Jan Schjøtt - Academia.edu (original) (raw)
Papers by Jan Schjøtt
Pharmacology & Toxicology
ABSTRACT
Physiological research / Academia Scientiarum Bohemoslovaca
Aging (Milan, Italy)
We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og ... more We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og Fjordane, Norway. Data on administration of hypnotics on 3 separate days within a week in August 1995 was obtained from the drug administration records in 31 institutions. Twenty-five percent of the 1062 patients in the institutions used hypnotics, with no difference between patients from nursing homes and old age homes. The number of patients treated with hypnotics, the doses administered, and the time of administration were similar for weekends and workdays. About 100% of the hypnotics were used as scheduled, and 29% of the doses administered were higher than the recommended lowest dose for elderly patients. Furthermore, about 50% of the hypnotics administered were long-acting benzodiazepines. The results indicate a need for a review of the prescribing of hypnotics in geriatric institutions.
Tidsskrift for den Norske laegeforening
Tidsskrift for Den norske legeforening
RELIS Vest provides drug information by answering questions from mainly physicians and pharmacist... more RELIS Vest provides drug information by answering questions from mainly physicians and pharmacists. In the present paper we evaluated this service. All questions to RELIS Vest during the 1995-98 period were systematically categorized and analysed. The quality of the service was assessed by evaluation forms. Of a total of 875 queries, 393 came from physicians and 370 from pharmacists. 42% were about psychoactive drugs; the most frequent types of queries concerned documentation and adverse effects. Analysis of 180 evaluation forms showed that 79% of the physicians and 56% of the pharmacists found the answers fast enough, relevant, adequately comprehensive and with valuable references while 16% of the physicians and 29% of the pharmacists found that the answers satisfied three of these four criteria. We conclude that problem-oriented drug information based on actual cases of prescribing is highly appreciated.
Clinical Therapeutics, 2015
BMC research notes, 2014
Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome,... more Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome, but may also represent adverse drug reactions. Psychostimulating drugs raise both blood pressure and heart rate, and case reports of sudden death, stroke, and myocardial infarction have led to regulatory and public concern about the cardiovascular safety of these drugs. We present a case where a 41-year-old Norwegian male with radiating chest pain, elevated troponins, and supraventricular tachycardia was hospitalized. Tentative diagnosis was acute coronary syndrome. Percutaneous coronary angiography, but not cardiac magnetic resonance imaging, was performed and medical antiplatelet treatment started. Because of an attention deficit/hyperactivity disorder the patient had recently increased his dose of methylphenidate, but still within the therapeutic dose range. Apart from venlafaxine, also in a therapeutic dose, the patient took no other drugs. An acute coronary syndrome was excluded du...
Drug, healthcare and patient safety, 2014
RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers ... more RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers where pharmacists and clinical pharmacologists provide feedback to health care professionals in spontaneous drug-related questions and adverse drug-reaction (ADR) reports published in a question-answer pair (QAP) database (the RELIS database) and the Norwegian ADR database, respectively. To describe the potential of RELIS's dual service to improve detection and communication of drug-safety problems. We searched the RELIS database for QAPs about ADRs with use of the Norwegian ADR database as a reference. We also searched the Norwegian ADR database for reports that used the RELIS database as a reference. Both searches were limited to the years 2003-2012. We then selected the example of pregabalin and drug abuse after the marketing of Lyrica in Norway in September 2004 to illustrate RELIS's potential to detect new drug-safety information through a limited number of QAPs and ADR repo...
BMC pharmacology & toxicology, 2014
Chemotherapy with doxorubicin is limited by cardiotoxicity. Free radical generation and mitochond... more Chemotherapy with doxorubicin is limited by cardiotoxicity. Free radical generation and mitochondrial dysfunction are thought to contribute to doxorubicin-induced cardiac failure. In this study we wanted to investigate if opening of mitochondrial KATP-channels by diazoxide is protective against doxorubicin cardiotoxicity, and if 5-hydroxydecanoate (5-HD), a selective mitochondrial KATP-channel antagonist, abolished any protection by this intervention. Wistar rats were divided into 7 groups (n = 6) and followed for 10 days with 5 intervention groups including the following treatments: (1) Diazoxide and doxorubicin, (2) diazoxide and 5-hydroxydecanoate (5-HD), (3) 5-HD and doxorubicin, (4) diazoxide and saline and (5) 5-HD and saline. On day 1, 3, 5 and 7 the animals received intraperitoneal (i.p.) injections with 10 mg/kg diazoxide and/or 40 mg/kg 5-HD, 30 minutes before i.p. injections with 3.0 mg/kg doxorubicin. One control group received only saline injections and the other contro...
Cardiovascular toxicology, 2014
Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacologica... more Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacological preconditioning mimicking ischemic preconditioning has been demonstrated with morphine and represents an acceptable clinical intervention. The purpose of this study was to examine if pretreatment in vivo with morphine could reduce doxorubicin-induced cardiotoxicity ex vivo in a rat model. Wistar rats were divided into six groups and pretreated with an intraperitoneal (i.p.) injection of 3 or 10 mg/kg morphine, 1 mg/kg naloxone and saline, 1 mg/kg naloxone and 3 mg/kg morphine or saline, 60 min before excision of the heart. Biochemical indices such as troponin T (TnT) and hydrogen peroxide (H2O2) in effluate were measured together with physiological parameters in Langendorff hearts before and after doxorubicin infusion (2 mg/mL 0.05 mL/min for 45 min). Myocardial content of doxorubicin was measured at the end of infusion. Pretreatment with morphine, irrespective of dosage, produced a si...
BMJ open, 2012
To assess a question-answer pair (QAP) database integrated with websites developed for drug infor... more To assess a question-answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively. Descriptive study with comparison of two subsequent 6-year periods (1995-2000 and 2001-2006). The Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). A randomised sample of QAPs from the RELIS database. Answer time in days compared with Mann-Whitney U test. Number of drugs involved (one, two, three or more), complexity (judgemental and/or patient-related or not) and literature search (none, simple or advanced) compared with χ(2) tests. 842 QAPs (312 from 1995 to 2000 and 530 from 2001 to 2006) were compared. The fraction of judgemental and patient-related questions increased (66%-75% and 54%-72%, respectively, p<0.01). Number of drugs and literature search (>50% advanced) was similar in the two periods, but the fraction of answers referring to the RELIS database increased (13%-31%, p<0.01). Media...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 29, 2009
The aim of this paper is to assess the substance pregabaline's potential for abuse. Little in... more The aim of this paper is to assess the substance pregabaline's potential for abuse. Little information is available on the subject and that retrieved is in part conflicting. Pregabaline is likely to be abused for its positive psychological effects, e.g. euphoria. However, these effects are weak and not sustained during long-term use. Pregabaline is therefore likely to have a lower potential for abuse than benzodiazepines. In clinical studies, symptoms suggestive of physical dependence (e.g. insomnia, nausea, headache, diarrhoea) have been observed in some patients after abrupt discontinuation of pregabaline. However, available documentation indicates that pregabaline is associated with less physical and psychological dependence than benzodiazepines.
Drug safety, 2008
Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sour... more Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sources providing drug information can give rise to confusion with possible therapeutic consequences. Therefore, it is important to measure clinically important differences between drug information sources. The objective of this study was to compare two easily accessible Norwegian sources providing advice on drug safety in pregnancy - the product monographs in the Felleskatalog (FK), published by the pharmaceutical companies, and the five regional Drug Information Centres (DICs) in Norway - in addition to assessing the frequency of questions regarding drug safety in pregnancy made to the DICs according to the Anatomical Therapeutic Chemical (ATC) classification system. Advice on drug use in pregnancy provided by the DICs in 2003 and 2005 were compared with advice in the product monographs for the respective drugs in the FK. Comparison of advice was based on categorization to one of four cate...
Pharmacy world & science : PWS, 2001
This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. Th... more This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. The study was performed in departments of rheumatology at nine Norwegian hospitals during five weeks in 1998. Pharmacists recorded all drugs on admittance among patients 18 years or older with rheumatic diseases. Sixty percent of 313 patients had polypharmacy defined as the concurrent use of five or more drugs, and this was most frequent among the older patients. However, they used fewer antirheumatic drugs compared to the younger patients. With regard to the three most common drug groups, older patients used more corticosteroids, and less nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs), compared to the younger. Eighty-four percent of patients on methotrexate used folic acid, but only 52% of the patients who used corticosteroids used calcium supplements. Polypharmacy among patients with rheumatic diseases is common, and the present descriptio...
Tidsskrift for Den norske legeforening, 2010
Reactions to drug withdrawal may lead to unnecessary reintroduction and inappropriate prescribing... more Reactions to drug withdrawal may lead to unnecessary reintroduction and inappropriate prescribing. This problem is often encountered after long-term therapy with drugs acting on the cardiovascular and central nervous systems. The adverse effects include rebound effects, withdrawal syndrome, termination of drug-drug interaction, increased risk of disease and recurrence of disease. Lack of scientific evidence limits development of guidelines on how to terminate drug therapy. Slow and gradual tapering schedules for substances with long half-lives is usually recommended to avoid withdrawal syndrome and rebound effects. However, the most important measure is to avoid prescribing drugs that are difficult to withdraw. Appropriate information and involvement of the patient are also important.
Tidsskrift for Den norske legeforening, 2009
Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a varie... more Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a variety of medical conditions. The most common indication is currently chronic venous insufficiency, for which conventional therapy includes use of compression stockings. Horse chestnut seed extract is generally well tolerated; the most common side effects are gastrointestinal disturbances, dizziness and calf-muscle spasms. Clinical trials have shown that horse- chestnut seed extract and placebo are associated with similar side effects Horse- chestnut may interact with anticoagulants and antidiabetics, and caution is advised in patients taking these drugs. A number of clinical trials have shown that horse- chestnut seed extract may be beneficial to patients with mild to moderate chronic venous insufficiency. However, inadequate randomization, short duration and use of different end-points in these trials makes it difficult to conclude regarding effectiveness and safety, especially in long-term use. Horse- chestnut seed extract appears to be a short-term treatment option in patients with mild to moderate chronic venous insufficiency, but more rigorous trials are required to confirm the efficacy of this treatment.
Toxicology Mechanisms and Methods, 2013
Short-time models (STM) to study the cardiotoxicity (acute or chronic) of doxorubicin in rats are... more Short-time models (STM) to study the cardiotoxicity (acute or chronic) of doxorubicin in rats are of interest to assess protective interventions and pathways. STM promotes more ethical animal treatment with less stress, and at a lower cost compared to established long-time models (LTM). We wanted to investigate if an STM of 9 d yields the same information regarding cardiotoxicity as an LTM of 9 weeks. Male Wistar rats received identical drug administration protocols in STM and LTM. The two intervention groups (n = 6) received intraperitoneal (i.p.) injections of 2 mg/kg doxorubicin every day for five consecutive days, with a total cumulative dose of 10 mg/kg. The two control groups (n = 6), received an equivalent volume of saline injected every day for five consecutive days. Hearts from STM and LTM were excised and Langendorff-perfused after 9 d or 9 weeks, respectively, after the first drug injection. Cardiotoxicity was assessed in paced Langendorff hearts by a release of hydrogenperoxide (H2O2) and troponin T (TnT) in effluent, by myocardial accumulation of doxorubicin and its metabolite doxorubicinol, and by physiological parameters recorded during pressure, or volume-regulated perfusion. In STM, hearts exposed to doxorubicin demonstrated a 15% reduction in left ventricular developed pressure (LVDP) irrespective of flow mode, and a 13% increase in aortic pressure (AoP), during volume-regulated perfusion, an index of coronary resistance, compared to controls. Left ventricular end-diastolic pressure (LVEDP) was increased by 72% during pressure-regulated perfusion and 100% during volume-regulated perfusion in STM. In LTM, hearts exposed to doxorubicin demonstrated a 40% reduction in LVDP during pressure-regulated perfusion and a 20% reduction during volume-regulated perfusion. LVEDP was 70% higher in doxorubicin-treated hearts during pressure-regulated perfusion and 80% higher during volume-regulated perfusion. In addition, aortic pressure was increased by 30% during volume-regulated perfusion. In both STM and LTM, hearts exposed to doxorubicin demonstrated a higher H2O2 and TnT release, compared to respective controls. The difference was most pronounced in STM. Myocardial content of doxorubicin was detectable in both STM and LTM. However, doxorubicinol was only detectable in STM. STM is comparable to LTM to study relevant indices of cardiotoxicity of doxorubicin in rat hearts. Biochemical differences are more pronounced in STM, while contractile differences are more pronounced in LTM. STM could be a preferred model for preliminary studies of protective interventions.
Seizure, 2012
To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE).... more To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE). In-depth interviews with pregnant WWE treated with antiepileptic drugs (AEDs). Ten women aged 22-39 years in 20-34 weeks&amp;#39; gestation were interviewed. Avoiding seizures by taking AEDs in pregnancy outweighed perceived risks, but dose adjustments during and after pregnancy increased perceived risks of teratogenicity or seizures. The women had restrictive attitudes towards taking medicines for other indications than epilepsy. They appreciated their neurologist as a source for medicines information, though their needs for medicines information were reduced by long-term use of AEDs. Pregnant WWE were confident in using AEDs through communication with their neurologist, but dose adjustments caused concern. Medicines information to pregnant WWE should focus on empowering the women to control the disease, supporting realistic risk perceptions of AEDs and other necessary medicines. In this article, we outline some medicines information strategies to pregnant WWE.
Scandinavian Journal of Clinical & Laboratory Investigation, 1995
31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic pr... more 31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic preconditioning was due to improved metabolic recovery in isolated rat hearts. The preconditioning stimulus was global ischaemia of 1 or 4 min followed by 12 min of reperfusion (Langendorff mode). The hearts were then subjected to a main ischaemic period of 16 min and 40 min of reperfusion. Functional and metabolic recoveries of hearts were compared to a control group subjected only to the main ischaemia. Preconditioning improved recovery of contractile function during the final reperfusion. Thus left ventricular developed pressure (LVDP) and heart rate (HR) product after 40 min of reperfusion recovered to 56, 67 and 68% in the control group, 1 min group and 4 min group, respectively. However, the metabolic recovery was comparable in all groups. CrP and ATP recovered to levels of 67-78% (CrP) and 35-41% (ATP), and pH to a level of 7.13-7.15 (not different from baseline values) at the end of the final reperfusion. We conclude that the improved functional recovery in preconditioning is not due to a higher level of high energy phosphates or less acidosis during the final reperfusion.
Scandinavian Journal of Clinical & Laboratory Investigation, 1993
The aim of the present study was to examine the effect of acute infusion of lipid emulsions enric... more The aim of the present study was to examine the effect of acute infusion of lipid emulsions enriched with either docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA) on heart lipids, tolerance to infusion and to ischaemia-reperfusion. Isolated rat hearts were subjected to a 10 min lipid infusion period prior to 25 min of total global ischaemia and 30 min of reperfusion. Effects on physiology and metabolism were recorded during infusion and reperfusion. A more than doubled increase of DHA and a 12-fold increase of EPA in terms of relative concentration was demonstrated in the free fatty acid fraction after infusion with the respective triglyceride emulsions, without any profound change in physiology. High levels of DHA were associated with a reduced recovery of left ventricular developed pressure (LVDP) and increased release of lactate dehydrogenase (LDH) during reperfusion, while the hearts infused with the EPA-emulsion showed a recovery comparable to the control group. Heart lipid peroxidation, evaluated by release of thiobarbituric acid reactive substances (TBARS) in effluate, was about 4-fold higher in the DHA-group compared to the EPA-group during start of reperfusion and may in part explain the reduced recovery observed in these hearts. The present study demonstrates enrichment of DHA and EPA in the free fatty acid fraction after a short period of infusion. Protective effects of the emulsions were not found, instead the data indicate harmful effects of DHA during ischaemia-reperfusion. However, the presence of TBARS in this emulsion could have influenced the results.
Pharmacology & Toxicology
ABSTRACT
Physiological research / Academia Scientiarum Bohemoslovaca
Aging (Milan, Italy)
We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og ... more We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og Fjordane, Norway. Data on administration of hypnotics on 3 separate days within a week in August 1995 was obtained from the drug administration records in 31 institutions. Twenty-five percent of the 1062 patients in the institutions used hypnotics, with no difference between patients from nursing homes and old age homes. The number of patients treated with hypnotics, the doses administered, and the time of administration were similar for weekends and workdays. About 100% of the hypnotics were used as scheduled, and 29% of the doses administered were higher than the recommended lowest dose for elderly patients. Furthermore, about 50% of the hypnotics administered were long-acting benzodiazepines. The results indicate a need for a review of the prescribing of hypnotics in geriatric institutions.
Tidsskrift for den Norske laegeforening
Tidsskrift for Den norske legeforening
RELIS Vest provides drug information by answering questions from mainly physicians and pharmacist... more RELIS Vest provides drug information by answering questions from mainly physicians and pharmacists. In the present paper we evaluated this service. All questions to RELIS Vest during the 1995-98 period were systematically categorized and analysed. The quality of the service was assessed by evaluation forms. Of a total of 875 queries, 393 came from physicians and 370 from pharmacists. 42% were about psychoactive drugs; the most frequent types of queries concerned documentation and adverse effects. Analysis of 180 evaluation forms showed that 79% of the physicians and 56% of the pharmacists found the answers fast enough, relevant, adequately comprehensive and with valuable references while 16% of the physicians and 29% of the pharmacists found that the answers satisfied three of these four criteria. We conclude that problem-oriented drug information based on actual cases of prescribing is highly appreciated.
Clinical Therapeutics, 2015
BMC research notes, 2014
Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome,... more Elevated cardiac troponin levels are consistent with the diagnosis of an acute coronary syndrome, but may also represent adverse drug reactions. Psychostimulating drugs raise both blood pressure and heart rate, and case reports of sudden death, stroke, and myocardial infarction have led to regulatory and public concern about the cardiovascular safety of these drugs. We present a case where a 41-year-old Norwegian male with radiating chest pain, elevated troponins, and supraventricular tachycardia was hospitalized. Tentative diagnosis was acute coronary syndrome. Percutaneous coronary angiography, but not cardiac magnetic resonance imaging, was performed and medical antiplatelet treatment started. Because of an attention deficit/hyperactivity disorder the patient had recently increased his dose of methylphenidate, but still within the therapeutic dose range. Apart from venlafaxine, also in a therapeutic dose, the patient took no other drugs. An acute coronary syndrome was excluded du...
Drug, healthcare and patient safety, 2014
RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers ... more RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers where pharmacists and clinical pharmacologists provide feedback to health care professionals in spontaneous drug-related questions and adverse drug-reaction (ADR) reports published in a question-answer pair (QAP) database (the RELIS database) and the Norwegian ADR database, respectively. To describe the potential of RELIS's dual service to improve detection and communication of drug-safety problems. We searched the RELIS database for QAPs about ADRs with use of the Norwegian ADR database as a reference. We also searched the Norwegian ADR database for reports that used the RELIS database as a reference. Both searches were limited to the years 2003-2012. We then selected the example of pregabalin and drug abuse after the marketing of Lyrica in Norway in September 2004 to illustrate RELIS's potential to detect new drug-safety information through a limited number of QAPs and ADR repo...
BMC pharmacology & toxicology, 2014
Chemotherapy with doxorubicin is limited by cardiotoxicity. Free radical generation and mitochond... more Chemotherapy with doxorubicin is limited by cardiotoxicity. Free radical generation and mitochondrial dysfunction are thought to contribute to doxorubicin-induced cardiac failure. In this study we wanted to investigate if opening of mitochondrial KATP-channels by diazoxide is protective against doxorubicin cardiotoxicity, and if 5-hydroxydecanoate (5-HD), a selective mitochondrial KATP-channel antagonist, abolished any protection by this intervention. Wistar rats were divided into 7 groups (n = 6) and followed for 10 days with 5 intervention groups including the following treatments: (1) Diazoxide and doxorubicin, (2) diazoxide and 5-hydroxydecanoate (5-HD), (3) 5-HD and doxorubicin, (4) diazoxide and saline and (5) 5-HD and saline. On day 1, 3, 5 and 7 the animals received intraperitoneal (i.p.) injections with 10 mg/kg diazoxide and/or 40 mg/kg 5-HD, 30 minutes before i.p. injections with 3.0 mg/kg doxorubicin. One control group received only saline injections and the other contro...
Cardiovascular toxicology, 2014
Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacologica... more Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacological preconditioning mimicking ischemic preconditioning has been demonstrated with morphine and represents an acceptable clinical intervention. The purpose of this study was to examine if pretreatment in vivo with morphine could reduce doxorubicin-induced cardiotoxicity ex vivo in a rat model. Wistar rats were divided into six groups and pretreated with an intraperitoneal (i.p.) injection of 3 or 10 mg/kg morphine, 1 mg/kg naloxone and saline, 1 mg/kg naloxone and 3 mg/kg morphine or saline, 60 min before excision of the heart. Biochemical indices such as troponin T (TnT) and hydrogen peroxide (H2O2) in effluate were measured together with physiological parameters in Langendorff hearts before and after doxorubicin infusion (2 mg/mL 0.05 mL/min for 45 min). Myocardial content of doxorubicin was measured at the end of infusion. Pretreatment with morphine, irrespective of dosage, produced a si...
BMJ open, 2012
To assess a question-answer pair (QAP) database integrated with websites developed for drug infor... more To assess a question-answer pair (QAP) database integrated with websites developed for drug information centres to answer complex questions effectively. Descriptive study with comparison of two subsequent 6-year periods (1995-2000 and 2001-2006). The Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS). A randomised sample of QAPs from the RELIS database. Answer time in days compared with Mann-Whitney U test. Number of drugs involved (one, two, three or more), complexity (judgemental and/or patient-related or not) and literature search (none, simple or advanced) compared with χ(2) tests. 842 QAPs (312 from 1995 to 2000 and 530 from 2001 to 2006) were compared. The fraction of judgemental and patient-related questions increased (66%-75% and 54%-72%, respectively, p<0.01). Number of drugs and literature search (>50% advanced) was similar in the two periods, but the fraction of answers referring to the RELIS database increased (13%-31%, p<0.01). Media...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 29, 2009
The aim of this paper is to assess the substance pregabaline's potential for abuse. Little in... more The aim of this paper is to assess the substance pregabaline's potential for abuse. Little information is available on the subject and that retrieved is in part conflicting. Pregabaline is likely to be abused for its positive psychological effects, e.g. euphoria. However, these effects are weak and not sustained during long-term use. Pregabaline is therefore likely to have a lower potential for abuse than benzodiazepines. In clinical studies, symptoms suggestive of physical dependence (e.g. insomnia, nausea, headache, diarrhoea) have been observed in some patients after abrupt discontinuation of pregabaline. However, available documentation indicates that pregabaline is associated with less physical and psychological dependence than benzodiazepines.
Drug safety, 2008
Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sour... more Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sources providing drug information can give rise to confusion with possible therapeutic consequences. Therefore, it is important to measure clinically important differences between drug information sources. The objective of this study was to compare two easily accessible Norwegian sources providing advice on drug safety in pregnancy - the product monographs in the Felleskatalog (FK), published by the pharmaceutical companies, and the five regional Drug Information Centres (DICs) in Norway - in addition to assessing the frequency of questions regarding drug safety in pregnancy made to the DICs according to the Anatomical Therapeutic Chemical (ATC) classification system. Advice on drug use in pregnancy provided by the DICs in 2003 and 2005 were compared with advice in the product monographs for the respective drugs in the FK. Comparison of advice was based on categorization to one of four cate...
Pharmacy world & science : PWS, 2001
This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. Th... more This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. The study was performed in departments of rheumatology at nine Norwegian hospitals during five weeks in 1998. Pharmacists recorded all drugs on admittance among patients 18 years or older with rheumatic diseases. Sixty percent of 313 patients had polypharmacy defined as the concurrent use of five or more drugs, and this was most frequent among the older patients. However, they used fewer antirheumatic drugs compared to the younger patients. With regard to the three most common drug groups, older patients used more corticosteroids, and less nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs), compared to the younger. Eighty-four percent of patients on methotrexate used folic acid, but only 52% of the patients who used corticosteroids used calcium supplements. Polypharmacy among patients with rheumatic diseases is common, and the present descriptio...
Tidsskrift for Den norske legeforening, 2010
Reactions to drug withdrawal may lead to unnecessary reintroduction and inappropriate prescribing... more Reactions to drug withdrawal may lead to unnecessary reintroduction and inappropriate prescribing. This problem is often encountered after long-term therapy with drugs acting on the cardiovascular and central nervous systems. The adverse effects include rebound effects, withdrawal syndrome, termination of drug-drug interaction, increased risk of disease and recurrence of disease. Lack of scientific evidence limits development of guidelines on how to terminate drug therapy. Slow and gradual tapering schedules for substances with long half-lives is usually recommended to avoid withdrawal syndrome and rebound effects. However, the most important measure is to avoid prescribing drugs that are difficult to withdraw. Appropriate information and involvement of the patient are also important.
Tidsskrift for Den norske legeforening, 2009
Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a varie... more Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a variety of medical conditions. The most common indication is currently chronic venous insufficiency, for which conventional therapy includes use of compression stockings. Horse chestnut seed extract is generally well tolerated; the most common side effects are gastrointestinal disturbances, dizziness and calf-muscle spasms. Clinical trials have shown that horse- chestnut seed extract and placebo are associated with similar side effects Horse- chestnut may interact with anticoagulants and antidiabetics, and caution is advised in patients taking these drugs. A number of clinical trials have shown that horse- chestnut seed extract may be beneficial to patients with mild to moderate chronic venous insufficiency. However, inadequate randomization, short duration and use of different end-points in these trials makes it difficult to conclude regarding effectiveness and safety, especially in long-term use. Horse- chestnut seed extract appears to be a short-term treatment option in patients with mild to moderate chronic venous insufficiency, but more rigorous trials are required to confirm the efficacy of this treatment.
Toxicology Mechanisms and Methods, 2013
Short-time models (STM) to study the cardiotoxicity (acute or chronic) of doxorubicin in rats are... more Short-time models (STM) to study the cardiotoxicity (acute or chronic) of doxorubicin in rats are of interest to assess protective interventions and pathways. STM promotes more ethical animal treatment with less stress, and at a lower cost compared to established long-time models (LTM). We wanted to investigate if an STM of 9 d yields the same information regarding cardiotoxicity as an LTM of 9 weeks. Male Wistar rats received identical drug administration protocols in STM and LTM. The two intervention groups (n = 6) received intraperitoneal (i.p.) injections of 2 mg/kg doxorubicin every day for five consecutive days, with a total cumulative dose of 10 mg/kg. The two control groups (n = 6), received an equivalent volume of saline injected every day for five consecutive days. Hearts from STM and LTM were excised and Langendorff-perfused after 9 d or 9 weeks, respectively, after the first drug injection. Cardiotoxicity was assessed in paced Langendorff hearts by a release of hydrogenperoxide (H2O2) and troponin T (TnT) in effluent, by myocardial accumulation of doxorubicin and its metabolite doxorubicinol, and by physiological parameters recorded during pressure, or volume-regulated perfusion. In STM, hearts exposed to doxorubicin demonstrated a 15% reduction in left ventricular developed pressure (LVDP) irrespective of flow mode, and a 13% increase in aortic pressure (AoP), during volume-regulated perfusion, an index of coronary resistance, compared to controls. Left ventricular end-diastolic pressure (LVEDP) was increased by 72% during pressure-regulated perfusion and 100% during volume-regulated perfusion in STM. In LTM, hearts exposed to doxorubicin demonstrated a 40% reduction in LVDP during pressure-regulated perfusion and a 20% reduction during volume-regulated perfusion. LVEDP was 70% higher in doxorubicin-treated hearts during pressure-regulated perfusion and 80% higher during volume-regulated perfusion. In addition, aortic pressure was increased by 30% during volume-regulated perfusion. In both STM and LTM, hearts exposed to doxorubicin demonstrated a higher H2O2 and TnT release, compared to respective controls. The difference was most pronounced in STM. Myocardial content of doxorubicin was detectable in both STM and LTM. However, doxorubicinol was only detectable in STM. STM is comparable to LTM to study relevant indices of cardiotoxicity of doxorubicin in rat hearts. Biochemical differences are more pronounced in STM, while contractile differences are more pronounced in LTM. STM could be a preferred model for preliminary studies of protective interventions.
Seizure, 2012
To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE).... more To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE). In-depth interviews with pregnant WWE treated with antiepileptic drugs (AEDs). Ten women aged 22-39 years in 20-34 weeks&amp;#39; gestation were interviewed. Avoiding seizures by taking AEDs in pregnancy outweighed perceived risks, but dose adjustments during and after pregnancy increased perceived risks of teratogenicity or seizures. The women had restrictive attitudes towards taking medicines for other indications than epilepsy. They appreciated their neurologist as a source for medicines information, though their needs for medicines information were reduced by long-term use of AEDs. Pregnant WWE were confident in using AEDs through communication with their neurologist, but dose adjustments caused concern. Medicines information to pregnant WWE should focus on empowering the women to control the disease, supporting realistic risk perceptions of AEDs and other necessary medicines. In this article, we outline some medicines information strategies to pregnant WWE.
Scandinavian Journal of Clinical & Laboratory Investigation, 1995
31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic pr... more 31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic preconditioning was due to improved metabolic recovery in isolated rat hearts. The preconditioning stimulus was global ischaemia of 1 or 4 min followed by 12 min of reperfusion (Langendorff mode). The hearts were then subjected to a main ischaemic period of 16 min and 40 min of reperfusion. Functional and metabolic recoveries of hearts were compared to a control group subjected only to the main ischaemia. Preconditioning improved recovery of contractile function during the final reperfusion. Thus left ventricular developed pressure (LVDP) and heart rate (HR) product after 40 min of reperfusion recovered to 56, 67 and 68% in the control group, 1 min group and 4 min group, respectively. However, the metabolic recovery was comparable in all groups. CrP and ATP recovered to levels of 67-78% (CrP) and 35-41% (ATP), and pH to a level of 7.13-7.15 (not different from baseline values) at the end of the final reperfusion. We conclude that the improved functional recovery in preconditioning is not due to a higher level of high energy phosphates or less acidosis during the final reperfusion.
Scandinavian Journal of Clinical & Laboratory Investigation, 1993
The aim of the present study was to examine the effect of acute infusion of lipid emulsions enric... more The aim of the present study was to examine the effect of acute infusion of lipid emulsions enriched with either docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA) on heart lipids, tolerance to infusion and to ischaemia-reperfusion. Isolated rat hearts were subjected to a 10 min lipid infusion period prior to 25 min of total global ischaemia and 30 min of reperfusion. Effects on physiology and metabolism were recorded during infusion and reperfusion. A more than doubled increase of DHA and a 12-fold increase of EPA in terms of relative concentration was demonstrated in the free fatty acid fraction after infusion with the respective triglyceride emulsions, without any profound change in physiology. High levels of DHA were associated with a reduced recovery of left ventricular developed pressure (LVDP) and increased release of lactate dehydrogenase (LDH) during reperfusion, while the hearts infused with the EPA-emulsion showed a recovery comparable to the control group. Heart lipid peroxidation, evaluated by release of thiobarbituric acid reactive substances (TBARS) in effluate, was about 4-fold higher in the DHA-group compared to the EPA-group during start of reperfusion and may in part explain the reduced recovery observed in these hearts. The present study demonstrates enrichment of DHA and EPA in the free fatty acid fraction after a short period of infusion. Protective effects of the emulsions were not found, instead the data indicate harmful effects of DHA during ischaemia-reperfusion. However, the presence of TBARS in this emulsion could have influenced the results.