Robert J. Lipsy

Adverse Effects and Drug Interactions Associated with Fluoxetine Therapy

Fluoxetine, an inhibitor of serotonin reuptake, was released by the Food and Drug Administration in 1988 and was among the most prescribed drugs for that year. Although fluoxetine has been promoted as a safe antidepressant, a recent literature search revealed a number of case reports of adverse effects and drug interactions attributed to its use. This review familiarizes healthcare professionals with some of the currently known interactions and adverse effects and suggests ways of avoiding such events in clinical practice.

Hemodynamic effects of intravenous famotidine in critically ill patients.

Study Objective: To study the hemodynamic effects of famotidine administered undiluted intravenously over 2 minutes.

Adverse Gastrointestinal Effects of Nonsteroidal Anti-Inflammatory Drugs

There are a substantial number of adverse reactions attributable to nonsteroidal anti-inflammatory drug (NSAID) therapy, particularly of the gastrointestinal (GI) tract. The stomach is most commonly affected, although injury may occur from esophagus to colon. The incidence of developing serious GI toxicity seems to be three times as great in users compared with nonusers of NSAIDs. Age greater than 60 years, history of GI problems, previous corticosteroid use, and recency of NSAID use seem to increase the risk of toxicity. Short-term studies have found differences in ulceration or bleeding caused by various NSAIDs. However, there are insufficient long-term clinical trials involving adequate numbers of patients to demonstrate substantial advantages for any particular NSAID based on its toxicity profile. Prostaglandin inhibition seems to be one mechanism responsible for the GI toxicity of NSAIDs, but it is probably not the only mechanism. When serious GI bleeding occurs, the NSAID use must be stopped, although omeprazole and misoprostol have been used successfully to treat gastroduodenal ulcerations in patients while continuing NSAID therapy. Misoprostol and possibly omeprazole have effectively prevented GI ulceration associated with NSAID therapy, but questions remain regarding patient selection, length of therapy, and their utility in preventing serious GI bleeding. At this time, routine prophylaxis for patients receiving long-term NSAID therapy cannot be recommended.