ]]
* [[Lupus nephritis ]]
* [[Lymphomatoid granulomatosis ]]
* [[Medroxyprogesterone]]
* [[Meloxicam]]
* [[Meningitis]]
* [[Meropenem]]
* [[Metabolic syndrome]]
* [[Methylphenidate]]
* [[Mifepristone]]
* [Milnacipran hydrochloride]]
* [[Mineralocorticoid excess]]
* [[Monoamine oxidase inhibitor]]s
* [[MSBD syndrome ]]
* [[Mucopolysaccharidosis]] type I [[Hurler syndrome]]
* Multicentric [[Reticulohistiocytosis]]
* [[Multiple endocrine neoplasia type 1]]
* [[Mustard tree poisoning ]]
* [[Myxoedema]]
* [[Nasal decongestants]]
* [[Nephrocalcinosis ]]
* [[Nephrosclerosis ]]
* [[Nephrosis -- deafness -- urinary tract -- digital malformation ]]
* [[Nephrotic syndrome ]]
* [[Neuroblastoma ]]
* [[Neurofibromatosis syndrome Type II]]
* [[Neurogenic hypertension ]]
* [[Neuroleptic malignant Syndrome ]]
* [[Nicotine addiction ]]
* [[Nipah virus encephalitis ]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Nortriptyline]]
* [[NSAIDs]]
* [[Obesity]]
{{ColBreak}}
* [[Obstructive sleep apnea ]]
* [[Oculo skeletal renal syndrome ]]
* [[Oral contraceptive pill]]
* [[Ovarian dysgenesis]]
*[[Oxaprozin]]
* [[Paget's disease of bone ]]
* [[Pain]]
* [[Pancreatitis]]
* [[Patent ductus arteriosus]]
*[[Pergolide]]
* [[PCOS]]
* [[Pheochromocytoma]]
* [[Phencyclidine]]
* [[Phenylpropanolamine]]
* [[Physical inactivity ]]
* [[Pierre Robin's sequence ]]
* [[Pierson syndrome ]]
*[[Pilocarpine]]
* [[Piroxicam]]
* [[Pituitary Cancer ]]
* [[Poliomyelitis]]
* [[Polyarteritis nodosa ]]
* [[Polycystic kidneys, severe infantile, with tuberous sclerosis ]]
* [[Polycythemia ]]
* [[Polyradiculitis]]
* [[Post streptococcal glomerulonephritis ]]
* [[Post-exercise]]
*[[Pralidoxime]]
* [[Pregnancy toxemia /hypertension ]]
* [[Primary aldosteronism]]
* [[Primary cortisol resistance]]
* [[Protriptyline]]
* [[Pseudoephedrine]]
* [[Pseudohyperaldosteronism ]]
* [[Pseudohypoaldosteronism ]]
* [[Pulmonary artery agenesis ]]
* [[Pulmonary cystic lymphangiectasis ]]
* [[Pulmonary embolism ]]
* [[Pulmonary fibrosis /granuloma ]]
* [[Pulmonary veno-occlusive disease ]]
* [[Pulmonary Lymphangiomatosis]]
* [[Quadriplegia]]
*[[Ramucirumab]]
* [[Renal artery thrombosis]]
* [[Renal artery stenosis]]
* [[Renal emboli]]
* [[Renal segmental hypoplasia-induced Hypertension ]]
* [[Renal tuberculosis]]
* [[Renin-secreting tumors]]
* [[Respiratory acidosis ]]
* [[Respiratory failure ]]
* [[Retroperitoneal fibrosis]]
* [[Rhabdoid tumor ]]
* [[Rizatriptan]]
* [[Salcedo syndrome ]]
* [[Schroeder syndrome 1 ]]
* [[Scleroderma ]]
* [[Sedative dependence]]
* [[Selye syndrome ]]
* [[Senior-Loken Syndrome]]
* [[Serotonin Syndrome ]]
* [[Serotonin toxicity]]
* [[Shaken Baby Syndrome ]]
* [[Silicosis ]]
* [[Simple kidney cysts ]]
*[[Sipuleucel-T]]
* [[Skull fracture ]]
* [[Sneddon Syndrome ]]
*[[Sorafenib]]
* [[Steroid abuse]]
* [[Stress-induced hypertension ]]
* [[Sumatriptan]]
* [[Sunitinib]]
* [[Systemic lupus erythematosus]]
* [[Takayasu arteritis ]]
* [[Thieffry and Sorrell Dejerine syndrome ]]
* [[Third degree AV block]]
* [[Thromboembolism ]]
* [[Thrombotic thrombocytopenic purpura]]
*[[Tiagabine]]
* [[Toxic mushrooms -- Psychedelic ]]
* [[Transfusion of large blood volumes]]
* [[Turner Syndrome ]]
* [[Twin-Twin Transfusion Syndrome]]
* [[Type A personality]]
* [[Tyrosinemia ]]
* [[Unilateral pulmonary agenesis ]]
* [[Upper spinal cord lesions]]
* [[Urinary tract infections ]]
* [[Urinary tract obstruction]]
* [[Valganciclovir hydrochloride]]
* [[Vasculitis ]]
* [[Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency ]]
* [[Vesicoureteral reflux ]]
* [[Vitamin D -- adverse effects]]
* [[Von Gierke disease IB ]]
* [[Von Hippel-Lindau Disease ]]
* [[Wagener syndrome ]]
* [[Wegener's granulomatosis ]]
* [[Werner syndrome ]]
* [[White coat hypertension]]
* [[Williams Syndrome ]]
* [[Wilms' tumor ]]
* [[Wolfram's disease]]
* [[Zolmitriptan]]
{{EndMultiCol}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Aging-associated diseases]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Cardiovascular diseases]]
[[Category:Cardiology board review]]
[[Category:Medical conditions related to obesity]]
[[Category:Nephrology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Aplastic anemia causes

2015-04-28T18:16:04Z

Rabin Bista: /* Drug Side Effect */

{{Aplastic anemia}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
==Overview==
The cause of the damage can be acquired or inherited. Acquired aplastic anemia is more common, and sometimes it's only temporary. Inherited aplastic anemia is rare. More than half of the cases of [[aplastic anemia]] are idiopathic. Chemicals, drugs, viral infections, [[collagen vascular disease]]s, and [[thymoma]] can be implicated as the causative factor in the other cases. Some research suggests that stem cell damage may occur because the body's immune system attacks its own cells by mistake.

==Causes==
===Acquired Causes===
Many diseases, conditions, and factors can cause aplastic anemia, including:
* Toxins, such as [[pesticides]], [[arsenic]], and [[benzene]].
* Radiation and chemotherapy
* Medicines, such as [[Albendazole]], [[Cefadroxil]], [[Chlorpromazine]], [[chloramphenicol]] (an antibiotic rarely used in the United States, [[Carbamazepine]], [[Hydroxychloroquine]], [[Methimazole]], [[Orphenadrine]], [[Oxcarbazepine]], [[Phenytoin]], [[Quinine]], [[Phenylbutazone]], [[Sulindac]], [[Sulfadiazine]], [[Sulfasalazine]], [[Valganciclovir hydrochloride]].
* Infectious diseases, such as [[hepatitis]], [[Epstein-Barr virus]], [[cytomegalovirus]], [[parvovirus B19]], and [[HIV]].
* [[Collagen vascular disease]]
* [[Thymoma]]
* Autoimmune disorders, such as lupus and [[rheumatoid arthritis]].
* [[Pregnancy]] (aplastic anemia that occurs during pregnancy often goes away after delivery.)
* Metastaic involvement of bone marrow

===Inherited Causes===
Certain inherited conditions can damage the stem cells and lead to aplastic anemia. Examples include:
* [[Fanconi anemia]]
* [[Shwachman-Diamond syndrome]]
* [[Dyskeratosis congenita]]
* [[Diamond-Blackfan anemia]].

===Drug Side Effect===
* [[Ceftazidime]]
* [[Cefaclor]]
* [[Cefaclor]]
* [[Certolizumab pegol]]
* [[Chlorpropamide]]
* [[Chloramphenicol sodium succinate]]
* [[Dactinomycin]]
* [[Dapsone]]
* [[Eltrombopag]]
* [[Felbamate]]
* [[Flurbiprofen]]
* [[Flucytosine]]
* [[interferon alfacon-1]]
* [[Isoniazid]]
* [[Lincomycin Hydrochloride]]
* [[Meprobamate]]
* [[Nilutamide]]
* [[Oxaprozin]]
* [[Penicillamine]]
* [[Probenecid]]
* [[Tolbutamide]]
* [[Tolazamide]]
* [[Sodium aurothiomalate]]
* [[Sodium phenylbutyrate]]
* [[Sulfasalazine]]
* [[Sulfacetamide]]

==References==
{{reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Hematology]]
[[Category:Autoimmune diseases]]

Suicide causes

2015-04-28T18:13:53Z

Rabin Bista: /* Drugs */

__NOTOC__
{{Suicide}}
{{CMG}}

==Causes of Suicide==
There are a variety of reasons posited or given for suicide:
* [[Mental disorder]]s
* [[Suffering]]
* Unrequited love
* [[Stress (medicine)|Stress]]
* [[Grief]]
* [[Withdrawal]] or discontinuation of psychoactive substances.
* As [[Philosophy|philosophically]] or ideologically motivated move
* To escape [[punishment]] or an [[Abuse|abusive]] environment
* [[Guilt]] or [[shame]]
* Catastrophic injury
* Financial loss
* Self sacrifice
* As part of a military or social strategy (e.g. suicide attacks)
* Belief that life has no inherent value (e.g. absurdism, pessimism, [[nihilism]])
* As part of a religious [[cult]]
* [[Loneliness]]
* To restore honor (e.g. seppuku)
* [[Curiosity]] for post-life occurrences.

===Drugs===
* [[Eslicarbazepine acetate]]
* [[interferon alfacon-1]]

===Other Causes===
====Suicide as a form of defiance and protest====
Heroic suicide, for the greater good of others, is often celebrated. For instance, Mahatma Gandhi went on a hunger strike to prevent fighting between Hindus and Muslims, and, although he was stopped before dying, it appeared he would have willingly succumbed to starvation. This attracted attention to Gandhi's cause, and generated a great deal of respect for him as a spiritual leader. In the 1960s, Buddhist monks, most notably Thích Quảng Đức, in South Vietnam drew Western attention to their protests against President Ngô Đình Diệm by burning themselves to death. Also in the 1960s, Quaker Norman Morrison committed suicide by self-immolation to protest the United States involvement in the Vietnam War.

Similar events were reported during the Cold War in eastern Europe, such as the deaths of Ryszard Siwiec and later of Jan Palach and Jan Zajíc following the Soviet invasion of Czechoslovakia, or Romas Kalanta's self-immolation in the main street of Kaunas, Lithuania in 1972. More recently, in 2006, an American anti-war activist, Malachi Ritscher, died by suicide by self-immolation as a protest against the 2003 Iraq war. In Ireland there exists a long tradition of hunger strike to the death against British rule, predominantly in Northern Ireland during the infamous 1981 hunger strikes, led by Bobby Sands, which resulted in 10 deaths. The period caused international outrage as shown, for example, by the Indian parliament standing for two minutes of silence or, more bemusingly, the Iranian government renaming the street in Tehran on which the British Embassy stands to "Bobby Sands Street", named after the first hunger-striker to die in 1981.

Before the Republic of Ireland got its independence there were also examples of hunger striking, such as Terence McSwiney in Cork. Critics may see such suicides as counter-productive, arguing that these people would probably achieve a comparable or greater result by spending the rest of their lives in active struggle. This is a contentious issue, especially when one considers that the Northern Ireland hunger strikers who died trying to obtain certain prisoners rights (e.g. POW status, right to wear own clothes, right not to have to work, etc.) actually had nearly all their requests eventually granted in the years after the spate of 1981 hunger strikes happened.

People who commit suicide may not always be suffering from depression or despair. Some people may kill themselves for the purpose of experiencing life after death, or have a different existential, religious or philosophical motive. This points out that views of suicide are individually and culturally subjective.

====Judicial Suicide====
A person who has committed a crime will often commit suicide to avoid prosecution and disgrace:
* Colonel Alfred Redl was presented with the evidence of his espionage and shot himself to avoid a trial.
* In ''The Unpleasantness at the Bellona Club'', Lord Peter Wimsey presents Dr. Penberthy with evidence proving that he is a murderer, then leaves him in a room with a loaded gun. A shot rings out, and the club members rush in to find the dead doctor, along with a signed confession.
* Budd Dwyer, a Pennsylvanian politician, killed himself on live television after being convicted (wrongly, he claimed) of financial crimes, in order to draw attention to his case, and to enable his widow to draw survivor benefits (since he died before being removed from office).
* More recently, Deborah Jeane Palfrey, dubbed the DC Madam by the media, was convicted on April 15, 2008 of racketeering, using the mail for illegal purposes, and money laundering. On May 1, 2008 she was found dead by hanging and apparent suicide.

====Military suicide====
[[Image:USS White Plains attack by Tokkotai unit 25.10.1945 kk1a.jpg|thumb|left|A kamikaze attack on the escort carrier [[USS White Plains (CVE-66)|USS White Plains]]]]
In the desperate final days of World War II, many Japanese pilots volunteered for kamikaze missions in an attempt to forestall defeat for the Empire. Near the end of WW2 the Japanese attempted to design a small bomb laden aircraft whose only purpose was kamikaze missions. However, the craft was a failure, partly because its range was insubstantual to that of other more conventional planes but also because it was produced at a far greater cost than even the Japanese felt necessary to spend on their kamikaze pilots. In Nazi Germany, many soldiers and government officials (including Adolf Hitler and many in his inner circle) killed themselves rather than surrender to Allied forces; Luftwaffe squadrons were formed to smash into American B-17 Flying Fortress|B-17s during daylight bombing missions, in order to delay the highly-probable Allied victory, although in this case, inspiration was primarily the Soviet and Polish ''taran'' ramming attacks, and death of the pilot was not a desired outcome. Whether such pilots were engaging in heroic, selfless actions or if immense social pressure motivated them is a matter of historical debate. The Japanese also built one-man "human torpedo" suicide submarines.

However, suicide has been fairly common in warfare throughout history. Soldiers and civilians committed suicide to avoid capture and slavery (including the wave of German and Japanese suicides in the last days of World War II). Commanders committed suicide rather than accept defeat. Spies and officers have often committed suicide to avoid revealing secrets under interrogation and/or [[torture]]. Behaviour that could be seen as suicidal occurred often in battle, for instance a soldier [[falling on a grenade]] to save his comrades. Other examples include soldiers under cannon fire at the Battle of Waterloo who took fatal hits rather than duck and place their comrades in harm's way.{{Verify source|date=April 2007}} The Charge of the Light Brigade in the Crimean War, Pickett's Charge at Battle of Gettysburg|Gettysburg in the American Civil War, and the charge of the French cavalry at the Battle of Sedan in the Franco-Prussian War were assaults that continued even after it was obvious to participants that the attacks were unlikely to succeed, and would probably be fatal to most of the attackers. Japanese infantry men usually fought to the last man, launched Banzai charge|"banzai" suicide charges, and committed suicide during the Pacific island battles in World War II. At Saipan and Okinawa, civilians joined in the suicides. Suicidal attacks by pilots were common in the 20th century: the attack by U.S. torpedo planes at the Battle of Midway was very similar to kamikaze.

====Ritual suicide====
Ritual suicide is the act of suicide motivated by a religious, spiritual, or traditional ritual.

An extreme interpretation of Hindu custom historically practiced, mostly in the 2nd millennium, was self-immolation by a widow as an assurance that she will be with her husband for the next life. This, however, is extreme, and is looked down upon by other Hindus in most cases. Other rituals of self-immolation or self-starvation were used by Hinduism|Hindu, Jainism|Jain and Buddhist monks for religious or philosophical purposes, or as a form of extreme non-violent protest. In China, some groups would practice suicide for similar reasons. In Japan, rituals of suicide like seppuku by men and jigai by women were practiced.

====Dutiful suicide====
Dutiful suicide is an act, or attempted act, of fatal self-violence at one's own hands done in the belief that it will secure a greater good, rather than to escape harsh or impossible conditions. It can be voluntary, to relieve some dishonor or punishment, or imposed by threats of death or reprisals on one's family or reputation (a kind of murder by remote control). It can be culturally traditional or generally abhorred; it can be heavily ritualized as in seppuku or purely functional. Dutiful suicide can be distinguished from a kamikaze or suicide bomb attack, in which a fighter consumes his own life in delivering a weapon to the enemy. Perhaps the most famous example of dutiful suicide is a soldier in a foxhole throwing his body on a live grenade to save the lives of his comrades.

=====Examples=====
* Disgraced Roman patricians were sometimes allowed to commit suicide to spare themselves a trial and penalties against their families. {{Fact|date=February 2008}}
* [[Erwin Rommel]], found to have foreknowledge of the German attempt on Hitler's life, was threatened with public trial, execution and reprisals on his family unless he killed himself, which he did.{{Fact|date=February 2008}}

==References==
{{Reflist|2}}

[[Category:Primary care]]
[[Category:Psychiatry]]
[[Category:Needs overview]]

{{WH}}
{{WS}}

Interferon alfacon-1

2015-04-28T18:06:40Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=[[Immunology|Immunological Agent]]
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have [[anti-HCV serum antibodies]] and/or the presence of [[HCV RNA]]. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=[[Injection site reactions]], [[fatigue]], [[fever]], [[rigors]], [[body pain]]


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 




|fdaLIADAdult=====Indications====
* INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
* The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN.

* Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks.

* There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

=====Dose Reduction=====
* For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

* If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

* During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

=====Administration of INFERGEN=====
* If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles.

Storage
* Just prior to injection, INFERGEN may be allowed to reach room temperature.

* Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known [[hypersensitivity]] to alpha interferons or to any component of the product

* [[decompensated hepatic disease]]

* [[autoimmune hepatitis]]


|warnings=* Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

* Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

=====Neuropsychiatric Disorders=====
* Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and [[suicide]] may occur. Other prominent psychiatric adverse events may also occur, including [[psychosis]], aggressive behavior, [[nervousness]], [[anxiety]], [[emotional liability]], abnormal thinking, [[agitation]], apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted.

=====Bone Marrow Toxicity=====
* Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of [[aplastic anemia]]. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in [[neutrophil]] (<0.5 x 109/L) or [[platelet counts]] (<50 x 109/L).

=====Cardiovascular Disorders=====
* [[Hypertension]], [[tachycardia]], [[palpitation]], and [[tachyarrhythmias]] have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. [[Supraventricular arrhythmias]], [[chest pain]], and [[myocardial infarction]] have been associated with alpha interferon therapies.8

=====Hypersensitivity=====
* Serious acute [[hypersensitivity reactions]] have been reported in rare instances following treatment with alpha interferons. If [[hypersensitivity reactions]] occur (e.g., [[urticaria]], [[angioedema]], [[bronchoconstriction]], [[anaphylaxis]]), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

=====Endocrine Disorders=====
* INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of [[hyperthyroidism]] or [[hypothyroidism]] have been reported with INFERGEN. [[Hyperglycemia]] and [[diabetes mellitus]] have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

=====Autoimmune Disorders=====
* Development of or exacerbation of [[autoimmune]] disorders (e.g., autoimmune [[thrombocytopenia]], [[idiopathic thrombocytopenic purpura]], [[psoriasis]], [[rheumatoid arthritis]]) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with [[autoimmune hepatitis]] and should be used with caution in patients with other autoimmune disorders.

=====Pulmonary Disorder=====
* [[Pneumonia]] and [[interstitial pneumonitis]], some resulting in [[respiratory failure]] and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained [[pulmonary infiltrates]] or [[pulmonary function]] impairment should discontinue treatment with INFERGEN.

=====Colitis=====
* Hemorrhagic/[[ischemic colitis]], sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

=====Pancreatitis=====
* [[Pancreatitis]], sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of [[pancreatitis]] and discontinued in patients diagnosed with [[pancreatitis]].

=====Hepatic Exacerbations and Decompensated Hepatic Disease=====
* [[Chronic hepatitis C]] patients with [[cirrhosis]] may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as [[jaundice]], [[ascites]], [[coagulopathy]], or decreased serum [[albumin]], are observed.

=====Ophthalmologic Disorders=====
* Decrease or loss of vision, [[retinopathy]] including [[macular edema]], retinal artery or vein thrombosis, [[retinal hemorrhages]] and cotton wool spots; [[optic neuritis]], and [[papilledema]] are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or [[hypertensive retinopathy]]) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

=====Cerebrovascular Disorders=====
* Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for [[stroke]], including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

=====General=====
* While [[fever]] may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

=====Bone Marrow Toxicity=====
* INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause [[myelosuppression]]. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

=====Renal Impairment=====
* Increases in serum [[creatinine]] levels, and rarely [[renal failure]], have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

=====Laboratory Tests=====
* Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

[[Platelet count]] ≥ 75 x 109/L

[[Hemoglobin]] concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum [[creatinine]] concentration < 180 μmol/L (< 2.0 mg/dL) or [[creatinine clearance]] > 0.83 mL/second (> 50 mL/minute)

Serum [[albumin]] concentration ≥ 25 g/L

[[Bilirubin]] within normal limits

[[TSH]] and [[T4]] within normal limits

[[Neutropenia]], [[thrombocytopenia]], [[hypertriglyceridemia]], and thyroid disorders have been reported with administration of INFERGEN. Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=* Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

* Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., [[headache]], [[fatigue]], [[fever]], [[rigors]], [[myalgia]], [[sweating]] increased, and [[arthralgia]]) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

* [[Depression]], usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

* In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of [[leukopenia]] and [[granulocytopenia]]. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

=====Laboratory Values=====
* The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

* Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for [[hemoglobin]] and [[hematocrit]], which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in [[hemoglobin]] or [[hematocrit]] were seen in 1% of patients or less.

* White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total [[white blood cell]] (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for [[ANC]] were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in [[neutrophils]] were not associated with infections.

* Platelets: INFERGEN treatment was associated with alterations in [[platelet count]]. Decreases in mean [[platelet count]] of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

* Triglycerides: Mean values for serum [[triglyceride]] increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

* Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with [[hypothyroidism]] including increases in [[TSH]] and decreases in [[T4]] mean values. Increases in [[TSH]] to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

* Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for [[ANC]] were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in [[ANC]] to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.
|postmarketing=* In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

* Application site: [[injection site reaction]], including injection site [[necrosis]] [[ulcer]], and bruising; [[Ear]] and [[Labyrinth]]: [[hearing loss]], hearing impairment; Gastrointestinal: [[abdominal distention]], [[gastrointestinal bleeding]], [[gastritis]]; Hepatobiliary: hepatic enzyme elevations, including [[ALT]] and [[AST]] elevation, abnormal hepatic function, [[hyperbilirubinemia]], [[jaundice]], [[ascites]], [[hepatic encephalopathy]]; [[Infections]]: [[sepsis]]; Metabolism and Nutritional: [[dehydration]]; Musculoskeletal: [[rhabdomyolysis]], [[arthritis]], [[bone pain]]; Nervous: speech disorder, [[ataxia]], gait abnormal, [[convulsions]], [[loss of consciousness]], [[memory]] impairment, [[tremors]], [[visual field defect]]; Psychiatric: [[delusions]], [[hallucinations]]; Skin and Subcutaneous: [[bruising]], [[pyoderma gangrenosum]], [[toxic epidermal necrolysis]]; Vascular Disorders: [[hemorrhage]]
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=* It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=* Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* [[subcutaneous]]
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as [[jaundice]], [[ascites]], [[coagulopathy]], or decreased serum [[albumin]], are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=* In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in [[anorexia]], [[chills]], [[fever]], and [[myalgia]]. Increases in [[ALT]] (15 to 127 IU/L), [[aspartate transaminase]] (AST) (15 to 164 IU/L), and [[lactic dehydrogenase]] (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox={{Drugbox2
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| pregnancy_AU = 
| pregnancy_US = C
| pregnancy_category=
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| legal_CA = 
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| legal_US = Rx-only
| legal_status =
| dependency_liability =
| routes_of_administration = Parenteral


| bioavailability =
| protein_bound =
| metabolism =
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| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 118390-30-0
| CAS_supplemental =
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| ATC_prefix = L03
| ATC_suffix = AB09
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| KEGG =
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI =
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL =


| C=860 | H=1353 | N=227 | O=255 | S=9
| molecular_weight = 19343 g/mol
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|mechAction=* Interferons are a family of naturally occurring, small protein molecules with molecular weights of 15,000 to 21,000 daltons that are produced and secreted by cells in response to viral infections or to various synthetic and biological inducers. Two major classes of interferons have been identified (i.e., type-I and type-II). Type-I interferons include a family of more than 25 alpha interferons as well as beta interferon and omega interferon. While all alpha interferons have similar biological effects, not all the activities are shared by each alpha interferon and, in many cases, the extent of activity varies substantially for each interferon subtype.

* All type-I interferons share common biological activities generated by binding of interferon to the cell-surface receptor, leading to the production of several interferon-stimulated gene products. Type-I interferons induce pleiotropic biologic responses which include antiviral, antiproliferative, and immunomodulatory effects, regulation of cell surface major histocompatibility antigen (HLA class I and class II) expression and regulation of cytokine expression. Examples of interferon-stimulated gene products include 2'5' oligoadenylate synthetase (2'5'OAS) and β-2 microglobulin.

* The antiviral, antiproliferative, natural killer (NK) cell activation, and gene-induction activities of INFERGEN have been compared with other recombinant alpha interfereons in in vitro assays and have demonstrated similar ranges of activity. INFERGEN exhibited at least 5 times higher specific activity in vitro than Interferon alfa-2a and Interferon alfa-2b.2 Comparison of INFERGEN with a WHO international potency standard for recombinant alpha interferon (83/514) revealed that the specific activity of INFERGEN in both an in vitro antiviral cytopathic effect assay and an antiproliferative assay was 1 x 109 U/mg. However, correlation between in vitro activity and clinical activity of any interferon is unknown.


|structure=
|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=* The pharmacokinetic properties of INFERGEN have not been evaluated in patients with chronic hepatitis C. Pharmacokinetic profiles were evaluated in normal, healthy volunteer subjects after SC injection of 1, 3, or 9 mcg INFERGEN. Plasma levels of INFERGEN after SC administration of any dose were too low to be detected by either enzyme-linked immunosorbent assay (ELISA) or by inhibition of viral cytopathic effect. However, analysis of INFERGEN-induced cellular products (induction of 2'5' OAS and β-2 microglobulin) after treatment in these subjects revealed a statistically significant, dose-related increase in the area under the curve ([[AUC]]) for the levels of 2'5' OAS or β-2 microglobulin induced over time (p < 0.001 for all comparisons). Concentrations of 2'5' OAS were maximal at 24 hours after dosing, while serum levels of β-2 microglobulin appeared to reach a maximum 24 to 36 hours after dosing. The dose-response relationships observed for 2'5' OAS and β-2 microglobulin were indicative of biological activity after SC administration of 1 to 9 mcg INFERGEN.

=====Preclinical Experience=====
* All interferons have been shown to be highly species-specific. Antiviral activity of INFERGEN was observed in the rhesus monkey LLC cell line and golden Syrian hamster BHK cell line. Antiviral activity of INFERGEN in the golden Syrian hamster was confirmed further in vivo.3 Pharmacokinetic studies of INFERGEN in golden Syrian hamsters and rhesus monkeys demonstrated rapid absorption following SC injection. Peak serum concentrations of INFERGEN were observed at 1 hour and 4 hours in golden Syrian hamsters and in rhesus monkeys, respectively. Subcutaneous bioavailability was high in both species, averaging 99% in golden Syrian hamsters and 83% to 104% in rhesus monkeys. Clearance of INFERGEN, averaging 1.99 mL/minute/kg in golden Syrian hamsters and 0.71 to 0.92 mL/minute/kg in rhesus monkeys, was due predominantly to catabolism and excretion by the kidneys. The terminal half-life of INFERGEN following SC dosing was 1.3 hours in golden Syrian hamsters and 3.4 hours in rhesus monkeys. Upon 7-day multiple SC dosing, no accumulation of serum levels was observed in golden Syrian hamsters.

* In preclinical toxicology studies in golden Syrian hamsters and rhesus monkeys, administration of INFERGEN at doses of up to 100 mcg/kg/day was associated with decreased body weight, decreased food consumption, and bone marrow suppression. High-dose chronic exposure at doses of 10 to 100 mcg/kg/day (50- to 500-fold higher than the maximum clinical dose given daily) in rhesus monkeys was not tolerated for greater than 1 month, due to the development of vascular leak syndrome.

* Reproductive toxicity studies in pregnant rhesus monkeys and golden Syrian hamsters demonstrated an increase in fetal loss in hamsters treated with INFERGEN at doses of > 150 mcg/kg/day and in rhesus monkeys at doses of 3 and 10 mcg/kg/day. The INFERGEN toxicity profile described is consistent with the known toxicity profile of other alpha interferons.4


|nonClinToxic======Carcinogenesis, Mutagenesis, Impairment of Fertility=====
* Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

* Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

* Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Use only 1 dose per vial; do not re-enter the vial. Discard unused portions. Do not save unused drug for later administration.

* Single-dose, preservative-free vials containing 9 mcg (0.3 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2007-06).

* Single-dose, preservative-free vials containing 15 mcg (0.5 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2006-05).
|storage=* INFERGEN should be stored in the refrigerator at 2° to 8°C (36° to 46°F). Do not freeze. Avoid vigorous shaking and exposure to direct sunlight.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Interferon I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=* If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including [[fatigue]], [[fever]], [[rigors]], [[headache]], [[arthralgia]], [[myalgia]], and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

* Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider

====MEDICATION GUIDE====
: [[File:Interferon MG.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* INFERGEN®<ref>{{Cite web | title = Interferon alfacon-1 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7248eca-45d6-472d-8c2a-d8887c2594d5}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}


[[Category:Drug]]

Interferon alfacon-1

2015-04-28T18:02:24Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=[[Immunology|Immunological Agent]]
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have [[anti-HCV serum antibodies]] and/or the presence of [[HCV RNA]]. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=[[Injection site reactions]], [[fatigue]], [[fever]], [[rigors]], [[body pain]]


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 




|fdaLIADAdult=====Indications====
* INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
* The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN.

* Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks.

* There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

=====Dose Reduction=====
* For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

* If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

* During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

=====Administration of INFERGEN=====
* If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles.

Storage
* Just prior to injection, INFERGEN may be allowed to reach room temperature.

* Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known [[hypersensitivity]] to alpha interferons or to any component of the product

* [[decompensated hepatic disease]]

* [[autoimmune hepatitis]]


|warnings=* Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

* Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

=====Neuropsychiatric Disorders=====
* Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and [[suicide]] may occur. Other prominent psychiatric adverse events may also occur, including [[psychosis]], aggressive behavior, [[nervousness]], [[anxiety]], [[emotional liability]], abnormal thinking, [[agitation]], apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted.

=====Bone Marrow Toxicity=====
* Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of [[aplastic anemia]]. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in [[neutrophil]] (<0.5 x 109/L) or [[platelet counts]] (<50 x 109/L).

=====Cardiovascular Disorders=====
* [[Hypertension]], [[tachycardia]], [[palpitation]], and [[tachyarrhythmias]] have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. [[Supraventricular arrhythmias]], [[chest pain]], and [[myocardial infarction]] have been associated with alpha interferon therapies.8

=====Hypersensitivity=====
* Serious acute [[hypersensitivity reactions]] have been reported in rare instances following treatment with alpha interferons. If [[hypersensitivity reactions]] occur (e.g., [[urticaria]], [[angioedema]], [[bronchoconstriction]], [[anaphylaxis]]), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

=====Endocrine Disorders=====
* INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of [[hyperthyroidism]] or [[hypothyroidism]] have been reported with INFERGEN. [[Hyperglycemia]] and [[diabetes mellitus]] have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

=====Autoimmune Disorders=====
* Development of or exacerbation of [[autoimmune]] disorders (e.g., autoimmune [[thrombocytopenia]], [[idiopathic thrombocytopenic purpura]], [[psoriasis]], [[rheumatoid arthritis]]) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with [[autoimmune hepatitis]] and should be used with caution in patients with other autoimmune disorders.

=====Pulmonary Disorder=====
* [[Pneumonia]] and [[interstitial pneumonitis]], some resulting in [[respiratory failure]] and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained [[pulmonary infiltrates]] or [[pulmonary function]] impairment should discontinue treatment with INFERGEN.

=====Colitis=====
* Hemorrhagic/[[ischemic colitis]], sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

=====Pancreatitis=====
* [[Pancreatitis]], sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of [[pancreatitis]] and discontinued in patients diagnosed with [[pancreatitis]].

=====Hepatic Exacerbations and Decompensated Hepatic Disease=====
* [[Chronic hepatitis C]] patients with [[cirrhosis]] may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as [[jaundice]], [[ascites]], [[coagulopathy]], or decreased serum [[albumin]], are observed.

=====Ophthalmologic Disorders=====
* Decrease or loss of vision, [[retinopathy]] including [[macular edema]], retinal artery or vein thrombosis, [[retinal hemorrhages]] and cotton wool spots; [[optic neuritis]], and [[papilledema]] are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or [[hypertensive retinopathy]]) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

=====Cerebrovascular Disorders=====
* Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for [[stroke]], including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

=====General=====
* While [[fever]] may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

=====Bone Marrow Toxicity=====
* INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause [[myelosuppression]]. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

=====Renal Impairment=====
* Increases in serum [[creatinine]] levels, and rarely [[renal failure]], have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

=====Laboratory Tests=====
* Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

[[Platelet count]] ≥ 75 x 109/L

[[Hemoglobin]] concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum [[creatinine]] concentration < 180 μmol/L (< 2.0 mg/dL) or [[creatinine clearance]] > 0.83 mL/second (> 50 mL/minute)

Serum [[albumin]] concentration ≥ 25 g/L

[[Bilirubin]] within normal limits

[[TSH]] and [[T4]] within normal limits

[[Neutropenia]], [[thrombocytopenia]], [[hypertriglyceridemia]], and thyroid disorders have been reported with administration of INFERGEN. Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=* Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

* Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., [[headache]], [[fatigue]], [[fever]], [[rigors]], [[myalgia]], [[sweating]] increased, and [[arthralgia]]) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

* [[Depression]], usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

* In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of [[leukopenia]] and [[granulocytopenia]]. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

=====Laboratory Values=====
* The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

* Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for [[hemoglobin]] and [[hematocrit]], which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in [[hemoglobin]] or [[hematocrit]] were seen in 1% of patients or less.

* White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total [[white blood cell]] (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for [[ANC]] were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in [[neutrophils]] were not associated with infections.

* Platelets: INFERGEN treatment was associated with alterations in [[platelet count]]. Decreases in mean [[platelet count]] of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

* Triglycerides: Mean values for serum [[triglyceride]] increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

* Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with [[hypothyroidism]] including increases in [[TSH]] and decreases in [[T4]] mean values. Increases in [[TSH]] to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

* Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for [[ANC]] were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in [[ANC]] to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.
|postmarketing=* In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

* Application site: [[injection site reaction]], including injection site [[necrosis]] [[ulcer]], and bruising; [[Ear]] and [[Labyrinth]]: [[hearing loss]], hearing impairment; Gastrointestinal: [[abdominal distention]], [[gastrointestinal bleeding]], [[gastritis]]; Hepatobiliary: hepatic enzyme elevations, including [[ALT]] and [[AST]] elevation, abnormal hepatic function, [[hyperbilirubinemia]], [[jaundice]], [[ascites]], [[hepatic encephalopathy]]; [[Infections]]: [[sepsis]]; Metabolism and Nutritional: [[dehydration]]; Musculoskeletal: [[rhabdomyolysis]], [[arthritis]], [[bone pain]]; Nervous: speech disorder, [[ataxia]], gait abnormal, [[convulsions]], [[loss of consciousness]], [[memory]] impairment, [[tremors]], [[visual field defect]]; Psychiatric: [[delusions]], [[hallucinations]]; Skin and Subcutaneous: [[bruising]], [[pyoderma gangrenosum]], [[toxic epidermal necrolysis]]; Vascular Disorders: [[hemorrhage]]
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=* It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=* Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* [[subcutaneous]]
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as [[jaundice]], [[ascites]], [[coagulopathy]], or decreased serum [[albumin]], are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=* In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in [[anorexia]], [[chills]], [[fever]], and [[myalgia]]. Increases in [[ALT]] (15 to 127 IU/L), [[aspartate transaminase]] (AST) (15 to 164 IU/L), and [[lactic dehydrogenase]] (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox=
|mechAction=* Interferons are a family of naturally occurring, small protein molecules with molecular weights of 15,000 to 21,000 daltons that are produced and secreted by cells in response to viral infections or to various synthetic and biological inducers. Two major classes of interferons have been identified (i.e., type-I and type-II). Type-I interferons include a family of more than 25 alpha interferons as well as beta interferon and omega interferon. While all alpha interferons have similar biological effects, not all the activities are shared by each alpha interferon and, in many cases, the extent of activity varies substantially for each interferon subtype.

* All type-I interferons share common biological activities generated by binding of interferon to the cell-surface receptor, leading to the production of several interferon-stimulated gene products. Type-I interferons induce pleiotropic biologic responses which include antiviral, antiproliferative, and immunomodulatory effects, regulation of cell surface major histocompatibility antigen (HLA class I and class II) expression and regulation of cytokine expression. Examples of interferon-stimulated gene products include 2'5' oligoadenylate synthetase (2'5'OAS) and β-2 microglobulin.

* The antiviral, antiproliferative, natural killer (NK) cell activation, and gene-induction activities of INFERGEN have been compared with other recombinant alpha interfereons in in vitro assays and have demonstrated similar ranges of activity. INFERGEN exhibited at least 5 times higher specific activity in vitro than Interferon alfa-2a and Interferon alfa-2b.2 Comparison of INFERGEN with a WHO international potency standard for recombinant alpha interferon (83/514) revealed that the specific activity of INFERGEN in both an in vitro antiviral cytopathic effect assay and an antiproliferative assay was 1 x 109 U/mg. However, correlation between in vitro activity and clinical activity of any interferon is unknown.


|structure=


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=* The pharmacokinetic properties of INFERGEN have not been evaluated in patients with chronic hepatitis C. Pharmacokinetic profiles were evaluated in normal, healthy volunteer subjects after SC injection of 1, 3, or 9 mcg INFERGEN. Plasma levels of INFERGEN after SC administration of any dose were too low to be detected by either enzyme-linked immunosorbent assay (ELISA) or by inhibition of viral cytopathic effect. However, analysis of INFERGEN-induced cellular products (induction of 2'5' OAS and β-2 microglobulin) after treatment in these subjects revealed a statistically significant, dose-related increase in the area under the curve ([[AUC]]) for the levels of 2'5' OAS or β-2 microglobulin induced over time (p < 0.001 for all comparisons). Concentrations of 2'5' OAS were maximal at 24 hours after dosing, while serum levels of β-2 microglobulin appeared to reach a maximum 24 to 36 hours after dosing. The dose-response relationships observed for 2'5' OAS and β-2 microglobulin were indicative of biological activity after SC administration of 1 to 9 mcg INFERGEN.

=====Preclinical Experience=====
* All interferons have been shown to be highly species-specific. Antiviral activity of INFERGEN was observed in the rhesus monkey LLC cell line and golden Syrian hamster BHK cell line. Antiviral activity of INFERGEN in the golden Syrian hamster was confirmed further in vivo.3 Pharmacokinetic studies of INFERGEN in golden Syrian hamsters and rhesus monkeys demonstrated rapid absorption following SC injection. Peak serum concentrations of INFERGEN were observed at 1 hour and 4 hours in golden Syrian hamsters and in rhesus monkeys, respectively. Subcutaneous bioavailability was high in both species, averaging 99% in golden Syrian hamsters and 83% to 104% in rhesus monkeys. Clearance of INFERGEN, averaging 1.99 mL/minute/kg in golden Syrian hamsters and 0.71 to 0.92 mL/minute/kg in rhesus monkeys, was due predominantly to catabolism and excretion by the kidneys. The terminal half-life of INFERGEN following SC dosing was 1.3 hours in golden Syrian hamsters and 3.4 hours in rhesus monkeys. Upon 7-day multiple SC dosing, no accumulation of serum levels was observed in golden Syrian hamsters.

* In preclinical toxicology studies in golden Syrian hamsters and rhesus monkeys, administration of INFERGEN at doses of up to 100 mcg/kg/day was associated with decreased body weight, decreased food consumption, and bone marrow suppression. High-dose chronic exposure at doses of 10 to 100 mcg/kg/day (50- to 500-fold higher than the maximum clinical dose given daily) in rhesus monkeys was not tolerated for greater than 1 month, due to the development of vascular leak syndrome.

* Reproductive toxicity studies in pregnant rhesus monkeys and golden Syrian hamsters demonstrated an increase in fetal loss in hamsters treated with INFERGEN at doses of > 150 mcg/kg/day and in rhesus monkeys at doses of 3 and 10 mcg/kg/day. The INFERGEN toxicity profile described is consistent with the known toxicity profile of other alpha interferons.4


|nonClinToxic======Carcinogenesis, Mutagenesis, Impairment of Fertility=====
* Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

* Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

* Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Use only 1 dose per vial; do not re-enter the vial. Discard unused portions. Do not save unused drug for later administration.

* Single-dose, preservative-free vials containing 9 mcg (0.3 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2007-06).

* Single-dose, preservative-free vials containing 15 mcg (0.5 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2006-05).
|storage=* INFERGEN should be stored in the refrigerator at 2° to 8°C (36° to 46°F). Do not freeze. Avoid vigorous shaking and exposure to direct sunlight.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Interferon I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=* If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including [[fatigue]], [[fever]], [[rigors]], [[headache]], [[arthralgia]], [[myalgia]], and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

* Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider

====MEDICATION GUIDE====
: [[File:Interferon MG.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* INFERGEN®<ref>{{Cite web | title = Interferon alfacon-1 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7248eca-45d6-472d-8c2a-d8887c2594d5}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}



[[Category:Drug]]

Interferon alfacon-1

2015-04-28T16:37:08Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=[[Immunology|Immunological Agent]]
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have [[anti-HCV serum antibodies]] and/or the presence of [[HCV RNA]]. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=[[Injection site reactions]], [[fatigue]], [[fever]], [[rigors]], [[body pain]]


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 




|fdaLIADAdult=====Indications====
* INFERGEN is indicated for the treatment of [[Hepatitis C|chronic HCV infection]] in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of [[hepatitis]], such as [[viral hepatitis B]] or [[autoimmune hepatitis]], should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum [[ALT]], reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
* The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN.

* Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks.

* There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

=====Dose Reduction=====
* For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

* If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

* During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

=====Administration of INFERGEN=====
* If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles.

Storage
* Just prior to injection, INFERGEN may be allowed to reach room temperature.

* Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known [[hypersensitivity]] to alpha interferons or to any component of the product

* [[decompensated hepatic disease]]

* [[autoimmune hepatitis]]


|warnings=Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

Neuropsychiatric Disorders
Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and suicide may occur. Other prominent psychiatric adverse events may also occur, including psychosis, aggressive behavior, nervousness, anxiety, emotional lability, abnormal thinking, agitation, apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted (SeeDOSAGE AND ADMINISTRATION: DOSE REDUCTION).

Bone Marrow Toxicity
Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of aplastic anemia. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in neutrophil (<0.5 x 109/L) or platelet counts (<50 x 109/L).

Cardiovascular Disorders
Hypertension, tachycardia, palpitation, and tachyarrhythmias have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. Supraventricular arrhythmias, chest pain, and myocardial infarction have been associated with alpha interferon therapies.8

Hypersensitivity
Serious acute hypersensitivity reactions have been reported in rare instances following treatment with alpha interferons. If hypersensitivity reactions occur (e.g., urticaria, angioedema, bronchoconstriction, anaphylaxis), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

Endocrine Disorders
INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of hyperthyroidism or hypothyroidism have been reported with INFERGEN. Hyperglycemia and diabetes mellitus have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

Autoimmune Disorders
Development of or exacerbation of autoimmune disorders (e.g., autoimmune thrombocytopenia, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with autoimmune hepatitis (seeCONTRAINDICATIONS) and should be used with caution in patients with other autoimmune disorders.

Pulmonary Disorder
Pneumonia and interstitial pneumonitis, some resulting in respiratory failure and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained pulmonary infiltrates or pulmonary function impairment should discontinue treatment with INFERGEN.

Colitis
Hemorrhagic/ischemic colitis, sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

Pancreatitis
Pancreatitis, sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of pancreatitis and discontinued in patients diagnosed with pancreatitis.

Hepatic Exacerbations and Decompensated Hepatic Disease
Chronic hepatitis C patients with cirrhosis may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed (seeCONTRAINDICATIONS).

Ophthalmologic Disorders
Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots; optic neuritis, and papilledema are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or hypertensive retinopathy) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

Cerebrovascular Disorders
Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

General
While fever may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

Bone Marrow Toxicity
INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause myelosuppression. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

Renal Impairment
Increases in serum creatinine levels, and rarely renal failure, have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

Laboratory Tests
Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

Platelet count ≥ 75 x 109/L

Hemoglobin concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum creatinine concentration < 180 μmol/L (< 2.0 mg/dL) or creatinine clearance > 0.83 mL/second (> 50 mL/minute)

Serum albumin concentration ≥ 25 g/L

Bilirubin within normal limits

TSH and T4 within normal limits

Neutropenia, thrombocytopenia, hypertriglyceridemia, and thyroid disorders have been reported with administration of INFERGEN (seeADVERSE REACTIONS). Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., headache, fatigue, fever, rigors, myalgia, sweating increased, and arthralgia) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

Depression, usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of leukopenia and granulocytopenia. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

Laboratory Values
The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for hemoglobin and hematocrit, which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in hemoglobin or hematocrit were seen in 1% of patients or less.

White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total white blood cell (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for ANC were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in neutrophils were not associated with infections.

Platelets: INFERGEN treatment was associated with alterations in platelet count. Decreases in mean platelet count of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

Triglycerides: Mean values for serum triglyceride increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with hypothyroidism including increases in TSH and decreases in T4 mean values. Increases in TSH to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for ANC were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in ANC to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.
|postmarketing=In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

Application site: injection site reaction, including injection site necrosis ulcer, and bruising; Ear and Labyrinth: hearing loss, hearing impairment; Gastrointestinal: abdominal distention, gastrointestinal bleeding, gastritis; Hepatobiliary: hepatic enzyme elevations, including ALT and AST elevation, abnormal hepatic function, hyperbilirubinemia, jaundice, ascites, hepatic encephalopathy; Infections: sepsis; Metabolism and Nutritional: dehydration; Musculoskeletal: rhabdomyolysis, arthritis, bone pain; Nervous: speech disorder, ataxia, gait abnormal, convulsions, loss of consciousness, memory impairment, tremors, visual field defect; Psychiatric: delusions, hallucinations; Skin and Subcutaneous: bruising, pyoderma gangrenosum, toxic epidermal necrolysis; Vascular Disorders: hemorrhage
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* subcutaneous
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in anorexia, chills, fever, and myalgia. Increases in ALT (15 to 127 IU/L), aspartate transaminase (AST) (15 to 164 IU/L), and lactic dehydrogenase (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox=
|mechAction=* Interferons are a family of naturally occurring, small protein molecules with molecular weights of 15,000 to 21,000 daltons that are produced and secreted by cells in response to viral infections or to various synthetic and biological inducers. Two major classes of interferons have been identified (i.e., type-I and type-II). Type-I interferons include a family of more than 25 alpha interferons as well as beta interferon and omega interferon. While all alpha interferons have similar biological effects, not all the activities are shared by each alpha interferon and, in many cases, the extent of activity varies substantially for each interferon subtype.

All type-I interferons share common biological activities generated by binding of interferon to the cell-surface receptor, leading to the production of several interferon-stimulated gene products. Type-I interferons induce pleiotropic biologic responses which include antiviral, antiproliferative, and immunomodulatory effects, regulation of cell surface major histocompatibility antigen (HLA class I and class II) expression and regulation of cytokine expression. Examples of interferon-stimulated gene products include 2'5' oligoadenylate synthetase (2'5'OAS) and β-2 microglobulin.

The antiviral, antiproliferative, natural killer (NK) cell activation, and gene-induction activities of INFERGEN have been compared with other recombinant alpha interfereons in in vitro assays and have demonstrated similar ranges of activity. INFERGEN exhibited at least 5 times higher specific activity in vitro than Interferon alfa-2a and Interferon alfa-2b.2 Comparison of INFERGEN with a WHO international potency standard for recombinant alpha interferon (83/514) revealed that the specific activity of INFERGEN in both an in vitro antiviral cytopathic effect assay and an antiproliferative assay was 1 x 109 U/mg. However, correlation between in vitro activity and clinical activity of any interferon is unknown.


|structure=*


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=The pharmacokinetic properties of INFERGEN have not been evaluated in patients with chronic hepatitis C. Pharmacokinetic profiles were evaluated in normal, healthy volunteer subjects after SC injection of 1, 3, or 9 mcg INFERGEN. Plasma levels of INFERGEN after SC administration of any dose were too low to be detected by either enzyme-linked immunosorbent assay (ELISA) or by inhibition of viral cytopathic effect. However, analysis of INFERGEN-induced cellular products (induction of 2'5' OAS and β-2 microglobulin) after treatment in these subjects revealed a statistically significant, dose-related increase in the area under the curve (AUC) for the levels of 2'5' OAS or β-2 microglobulin induced over time (p < 0.001 for all comparisons). Concentrations of 2'5' OAS were maximal at 24 hours after dosing, while serum levels of β-2 microglobulin appeared to reach a maximum 24 to 36 hours after dosing. The dose-response relationships observed for 2'5' OAS and β-2 microglobulin were indicative of biological activity after SC administration of 1 to 9 mcg INFERGEN.

Preclinical Experience
All interferons have been shown to be highly species-specific. Antiviral activity of INFERGEN was observed in the rhesus monkey LLC cell line and golden Syrian hamster BHK cell line. Antiviral activity of INFERGEN in the golden Syrian hamster was confirmed further in vivo.3 Pharmacokinetic studies of INFERGEN in golden Syrian hamsters and rhesus monkeys demonstrated rapid absorption following SC injection. Peak serum concentrations of INFERGEN were observed at 1 hour and 4 hours in golden Syrian hamsters and in rhesus monkeys, respectively. Subcutaneous bioavailability was high in both species, averaging 99% in golden Syrian hamsters and 83% to 104% in rhesus monkeys. Clearance of INFERGEN, averaging 1.99 mL/minute/kg in golden Syrian hamsters and 0.71 to 0.92 mL/minute/kg in rhesus monkeys, was due predominantly to catabolism and excretion by the kidneys. The terminal half-life of INFERGEN following SC dosing was 1.3 hours in golden Syrian hamsters and 3.4 hours in rhesus monkeys. Upon 7-day multiple SC dosing, no accumulation of serum levels was observed in golden Syrian hamsters.

In preclinical toxicology studies in golden Syrian hamsters and rhesus monkeys, administration of INFERGEN at doses of up to 100 mcg/kg/day was associated with decreased body weight, decreased food consumption, and bone marrow suppression. High-dose chronic exposure at doses of 10 to 100 mcg/kg/day (50- to 500-fold higher than the maximum clinical dose given daily) in rhesus monkeys was not tolerated for greater than 1 month, due to the development of vascular leak syndrome.

Reproductive toxicity studies in pregnant rhesus monkeys and golden Syrian hamsters demonstrated an increase in fetal loss in hamsters treated with INFERGEN at doses of > 150 mcg/kg/day and in rhesus monkeys at doses of 3 and 10 mcg/kg/day. The INFERGEN toxicity profile described is consistent with the known toxicity profile of other alpha interferons.4


|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Use only 1 dose per vial; do not re-enter the vial. Discard unused portions. Do not save unused drug for later administration.

Single-dose, preservative-free vials containing 9 mcg (0.3 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2007-06).

Single-dose, preservative-free vials containing 15 mcg (0.5 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2006-05).
|storage=INFERGEN should be stored in the refrigerator at 2° to 8°C (36° to 46°F). Do not freeze. Avoid vigorous shaking and exposure to direct sunlight.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Interferon I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including fatigue, fever, rigors, headache, arthralgia, myalgia, and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider

====MEDICATION GUIDE====
: [[File:Interferon MG.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* INFERGEN®<ref>{{Cite web | title = Interferon alfacon-1 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7248eca-45d6-472d-8c2a-d8887c2594d5}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

Interferon alfacon-1

2015-04-28T16:13:36Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=Immunological Agent
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=Injection site reactions, fatigue, fever, rigors, body pain


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

Dose Reduction
For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

Administration of INFERGEN
If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles. See theMEDICATION GUIDE for detailed instructions.

Storage
Just prior to injection, INFERGEN may be allowed to reach room temperature.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known hypersensitivity to alpha interferons or to any component of the product

decompensated hepatic disease

autoimmune hepatitis


|warnings=Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

Neuropsychiatric Disorders
Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and suicide may occur. Other prominent psychiatric adverse events may also occur, including psychosis, aggressive behavior, nervousness, anxiety, emotional lability, abnormal thinking, agitation, apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted (SeeDOSAGE AND ADMINISTRATION: DOSE REDUCTION).

Bone Marrow Toxicity
Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of aplastic anemia. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in neutrophil (<0.5 x 109/L) or platelet counts (<50 x 109/L).

Cardiovascular Disorders
Hypertension, tachycardia, palpitation, and tachyarrhythmias have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. Supraventricular arrhythmias, chest pain, and myocardial infarction have been associated with alpha interferon therapies.8

Hypersensitivity
Serious acute hypersensitivity reactions have been reported in rare instances following treatment with alpha interferons. If hypersensitivity reactions occur (e.g., urticaria, angioedema, bronchoconstriction, anaphylaxis), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

Endocrine Disorders
INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of hyperthyroidism or hypothyroidism have been reported with INFERGEN. Hyperglycemia and diabetes mellitus have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

Autoimmune Disorders
Development of or exacerbation of autoimmune disorders (e.g., autoimmune thrombocytopenia, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with autoimmune hepatitis (seeCONTRAINDICATIONS) and should be used with caution in patients with other autoimmune disorders.

Pulmonary Disorder
Pneumonia and interstitial pneumonitis, some resulting in respiratory failure and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained pulmonary infiltrates or pulmonary function impairment should discontinue treatment with INFERGEN.

Colitis
Hemorrhagic/ischemic colitis, sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

Pancreatitis
Pancreatitis, sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of pancreatitis and discontinued in patients diagnosed with pancreatitis.

Hepatic Exacerbations and Decompensated Hepatic Disease
Chronic hepatitis C patients with cirrhosis may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed (seeCONTRAINDICATIONS).

Ophthalmologic Disorders
Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots; optic neuritis, and papilledema are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or hypertensive retinopathy) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

Cerebrovascular Disorders
Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

General
While fever may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

Bone Marrow Toxicity
INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause myelosuppression. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

Renal Impairment
Increases in serum creatinine levels, and rarely renal failure, have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

Laboratory Tests
Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

Platelet count ≥ 75 x 109/L

Hemoglobin concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum creatinine concentration < 180 μmol/L (< 2.0 mg/dL) or creatinine clearance > 0.83 mL/second (> 50 mL/minute)

Serum albumin concentration ≥ 25 g/L

Bilirubin within normal limits

TSH and T4 within normal limits

Neutropenia, thrombocytopenia, hypertriglyceridemia, and thyroid disorders have been reported with administration of INFERGEN (seeADVERSE REACTIONS). Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., headache, fatigue, fever, rigors, myalgia, sweating increased, and arthralgia) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

Depression, usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of leukopenia and granulocytopenia. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

Laboratory Values
The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for hemoglobin and hematocrit, which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in hemoglobin or hematocrit were seen in 1% of patients or less.

White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total white blood cell (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for ANC were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in neutrophils were not associated with infections.

Platelets: INFERGEN treatment was associated with alterations in platelet count. Decreases in mean platelet count of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

Triglycerides: Mean values for serum triglyceride increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with hypothyroidism including increases in TSH and decreases in T4 mean values. Increases in TSH to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for ANC were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in ANC to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.
|postmarketing=In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

Application site: injection site reaction, including injection site necrosis ulcer, and bruising; Ear and Labyrinth: hearing loss, hearing impairment; Gastrointestinal: abdominal distention, gastrointestinal bleeding, gastritis; Hepatobiliary: hepatic enzyme elevations, including ALT and AST elevation, abnormal hepatic function, hyperbilirubinemia, jaundice, ascites, hepatic encephalopathy; Infections: sepsis; Metabolism and Nutritional: dehydration; Musculoskeletal: rhabdomyolysis, arthritis, bone pain; Nervous: speech disorder, ataxia, gait abnormal, convulsions, loss of consciousness, memory impairment, tremors, visual field defect; Psychiatric: delusions, hallucinations; Skin and Subcutaneous: bruising, pyoderma gangrenosum, toxic epidermal necrolysis; Vascular Disorders: hemorrhage
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* subcutaneous
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in anorexia, chills, fever, and myalgia. Increases in ALT (15 to 127 IU/L), aspartate transaminase (AST) (15 to 164 IU/L), and lactic dehydrogenase (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox=
|mechAction=* Interferons are a family of naturally occurring, small protein molecules with molecular weights of 15,000 to 21,000 daltons that are produced and secreted by cells in response to viral infections or to various synthetic and biological inducers. Two major classes of interferons have been identified (i.e., type-I and type-II). Type-I interferons include a family of more than 25 alpha interferons as well as beta interferon and omega interferon. While all alpha interferons have similar biological effects, not all the activities are shared by each alpha interferon and, in many cases, the extent of activity varies substantially for each interferon subtype.

All type-I interferons share common biological activities generated by binding of interferon to the cell-surface receptor, leading to the production of several interferon-stimulated gene products. Type-I interferons induce pleiotropic biologic responses which include antiviral, antiproliferative, and immunomodulatory effects, regulation of cell surface major histocompatibility antigen (HLA class I and class II) expression and regulation of cytokine expression. Examples of interferon-stimulated gene products include 2'5' oligoadenylate synthetase (2'5'OAS) and β-2 microglobulin.

The antiviral, antiproliferative, natural killer (NK) cell activation, and gene-induction activities of INFERGEN have been compared with other recombinant alpha interfereons in in vitro assays and have demonstrated similar ranges of activity. INFERGEN exhibited at least 5 times higher specific activity in vitro than Interferon alfa-2a and Interferon alfa-2b.2 Comparison of INFERGEN with a WHO international potency standard for recombinant alpha interferon (83/514) revealed that the specific activity of INFERGEN in both an in vitro antiviral cytopathic effect assay and an antiproliferative assay was 1 x 109 U/mg. However, correlation between in vitro activity and clinical activity of any interferon is unknown.


|structure=*


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=The pharmacokinetic properties of INFERGEN have not been evaluated in patients with chronic hepatitis C. Pharmacokinetic profiles were evaluated in normal, healthy volunteer subjects after SC injection of 1, 3, or 9 mcg INFERGEN. Plasma levels of INFERGEN after SC administration of any dose were too low to be detected by either enzyme-linked immunosorbent assay (ELISA) or by inhibition of viral cytopathic effect. However, analysis of INFERGEN-induced cellular products (induction of 2'5' OAS and β-2 microglobulin) after treatment in these subjects revealed a statistically significant, dose-related increase in the area under the curve (AUC) for the levels of 2'5' OAS or β-2 microglobulin induced over time (p < 0.001 for all comparisons). Concentrations of 2'5' OAS were maximal at 24 hours after dosing, while serum levels of β-2 microglobulin appeared to reach a maximum 24 to 36 hours after dosing. The dose-response relationships observed for 2'5' OAS and β-2 microglobulin were indicative of biological activity after SC administration of 1 to 9 mcg INFERGEN.

Preclinical Experience
All interferons have been shown to be highly species-specific. Antiviral activity of INFERGEN was observed in the rhesus monkey LLC cell line and golden Syrian hamster BHK cell line. Antiviral activity of INFERGEN in the golden Syrian hamster was confirmed further in vivo.3 Pharmacokinetic studies of INFERGEN in golden Syrian hamsters and rhesus monkeys demonstrated rapid absorption following SC injection. Peak serum concentrations of INFERGEN were observed at 1 hour and 4 hours in golden Syrian hamsters and in rhesus monkeys, respectively. Subcutaneous bioavailability was high in both species, averaging 99% in golden Syrian hamsters and 83% to 104% in rhesus monkeys. Clearance of INFERGEN, averaging 1.99 mL/minute/kg in golden Syrian hamsters and 0.71 to 0.92 mL/minute/kg in rhesus monkeys, was due predominantly to catabolism and excretion by the kidneys. The terminal half-life of INFERGEN following SC dosing was 1.3 hours in golden Syrian hamsters and 3.4 hours in rhesus monkeys. Upon 7-day multiple SC dosing, no accumulation of serum levels was observed in golden Syrian hamsters.

In preclinical toxicology studies in golden Syrian hamsters and rhesus monkeys, administration of INFERGEN at doses of up to 100 mcg/kg/day was associated with decreased body weight, decreased food consumption, and bone marrow suppression. High-dose chronic exposure at doses of 10 to 100 mcg/kg/day (50- to 500-fold higher than the maximum clinical dose given daily) in rhesus monkeys was not tolerated for greater than 1 month, due to the development of vascular leak syndrome.

Reproductive toxicity studies in pregnant rhesus monkeys and golden Syrian hamsters demonstrated an increase in fetal loss in hamsters treated with INFERGEN at doses of > 150 mcg/kg/day and in rhesus monkeys at doses of 3 and 10 mcg/kg/day. The INFERGEN toxicity profile described is consistent with the known toxicity profile of other alpha interferons.4


|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=* Use only 1 dose per vial; do not re-enter the vial. Discard unused portions. Do not save unused drug for later administration.

Single-dose, preservative-free vials containing 9 mcg (0.3 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2007-06).

Single-dose, preservative-free vials containing 15 mcg (0.5 mL) of Interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 0187-2006-05).
|storage=INFERGEN should be stored in the refrigerator at 2° to 8°C (36° to 46°F). Do not freeze. Avoid vigorous shaking and exposure to direct sunlight.
|packLabel=====INGREDIENTS AND APPEARANCE====
: [[File:Interferon I n A.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|fdaPatientInfo=If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including fatigue, fever, rigors, headache, arthralgia, myalgia, and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider

====MEDICATION GUIDE====
: [[File:Interferon MG.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* INFERGEN®<ref>{{Cite web | title = Interferon alfacon-1 | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7248eca-45d6-472d-8c2a-d8887c2594d5}}</ref>


|lookAlike=There is limited information regarding the look alike drug names.
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

File:Interferon I n A.png

2015-04-28T16:09:17Z

Rabin Bista:

File:Interferon MG.png

2015-04-28T16:08:53Z

Rabin Bista:

Interferon alfacon-1

2015-04-28T16:00:02Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=Immunological Agent
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=Injection site reactions, fatigue, fever, rigors, body pain


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

Dose Reduction
For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

Administration of INFERGEN
If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles. See theMEDICATION GUIDE for detailed instructions.

Storage
Just prior to injection, INFERGEN may be allowed to reach room temperature.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known hypersensitivity to alpha interferons or to any component of the product

decompensated hepatic disease

autoimmune hepatitis


|warnings=Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

Neuropsychiatric Disorders
Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and suicide may occur. Other prominent psychiatric adverse events may also occur, including psychosis, aggressive behavior, nervousness, anxiety, emotional lability, abnormal thinking, agitation, apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted (SeeDOSAGE AND ADMINISTRATION: DOSE REDUCTION).

Bone Marrow Toxicity
Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of aplastic anemia. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in neutrophil (<0.5 x 109/L) or platelet counts (<50 x 109/L).

Cardiovascular Disorders
Hypertension, tachycardia, palpitation, and tachyarrhythmias have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. Supraventricular arrhythmias, chest pain, and myocardial infarction have been associated with alpha interferon therapies.8

Hypersensitivity
Serious acute hypersensitivity reactions have been reported in rare instances following treatment with alpha interferons. If hypersensitivity reactions occur (e.g., urticaria, angioedema, bronchoconstriction, anaphylaxis), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

Endocrine Disorders
INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of hyperthyroidism or hypothyroidism have been reported with INFERGEN. Hyperglycemia and diabetes mellitus have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

Autoimmune Disorders
Development of or exacerbation of autoimmune disorders (e.g., autoimmune thrombocytopenia, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with autoimmune hepatitis (seeCONTRAINDICATIONS) and should be used with caution in patients with other autoimmune disorders.

Pulmonary Disorder
Pneumonia and interstitial pneumonitis, some resulting in respiratory failure and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained pulmonary infiltrates or pulmonary function impairment should discontinue treatment with INFERGEN.

Colitis
Hemorrhagic/ischemic colitis, sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

Pancreatitis
Pancreatitis, sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of pancreatitis and discontinued in patients diagnosed with pancreatitis.

Hepatic Exacerbations and Decompensated Hepatic Disease
Chronic hepatitis C patients with cirrhosis may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed (seeCONTRAINDICATIONS).

Ophthalmologic Disorders
Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots; optic neuritis, and papilledema are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or hypertensive retinopathy) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

Cerebrovascular Disorders
Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

General
While fever may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

Bone Marrow Toxicity
INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause myelosuppression. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

Renal Impairment
Increases in serum creatinine levels, and rarely renal failure, have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

Laboratory Tests
Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

Platelet count ≥ 75 x 109/L

Hemoglobin concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum creatinine concentration < 180 μmol/L (< 2.0 mg/dL) or creatinine clearance > 0.83 mL/second (> 50 mL/minute)

Serum albumin concentration ≥ 25 g/L

Bilirubin within normal limits

TSH and T4 within normal limits

Neutropenia, thrombocytopenia, hypertriglyceridemia, and thyroid disorders have been reported with administration of INFERGEN (seeADVERSE REACTIONS). Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., headache, fatigue, fever, rigors, myalgia, sweating increased, and arthralgia) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

Depression, usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of leukopenia and granulocytopenia. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

Laboratory Values
The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for hemoglobin and hematocrit, which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in hemoglobin or hematocrit were seen in 1% of patients or less.

White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total white blood cell (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for ANC were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in neutrophils were not associated with infections.

Platelets: INFERGEN treatment was associated with alterations in platelet count. Decreases in mean platelet count of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

Triglycerides: Mean values for serum triglyceride increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with hypothyroidism including increases in TSH and decreases in T4 mean values. Increases in TSH to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for ANC were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in ANC to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.
|postmarketing=In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

Application site: injection site reaction, including injection site necrosis ulcer, and bruising; Ear and Labyrinth: hearing loss, hearing impairment; Gastrointestinal: abdominal distention, gastrointestinal bleeding, gastritis; Hepatobiliary: hepatic enzyme elevations, including ALT and AST elevation, abnormal hepatic function, hyperbilirubinemia, jaundice, ascites, hepatic encephalopathy; Infections: sepsis; Metabolism and Nutritional: dehydration; Musculoskeletal: rhabdomyolysis, arthritis, bone pain; Nervous: speech disorder, ataxia, gait abnormal, convulsions, loss of consciousness, memory impairment, tremors, visual field defect; Psychiatric: delusions, hallucinations; Skin and Subcutaneous: bruising, pyoderma gangrenosum, toxic epidermal necrolysis; Vascular Disorders: hemorrhage
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* subcutaneous
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in anorexia, chills, fever, and myalgia. Increases in ALT (15 to 127 IU/L), aspartate transaminase (AST) (15 to 164 IU/L), and lactic dehydrogenase (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox=
|mechAction=* Interferons are a family of naturally occurring, small protein molecules with molecular weights of 15,000 to 21,000 daltons that are produced and secreted by cells in response to viral infections or to various synthetic and biological inducers. Two major classes of interferons have been identified (i.e., type-I and type-II). Type-I interferons include a family of more than 25 alpha interferons as well as beta interferon and omega interferon. While all alpha interferons have similar biological effects, not all the activities are shared by each alpha interferon and, in many cases, the extent of activity varies substantially for each interferon subtype.

All type-I interferons share common biological activities generated by binding of interferon to the cell-surface receptor, leading to the production of several interferon-stimulated gene products. Type-I interferons induce pleiotropic biologic responses which include antiviral, antiproliferative, and immunomodulatory effects, regulation of cell surface major histocompatibility antigen (HLA class I and class II) expression and regulation of cytokine expression. Examples of interferon-stimulated gene products include 2'5' oligoadenylate synthetase (2'5'OAS) and β-2 microglobulin.

The antiviral, antiproliferative, natural killer (NK) cell activation, and gene-induction activities of INFERGEN have been compared with other recombinant alpha interfereons in in vitro assays and have demonstrated similar ranges of activity. INFERGEN exhibited at least 5 times higher specific activity in vitro than Interferon alfa-2a and Interferon alfa-2b.2 Comparison of INFERGEN with a WHO international potency standard for recombinant alpha interferon (83/514) revealed that the specific activity of INFERGEN in both an in vitro antiviral cytopathic effect assay and an antiproliferative assay was 1 x 109 U/mg. However, correlation between in vitro activity and clinical activity of any interferon is unknown.


|structure=*

: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=The pharmacokinetic properties of INFERGEN have not been evaluated in patients with chronic hepatitis C. Pharmacokinetic profiles were evaluated in normal, healthy volunteer subjects after SC injection of 1, 3, or 9 mcg INFERGEN. Plasma levels of INFERGEN after SC administration of any dose were too low to be detected by either enzyme-linked immunosorbent assay (ELISA) or by inhibition of viral cytopathic effect. However, analysis of INFERGEN-induced cellular products (induction of 2'5' OAS and β-2 microglobulin) after treatment in these subjects revealed a statistically significant, dose-related increase in the area under the curve (AUC) for the levels of 2'5' OAS or β-2 microglobulin induced over time (p < 0.001 for all comparisons). Concentrations of 2'5' OAS were maximal at 24 hours after dosing, while serum levels of β-2 microglobulin appeared to reach a maximum 24 to 36 hours after dosing. The dose-response relationships observed for 2'5' OAS and β-2 microglobulin were indicative of biological activity after SC administration of 1 to 9 mcg INFERGEN.

Preclinical Experience
All interferons have been shown to be highly species-specific. Antiviral activity of INFERGEN was observed in the rhesus monkey LLC cell line and golden Syrian hamster BHK cell line. Antiviral activity of INFERGEN in the golden Syrian hamster was confirmed further in vivo.3 Pharmacokinetic studies of INFERGEN in golden Syrian hamsters and rhesus monkeys demonstrated rapid absorption following SC injection. Peak serum concentrations of INFERGEN were observed at 1 hour and 4 hours in golden Syrian hamsters and in rhesus monkeys, respectively. Subcutaneous bioavailability was high in both species, averaging 99% in golden Syrian hamsters and 83% to 104% in rhesus monkeys. Clearance of INFERGEN, averaging 1.99 mL/minute/kg in golden Syrian hamsters and 0.71 to 0.92 mL/minute/kg in rhesus monkeys, was due predominantly to catabolism and excretion by the kidneys. The terminal half-life of INFERGEN following SC dosing was 1.3 hours in golden Syrian hamsters and 3.4 hours in rhesus monkeys. Upon 7-day multiple SC dosing, no accumulation of serum levels was observed in golden Syrian hamsters.

In preclinical toxicology studies in golden Syrian hamsters and rhesus monkeys, administration of INFERGEN at doses of up to 100 mcg/kg/day was associated with decreased body weight, decreased food consumption, and bone marrow suppression. High-dose chronic exposure at doses of 10 to 100 mcg/kg/day (50- to 500-fold higher than the maximum clinical dose given daily) in rhesus monkeys was not tolerated for greater than 1 month, due to the development of vascular leak syndrome.

Reproductive toxicity studies in pregnant rhesus monkeys and golden Syrian hamsters demonstrated an increase in fetal loss in hamsters treated with INFERGEN at doses of > 150 mcg/kg/day and in rhesus monkeys at doses of 3 and 10 mcg/kg/day. The INFERGEN toxicity profile described is consistent with the known toxicity profile of other alpha interferons.4


|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=*
|packLabel=
|fdaPatientInfo=If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including fatigue, fever, rigors, headache, arthralgia, myalgia, and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>


|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>


|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}






[[Category:Drug]]

Interferon alfacon-1

2015-04-28T15:36:55Z

Rabin Bista:

{{DrugProjectFormSinglePage
|authorTag={{RB}}
|genericName=Interferon alfacon-1
|aOrAn=a
|drugClass=Immunological Agent
|indicationType=treatment
|indication=INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.
|adverseReactions=Injection site reactions, fatigue, fever, rigors, body pain


|blackBoxWarningTitle=ConditionName: 
|blackBoxWarningBody=ConditionName: 

* Content




|fdaLIADAdult=====Indications====
INFERGEN is indicated for the treatment of chronic HCV infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. Other causes of hepatitis, such as viral hepatitis B or autoimmune hepatitis, should be ruled out prior to initiation of therapy with INFERGEN. In some patients with chronic HCV infection, INFERGEN normalizes serum ALT, reduces serum HCV RNA concentrations to undetectable quantities (< 100 copies/mL), and improves liver histology.

====Dosage====
The recommended dose of INFERGEN for treatment of chronic HCV infection is 9 mcg TIW administered SC as a single injection for 24 weeks. At least 48 hours should elapse between doses of INFERGEN. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

Patients who tolerated previous interferon therapy and did not respond or relapsed following its discontinuation may be subsequently treated with 15 mcg of INFERGEN TIW administered SC as a single injection for up to 48 weeks. (SeeILLUSTRATED MEDICATION GUIDE for instructions.)

There are significant differences in specific activities among interferons. Healthcare providers should be aware that changes in interferon brand may require adjustments of dosage and/or change in route of administration. Patients should be warned not to change brands of interferon without medical consultation. Patients should also be instructed by their physician not to reduce the dosage of INFERGEN prior to medical consultation.

Dose Reduction
For patients who experience a severe adverse reaction on INFERGEN, dosage should be withheld temporarily. If the adverse reaction does not become tolerable, therapy should be discontinued. Dose reduction to 7.5 mcg may be necessary following an intolerable adverse event. In the pivotal study, 11% of patients (26/231) who initially received INFERGEN at a dose of 9 mcg (0.3 mL) were dose-reduced to 7.5 mcg (0.25 mL).

If adverse reactions continue to occur at the reduced dosage, the physician may discontinue treatment or reduce dosage further. However, decreased efficacy may result from continued treatment at dosages below 7.5 mcg.

During subsequent treatment for 48 weeks with 15 mcg of INFERGEN, up to 36% of patients required dose reductions in 3 mcg increments.

Administration of INFERGEN
If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. After administration of INFERGEN, it is essential to follow the procedure for proper disposal of syringes and needles. See theMEDICATION GUIDE for detailed instructions.

Storage
Just prior to injection, INFERGEN may be allowed to reach room temperature.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration; if particulates or discoloration are observed, the container should not be used.
|offLabelAdultGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in adult patients.


|offLabelAdultNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in adult patients.




|fdaLIADPed=* Safety and effectiveness has not been established on pediatric patients
|offLabelPedGuideSupport=There is limited information regarding Off-Label Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|offLabelPedNoGuideSupport=There is limited information regarding Off-Label Non–Guideline-Supported Use of {{PAGENAME}} in pediatric patients.


|contraindications=* known hypersensitivity to alpha interferons or to any component of the product

decompensated hepatic disease

autoimmune hepatitis


|warnings=Treatment with INFERGEN should be administered under the guidance of a qualified physician, and may lead to moderate-to-severe adverse experiences requiring dose reduction, temporary dose cessation, or discontinuation of further therapy.

Withdrawal from study for adverse events occurred in 7% of patients initially treated with 9 mcg INFERGEN (including 4% due to psychiatric events). Withdrawal from study due to adverse events occurred in 5% of patients subsequently treated with 15 mcg INFERGEN for 24 weeks and 11% of patients subsequently treated with 15 mcg INFERGEN for 48 weeks.

Neuropsychiatric Disorders
Severe psychiatric adverse events may manifest in patients receiving therapy with alpha interferons, including INFERGEN. Depression, suicidal ideation, suicide attempt, and suicide may occur. Other prominent psychiatric adverse events may also occur, including psychosis, aggressive behavior, nervousness, anxiety, emotional lability, abnormal thinking, agitation, apathy and relapse of drug addiction. INFERGEN should be used with extreme caution in patients who report a history of depression. Physicians should monitor all patients for evidence of depression and other psychiatric symptoms. Prior to initiation of INFERGEN therapy, physicians should inform patients of the possible development of depression and patients should be advised to immediately report any sign or symptom of depression and/or suicidal ideation. In severe cases, therapy should be stopped immediately and psychiatric intervention instituted (SeeDOSAGE AND ADMINISTRATION: DOSE REDUCTION).

Bone Marrow Toxicity
Alpha interferons suppress bone marrow function and may result in severe cytopenias including very rare events of aplastic anemia. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Alpha interferon therapy should be discontinued in patients who develop severe decreases in neutrophil (<0.5 x 109/L) or platelet counts (<50 x 109/L).

Cardiovascular Disorders
Hypertension, tachycardia, palpitation, and tachyarrhythmias have been reported in patients treated with INFERGEN. INFERGEN should be administered with caution to patients with preexisting cardiac disease. Supraventricular arrhythmias, chest pain, and myocardial infarction have been associated with alpha interferon therapies.8

Hypersensitivity
Serious acute hypersensitivity reactions have been reported in rare instances following treatment with alpha interferons. If hypersensitivity reactions occur (e.g., urticaria, angioedema, bronchoconstriction, anaphylaxis), INFERGEN should be discontinued immediately and appropriate medical treatment instituted.

Endocrine Disorders
INFERGEN should be administered with caution to patients with a history of endocrine disorders. Occurrence or aggravation of hyperthyroidism or hypothyroidism have been reported with INFERGEN. Hyperglycemia and diabetes mellitus have also been observed in patients treated with INFERGEN. Patients who develop these conditions during treatment that cannot be controlled with medication should not continue INFERGEN therapy.

Autoimmune Disorders
Development of or exacerbation of autoimmune disorders (e.g., autoimmune thrombocytopenia, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis) have been reported in patients receiving alpha interferon therapies, including INFERGEN. INFERGEN should not be used in patients with autoimmune hepatitis (seeCONTRAINDICATIONS) and should be used with caution in patients with other autoimmune disorders.

Pulmonary Disorder
Pneumonia and interstitial pneumonitis, some resulting in respiratory failure and/or patient deaths, have been induced or aggravated by alpha interferon therapy, including INFERGEN. Patients who develop persistent or unexplained pulmonary infiltrates or pulmonary function impairment should discontinue treatment with INFERGEN.

Colitis
Hemorrhagic/ischemic colitis, sometimes fatal, has been observed within 12 weeks of alpha interferon therapies and has been reported in patients treated with INFERGEN. INFERGEN treatment should be discontinued immediately in patients who develop signs and symptoms of colitis.

Pancreatitis
Pancreatitis, sometimes fatal, has been observed in patients treated with alpha interferons, including INFERGEN. INFERGEN should be suspended in patients with signs and symptoms suggestive of pancreatitis and discontinued in patients diagnosed with pancreatitis.

Hepatic Exacerbations and Decompensated Hepatic Disease
Chronic hepatitis C patients with cirrhosis may be at risk of hepatic decompensation when treated with alpha interferons, including INFERGEN. During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed (seeCONTRAINDICATIONS).

Ophthalmologic Disorders
Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots; optic neuritis, and papilledema are induced or aggravated by treatment with INFERGEN or other alpha interferons. All patients should receive an eye examination at baseline. Patients with preexisting ophthalmologic disorders (e.g., diabetic or hypertensive retinopathy) should receive periodic ophthalmologic exams during interferon alpha treatment. Any patient who develops ocular symptoms should receive a prompt and complete eye examination. INFERGEN therapy should be discontinued in patients who develop new or worsening ophthalmologic disorders.

Cerebrovascular Disorders
Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alfa-based therapies, including INFERGEN. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alfa-based therapies and these events is difficult to establish.

====Precautions====

General
While fever may be related to the flu-like symptoms reported in patients treated with INFERGEN, when fever occurs, other possible causes of persistent fever should be ruled out.

Bone Marrow Toxicity
INFERGEN should be used cautiously in patients with abnormally low peripheral blood cell counts or who are receiving agents that are known to cause myelosuppression. Transplantation patients or other chronically immunosuppressed patients should receive alpha interferon therapy with caution.

Renal Impairment
Increases in serum creatinine levels, and rarely renal failure, have been observed in patients receiving INFERGEN. INFERGEN has not been studied in patients with renal insufficiency. Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.

Laboratory Tests
Laboratory tests are recommended for all patients on INFERGEN therapy, prior to beginning treatment (baseline), 2 weeks after initiation of therapy, and periodically thereafter during the 24 or 48 weeks of therapy at the discretion of the physician. Following completion of INFERGEN therapy, any abnormal test values should be monitored periodically. The entrance criteria that were used for the clinical study of INFERGEN may be considered as a guideline to acceptable baseline values for initiation of treatment:

Platelet count ≥ 75 x 109/L

Hemoglobin concentration ≥ 100 g/L

ANC ≥ 1500 x 106/L

Serum creatinine concentration < 180 μmol/L (< 2.0 mg/dL) or creatinine clearance > 0.83 mL/second (> 50 mL/minute)

Serum albumin concentration ≥ 25 g/L

Bilirubin within normal limits

TSH and T4 within normal limits

Neutropenia, thrombocytopenia, hypertriglyceridemia, and thyroid disorders have been reported with administration of INFERGEN (seeADVERSE REACTIONS). Therefore, these laboratory parameters should be monitored closely.




|clinicalTrials=Adverse experiences that were reported, regardless of attribution to treatment, in at least 5% of patients in the 9 mcg INFERGEN or 3 MIU IFN α-2b groups of the pivotal study are presented in TABLE 3, listed in decreasing order by the 9 mcg INFERGEN group. The incidence of adverse events is expressed based on the number of patients experiencing each event at least once during treatment or during posttreatment observation.

Most adverse events were mild-to-moderate in severity and abated with cessation of therapy. Flu-like symptoms (i.e., headache, fatigue, fever, rigors, myalgia, sweating increased, and arthralgia) were the most frequently reported treatment-related adverse reactions. Most were short-lived and could be treated symptomatically.

Depression, usually mild-to-moderate in severity, was reported in 26% of patients who received 9 mcg INFERGEN and was the most common adverse event resulting in study drug discontinuation.

In patients who had tolerated previous interferon therapy (9 mcg INFERGEN or 3 MIU IFN α-2b) and failed to normalize ALT, or who had achieved normalization of ALT during the treatment period but who relapsed during the posttreatment observation period, subsequent treatment with 15 mcg TIW of INFERGEN for 24 or 48 weeks was generally tolerated. Adverse experiences of patients receiving subsequent treatment, regardless of attribution to treatment, are reported in TABLE 3. The higher dose of INFERGEN used in these patients was associated with a greater incidence of leukopenia and granulocytopenia. One or more dose reductions for all causes were required in up to 36% of patients. Patients who do not tolerate initial standard interferon therapy should not receive therapy with 15 mcg TIW of INFERGEN.

[[File:Interferon Adv.png|400px|none]]

Laboratory Values
The following laboratory values were found to be affected by therapy with INFERGEN in the 231 patients who received treatment with 9 mcg INFERGEN.

Hemoglobin and Hematocrit: Treatment with INFERGEN was associated with gradual decreases in mean values for hemoglobin and hematocrit, which were 4% and 5% below baseline at the end of treatment. Decreases from baseline of 20% or more in hemoglobin or hematocrit were seen in 1% of patients or less.

White Blood Cells: INFERGEN treatment was associated with decreases in mean values for both total white blood cell (WBC) count and ANC within the first 2 weeks of treatment. By the end of treatment, mean decreases from baseline of 19% for WBCs and 23% for ANC were observed. These effects reversed during the posttreatment observation period. In 2 INFERGEN-treated patients in the phase 3 trial, decreases in ANC to levels below 500 x 106 cells/L were seen. In both cases, the ANC returned to clinically acceptable levels with reduction of the dose of INFERGEN, and these transient decreases in neutrophils were not associated with infections.

Platelets: INFERGEN treatment was associated with alterations in platelet count. Decreases in mean platelet count of 16% compared to baseline were seen by the end of treatment. These decreases were reversed during the posttreatment observation period. Values below normal were common during treatment with 3% of patients developing values less than 50 x 109 cells/L, usually necessitating dose reduction.

Triglycerides: Mean values for serum triglyceride increased shortly after the start of administration of INFERGEN, with increases of 41%, compared with baseline, at the end of the treatment period. Seven percent of the patients developed values which were at least 3 times above pretreatment levels during treatment. This effect was promptly reversed after discontinuation of treatment.

Thyroid Function: INFERGEN treatment was associated with biochemical changes consistent with hypothyroidism including increases in TSH and decreases in T4 mean values. Increases in TSH to greater than 7 mU/L were seen in 10% of 9 mcg INFERGEN-treated patients either during the treatment period or the 24-week posttreatment observation period. Thyroid supplements were instituted in approximately one-third of these patients.

Laboratory Values for Subsequent Treatment: From a database of 165 patients receiving subsequent treatment with 15 mcg of INFERGEN for 24 weeks, and 168 patients receiving subsequent treatment with 15 mcg of INFERGEN for 48 weeks after failing initial interferon therapy, similar changes in the laboratory values as outlined above were observed. Mean decreases from baseline up to 23% for WBCs and up to 27% for ANC were observed for patients subsequently treated with interferon, which was greater than during initial treatment. Two patients in the 24-week group experienced reversible reductions in ANC to less than 500 x 106 cells/L, which were not associated with infectious complications. No patients discontinued as a result of hematologic toxicity.

|postmarketing=In addition, the following potential adverse reactions have been reported during post-approval use of INFERGEN. Because the reports of these adverse events are voluntary and the population of uncertain size, it is not possible to reliably estimate the frequency of the reaction or establish a causal relationship to drug exposure.

Application site: injection site reaction, including injection site necrosis ulcer, and bruising; Ear and Labyrinth: hearing loss, hearing impairment; Gastrointestinal: abdominal distention, gastrointestinal bleeding, gastritis; Hepatobiliary: hepatic enzyme elevations, including ALT and AST elevation, abnormal hepatic function, hyperbilirubinemia, jaundice, ascites, hepatic encephalopathy; Infections: sepsis; Metabolism and Nutritional: dehydration; Musculoskeletal: rhabdomyolysis, arthritis, bone pain; Nervous: speech disorder, ataxia, gait abnormal, convulsions, loss of consciousness, memory impairment, tremors, visual field defect; Psychiatric: delusions, hallucinations; Skin and Subcutaneous: bruising, pyoderma gangrenosum, toxic epidermal necrolysis; Vascular Disorders: hemorrhage
|drugInteractions=* No formal drug interaction studies have been conducted with INFERGEN. INFERGEN should be used cautiously in patients who are receiving agents that are known to cause myelosuppression or with agents known to be metabolized via the cytochrome P-450 pathway.9 Patients taking drugs that are metabolized by this pathway should be monitored closely for changes in the therapeutic and/or toxic levels of concomitant drugs.


|FDAPregCat=C
|useInPregnancyFDA=* INFERGEN has been shown to have embryolethal or abortifacient effects in golden Syrian hamsters when given at 135 times the human dose and in cynomolgus and rhesus monkeys when given at 9 to 81 times (based on body surface area) the human dose. There are no adequate and well-controlled studies in pregnant women. INFERGEN should not be used during pregnancy. If a woman becomes pregnant or plans to become pregnant while taking INFERGEN, she should be informed of the potential hazards to the fetus. Males and females treated with INFERGEN should be advised to use effective contraception.
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=It is not known whether INFERGEN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if INFERGEN is administered to a nursing woman. The effect on the nursing neonate of orallyingested INFERGEN in breast milk has not been evaluated.
|useInPed=The safety and effectiveness of INFERGEN have not been established in patients below the age of 18 years. INFERGEN therapy is not recommended in pediatric patients.
|useInGeri=Clinical studies of INFERGEN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, treatment with Interferons, including INFERGEN, is associated with psychiatric, cardiac, and systemic (flu-like) adverse effects. Since decreased hepatic, renal or cardiac function, concomitant disease and the use of other drug therapies in elderly patients may produce adverse reactions of greater severity, caution should be exercised in the use of INFERGEN in this population.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.


|administration=* subcutaneous
|monitoring=* It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy
* During treatment, patients’ clinical status and hepatic function should be closely monitored, and INFERGEN treatment should be immediately discontinued if symptoms of hepatic decompensation, such as jaundice, ascites, coagulopathy, or decreased serum albumin, are observed
* Patients with impaired renal function should be closely monitored and INFERGEN should be used with caution in patients with renal insufficiency.
|IVCompat=There is limited information regarding IV Compatibility of {{PAGENAME}} in the drug label.


|overdose=In INFERGEN trials, the maximum overdose reported was a dose of 150 mcg INFERGEN administered SC in a patient enrolled in a phase 1 advanced malignancy trial. The patient received 10 times the prescribed dosage for 3 days. The patient experienced a mild increase in anorexia, chills, fever, and myalgia. Increases in ALT (15 to 127 IU/L), aspartate transaminase (AST) (15 to 164 IU/L), and lactic dehydrogenase (LDH) (183 to 281 IU/L) were reported. These laboratory values returned to normal or to the patient’s baseline values within 30 days.
|drugBox=
|mechAction=*


|structure=*

: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


|PD=There is limited information regarding Pharmacodynamics of {{PAGENAME}} in the drug label.


|PK=There is limited information regarding Pharmacokinetics of {{PAGENAME}} in the drug label.


|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis: No carcinogenicity data for INFERGEN are available in animals or humans.

Mutagenesis: INFERGEN was not mutagenic when tested in several in vitro assays, including the Ames bacterial mutagenicity assay and an in vitro cytogenetic assay in human lymphocytes, either in the presence or absence of metabolic activation.

Impairment of Fertility: INFERGEN at doses as high as 100 mcg/kg did not selectively affect reproductive performance or the development of the offspring when administered SC to male and female golden Syrian hamsters for 70 and 14 days before mating, respectively, and then through mating and to day 7 of pregnancy.


|clinicalStudies=There is limited information regarding Clinical Studies of {{PAGENAME}} in the drug label.


|howSupplied=*
|packLabel=
|fdaPatientInfo=If home use is determined to be desirable by the physician, instructions on appropriate use should be given by a healthcare professional. The patient must be instructed as to the proper dosage and administration. Information included in the MEDICATION GUIDE should be fully reviewed with the patient; it is not a disclosure of all, or possible, adverse effects. The most common adverse reactions occurring with INFERGEN therapy are flu-like symptoms including fatigue, fever, rigors, headache, arthralgia, myalgia, and increased sweating. Non-narcotic analgesics and bedtime administration of INFERGEN may be used to prevent or lessen some of these symptoms.

Additionally, patients must be thoroughly instructed in the importance of proper disposal procedures and cautioned against the reuse of needles, syringes, or re-entry of the drug product. A puncture-resistant container for the disposal of used syringes and needles should be used by the patient and should be disposed of according to the directions provided by the health care provider
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>


|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>


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[[Category:Drug]]

File:Interferon Adv.png

2015-04-28T15:27:37Z

Rabin Bista:

Interferon alfacon-1

2015-04-28T15:08:32Z

Rabin Bista: