Journal of Pharmaceutical Research

Preenumol Thomas ¹, Somy Cherian ¹, T. P. Sreekrishnan ², K. P. Gireesh Kumar ²

Affiliations
1 Amrita School of Pharmacy, IN
2 Emergency Medicine, AIMS, Kochi, IN

Abstract

Octreotide is a long acting somatostatin analogue mainly used as the first line agent in the management of oesophageal variceal bleeding as well as used for its anti-diarrheal action in patients with metastatic carcinoid tumours.It hasan additional benefit of managing HIV induced chronic diarrhoea that cannot be managed with conventionaltreatment. Severe recurrent diarrhoea is one of the major manifestation of AIDS.

We reviewed 10 patients with chronic diarrhoea secondary to HIV infection who were admitted through Emergency department.They were not responding to standard therapy as the therapy mainly focused on the various causes of HIV induced diarrhoea.

During the study , 4 patients were found to have Cryptosporidium enteritis in their stool culture and 6 patients had no identifiable pathogens.

Treatment with conventional agents did not reduce the symptoms of the patients.

After this, all patients were given Octreotide which showed a significant reduction in frequency of diarrhoea and fluid and electrolyte abnormalities.

This shows the significant role played by Octreotide in management of chronic diarrhoea associated with HIV infection. Further studies are warranted to confirm complete outcomes of Octreotide in this area.

Keywords

Octreotide, Somatostatin, Cryptosporidium enteritis.

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Somy Cherian ¹, Preenumol Thomas ¹, T. P. Sreekrishnan ², K. P. Gireesh Kumar ³

Affiliations
1 Amrita School of Pharmacy, Kochi, IN
2 Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, IN
3 Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, IN

Abstract

Pramipexole is a dopamine agonist of non-ergoline class which is mainly used in the treatment of Parkinson's disease and restless leg syndrome. Fibromyalgia and depression are other off labelled indications.

Adverse events like orthostatic hypotension, worsening of motor and psychiatric symptoms, confusion ,and drowsiness are often stated. Pramipexole induced cardiac events are often less likely, especially in those who doesn't had any underlying heart failure or renal impairment.

We report a rare case of Pramipexole induced complete heart block which was observed in a 68 year old female who was admitted to the emergency department with syncope, generalised tiredness, and one episode of giddiness with blurring of vision.

She had a history of depression but no history of any cardiac and renal disease. She was on a trial of pramipexole on suspicion of Parkinson's disease after which she developed complete heart block with intermittent atrioventricular block which was evident in the electrocardiogram (ECG).

All alternative causes of AV block were ruled out. ECG returned to normal 24 hours after the withdrawal of pramipexole. A total of 7 reports have been found regarding Pramipexole induced cardiac failure. Among these, two reports from New Zealand are noted to have a causality score as 'unlikely'.

Since Pramipexole causing AV block remains a blurred adverse effect, and the relative unawareness of this syndrome among the physicians, makes it a prudent topic to be reported.

This case report gives emphasis on the importance of close monitoring, early detection and management of this adverse drug reaction based on current standard guidelines.

Keywords

Pramipexole, Parkinson's Disease.

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