DefinePK

Abstract

These questions Mere received and answered by the Drug Information Centre, recently set up at the Khyber Medical College, Peshawar, by the Department of Pharmacology andTherapeutics.
Question
Which preparation of iron could be convenienty administered perferably in syrup form to provide the following doses for different age, groups?
1. 100 mg B.I.D. orally
2, 100 mg T.I.D. orally
For: (a) Pregnant Women, (b) Lactating mothers, (c) Young Girls. 12-18 years, (d) Young Boys. 12-18 years (e) Children 1-5 years.
Sulaiman Daud, Paediatric Deptt., K.T.H. Peshawar.
Answer
The Iron preparation available in the market which provides 100mg of Iron as succinate is marketed by Wellcome of Pakistan Ltd., under the Trade name of Ferromyn Elixir and Ferromyn tab.
Ferromyn Elixir contains Ferrous succinate anhydrous 100mg. Each 100mg of Ferrous Succinate and will deliver 35mg of elemental Iron.
Other preparations such as Polysaccharide Iron complex elixir 100mg/ml and Tab. 50mg and Ferrous Fumerate Suspension 100mg/5ml are not available in the market.
Question
My nephew swallowed a rat posion by the name of Brumoline Flakes but apparently he seemed normal. What is the treatment for possible poisoning?
I nam Kaznti, Director P.M.R.Ci Islamabad.
Answer
Rat poison Brumoline Flakes, is a Spanish (Barcelona) preparation containing 4-Hydroxy Counarine 0.03115% Extract of organic sweet clover 0.004%
The active ingredient is4-hydroxycoumerinc intended to cause bleeding in rats and so are the chances in man.
The other ingredient is meant only to attract the animal towards taking this poison.
Anticoagulant antagonist Vit K lOmg may be given 1. M.stat. Gastric lavage is needed.
Supportive treatment may be kept ready as and when the need arises.
Question
A 19 year old epileptic patient received Dilantin for the last five years. He has developed Lymphoma, on biopsy confirmed as Dilantin Lymphoma.
1. Would it regress on withdrawal of the drug?
2. Which drug should replace Dilantin to prevent relapses?
3. Any side effects of the replacing drug?
Fazal Ahmad Assistant Professor of Pathology, Khyber Medical College, Peshawar.
Answer
The phenytoin lymphadenopathy is a fairly well documented side effect and you find Bjornberg.. A. Hoist committee has got 9 reports about lymphadenopathy and one report on malignant lymphonia during the seventies. Interestingly there have also been 4 cases of carbamazepine in monotherapy suspected to cause this syndrome. The mechanism behind this effect seems to be a drug induced depression of the immunological function. Sorreil and collaborators (1971) report about 63 patients on long term phenytoin therapy. About 20 percent of these had low immunoglobulin A levels and a decreased response to various antigens by skin-test. In an article by Fontane et al (1977) it is stated that predisposing factors are needed for the development of IgA depression. Charles-worth (1977) presents a case of phenytoin induced pseudolymphoma. Initially there was no skin reactions to tuberculin and a variety of other antigens. Half a year after stopping the treatment the patient developed normal and posi.. tive reactions to these antigens. Scully and Associates (1980) report a case of “angioim­munoblastic lymphadenopathy” where phenytoin medication was probably of importance for induction of the disease. This patient recovered and her antiepileptic therapy was changed from phenytoin to phenobarbital.
Reynolds (1975) does not specifically comment on the reversibility of Phenytoin induced lymphadenopathy. Lymphadenopathy is reversible as the closely related depression of various immunological parameters seems to bc reversible. In a longer perspective we are somewhat uneasy about the side effect profile. A change to carbamazepine would be highly questionable as this drug might also induce the syndrome. An alternative approach would be to use phenobarbital and carefully adjust the minimum level that controls the seizures.