https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39903 Wed 22 Mar 2023 10:31:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36958 Wed 19 Jul 2023 13:57:01 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30916 torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings. Methods: We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls. After their normal dose a continuous 12-lead Holter recorder was attached for 24 h. Digital electrocardiograms were extracted hourly from the Holter recordings. The QT interval was measured automatically (H-scribe software, Mortara Pty Ltd) and checked manually. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine abnormality. Demographics, dosing, medical history and laboratory investigations were recorded. Results: There were 58 patients (19 methadone, 20 buprenorphine and 19 control); median age 35 years (20–56 years); 33 males. Baseline characteristics were similar. Median dose of methadone was 110 mg day^–1 (70–170 mg day^–1) and buprenorphine was 16 mg day^–1 (12–32 mg day^–1). Seven participants had abnormal QT intervals. There was a significant difference in the proportion of prescribed methadone with abnormal QT intervals, 7/19 (37%; 95% confidence interval: 17–61%), compared to controls 0/19 (0%; 95% confidence interval: 0–21%; P = 0.008), but no difference between buprenorphine and controls (0/20). QT vs. HR plots showed patients prescribed methadone had higher QT-HR pairs over 24 h compared to controls. There was no difference in dose for patients prescribed methadone with abnormal QT intervals and those without. Conclusions: Methadone is associated with prolonged QT intervals, but there was no association with dose. Buprenorphine did not prolong the QT interval. Twenty four-hour Holter recordings using the QT nomogram is a feasible method to assess the QT interval in patients prescribed methadone.]]> Wed 11 Apr 2018 15:34:23 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14561 c) was linearly dependent on predicted escitalopram concentration [slope = 87 ms/(mg l–1)], using a hypothetical effectcompartment (half-life of effect-delay, 1.0h). Administration of SDAC significantly reduced QT prolongation and was shown to reduce the risk of having an abnormal QT by approximately 35% for escitalopram doses above 200 mg. Conclusions: There was a dose-related lengthening of the QT interval that lagged the increase in drug concentration. SDAC resulted in a moderate reduction in fraction of escitalopram absorbed and reduced the risk of the QT interval being abnormal.]]> Wed 11 Apr 2018 13:43:06 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:28081 Wed 11 Apr 2018 13:03:57 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14536 500 ms was defined as abnormal. Results: Forty-six patients had Holter recordings after 10–40 mg droperidol and 316 QT–HR pairs were included. There were 32 abnormal QT measurements in four patients, three given 10 mg and one 20 mg. In three of the four patients QTcF >500 ms but only in one taking methadone was the timing of QTcF >500 ms consistent with droperidol dosing. Of the three other patients, one took amphetamines, one still had QT prolongation 24 h after droperidol and one took a lamotrigine overdose. No patient given >30 mg had a prolonged QT. There were no arrhythmias. Conclusion: QT prolongation was observed with high dose droperidol. However, there was little evidence supporting droperidol being the cause and QT prolongation was more likely due to pre-existing conditions or other drugs.]]> Wed 11 Apr 2018 11:05:02 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14492 c of 440 ms or 500 ms. Plotting the QT-HR pair for patients on drugs suspected or known to cause QT prolongation allows assessment of the QT interval based on normal population QT variability. This risk assessment then allows the safer commencement of drugs therapeutically or management of drug induced effects in overdose.]]> Wed 11 Apr 2018 10:07:08 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24314 Wed 10 Nov 2021 15:14:15 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41685 Wed 10 Aug 2022 15:08:18 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45654 Wed 02 Nov 2022 15:37:57 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:48538 Tue 21 Mar 2023 15:23:57 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46364 Tue 15 Nov 2022 15:09:02 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:33603 Tue 03 Sep 2019 17:58:42 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37220 Tue 01 Sep 2020 18:15:55 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:34308 2 g) and paracetamol-codeine combinations presenting to a tertiary toxicology unit (1987-2013). Demographic information, clinical effects, treatment (naloxone, length of stay [LOS], mechanical ventilation) were extracted from a prospective database. Primary outcome was naloxone requirement or ventilation for respiratory depression. Results: From 4488 presentations, 1376 admissions were included with paracetamol alone (929), paracetamol-codeine combinations (346) or paracetamol-codeine-doxylamine combinations (101) without co-ingestants. Median age was 23 years (12-89 years); 1002 (73%) were female. Median dose was 12 g (interquartile range [IQR] : 7.5-20 g). Median LOS was 16 h (IQR: 6.5-27 h) and 564 (41%) were given acetylcysteine. Significantly larger paracetamol doses were ingested and more acetylcysteine given in paracetamol alone versus paracetamol combination overdoses. Seven out of 1376 patients were intubated or received naloxone (0.5%; 95% CI: 0.2-1.1%), three intubated, three given naloxone and one both. Three out of 929 patients ingesting paracetamol alone (0.3%; 95% CI: 0.1-1%) required intubation or naloxone, compared to two out of 346 ingesting paracetamol-codeine combinations (0.6%; 95% CI: 0.1-2.3%; absolute difference, 0.26%; 95% CI: -0.7-1.2%; P = 0.62). Two out of 101 patients ingesting paracetamol-codeine-doxylamine combinations (2%; 95% CI: 0.3-8%) required intubation or naloxone. Four patients were intubated for reasons other than respiratory depression: hepatotoxicity (2), retrieval (1), no data (1). Two out of 929 (0.2%) paracetamol alone overdoses had a Glasgow coma score < 9 compared to three out of 346 (0.9%) in the paracetamol-codeine group. Conclusions: Paracetamol-codeine combination overdoses are rarely associated with severe respiratory depression, with only two given naloxone and none intubated for respiratory depression.]]> Thu 27 Jan 2022 15:58:08 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29998 –2) to determine melphalan AUC for a total of 114 patients. Binary logistic regression was used to assess whether melphalan AUC was associated with severe (≥ grade 3) oral mucositis. Multivariate Cox regression was used to assess whether melphalan AUC was significantly associated with time to progression, progression-free survival and overall survival (OS). Results: Melphalan AUC ranged from 4.9 to 24.6 mg l^–1 h, median 12.84 mg l–1 h. Melphalan AUC above the median was a risk factor for severe mucositis (HR 1.21, 95% CI 1.06, 1.38, P = 0.004) but was also associated with significantly improved overall survival (OS) (HR 0.40, 95% CI 0.20, 0.81, P = 0.001), with an estimated median survival of 8.50 years vs. 5.38 years for high vs. low AUC groups. Multivariate analysis did not identify melphalan AUC as being significantly associated with time to progression or progression-free survival. Conclusions: This large scale pharmacodynamic analysis of HDM demonstrates that high melphalan exposure is associated with improved survival, with an acceptable increase in transplant toxicity. These results suggest studies targeting a higher AUC are warranted in patients undergoing HDM and ASCT for myeloma.]]> Thu 13 Jan 2022 10:31:39 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44058 Thu 06 Oct 2022 09:55:23 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52234 Thu 05 Oct 2023 11:39:44 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31384 Sat 24 Mar 2018 08:43:00 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7887 140 mmHg) in 40%. Severe hypertension (systolic BP >180 mmHg) and hypotension (systolic BP <90 mmHg) occurred in 3% and 5%, respectively. No arrhythmias occurred based on continuous telemetry, and conduction defects were found in only seven of 369 admissions; five of these conduction defects were pre-existing abnormalities. In 22 admissions [6%, 95% confidence interval (CI) 4–10] there was an abnormal QT–HR pair, with larger doses being more likely to be associated with an abnormal QT. The median maximum QRS width was 85ms (IQR 80–90 ms; range 70–145 ms) and the QRS was greater than 120 ms in only 24 admissions (7%, 95% CI 4–10). Conclusions: Venlafaxine overdose causes only minor abnormalities in the QT and QRS intervals, unlikely to be associated with major arrhythmias, except possibly with large doses.]]> Sat 24 Mar 2018 08:35:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14863 90) of seizure, respectively. Results: A linear logistic regression model described the data. Simulation from the model showed that the probability of seizure was 0.05 (0.03–0.08), 0.19 (0.09–0.35) and 0.75 (0.30–0.96) at 1000, 5000 and 10 000 mg, respectively (median and 95% credible interval). At the mean dose of 2100 mg the odds ratios (OR) in the presence of SDAC, WBI and SDAC/WBI were 0.48 (0.25–0.89), 0.71 (0.35–1.22) and 0.25 (0.08–0.62), respectively. A modified Gompertz model described the time to seizure events. Simulations from the Gompertz model showed that the t₉₀ values for first seizure was 26 h and was not affected by dose or decontamination procedure. Conclusion: SDAC/WBI provided greater benefits than the sum of the independent effects of SDAC and WBI. Patients should be observed for at least 24 h for seizures based on the dose and risk of seizure occurring.]]> Sat 24 Mar 2018 08:21:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10455 Sat 24 Mar 2018 08:09:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:17339 Sat 24 Mar 2018 08:01:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21163 Sat 24 Mar 2018 07:58:06 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:5441 Sat 24 Mar 2018 07:48:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:5485 Sat 24 Mar 2018 07:47:03 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:4974 Sat 24 Mar 2018 07:46:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:28591 Sat 24 Mar 2018 07:37:29 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29671 –1 provided a stable model and lowest objective function. This represents extremely rapid absorption with a half-life of 5 min. The final model had a clearance of 41.9 l h^–1 and volume of distribution of the central compartment of, 73.6 l. Median and interquartile range of initial (alpha) half-life was 0.32 h (0.26–0.37 h) and second (beta) half-life was 3.0 h (2.5–3.6 h). Simulations indicate that 10 mg alone provides an 80% probability of being above the lower limit of quantification (5 μg l^–1) for 7 h, 2 h longer than for 5 mg. Giving two 10 mg doses increased this duration to 10 h. Conclusions: Intramuscular droperidol is rapidly absorbed with high therapeutic concentrations after 5 and 10 mg doses, and supports clinical data in which droperidol sedates rapidly for up to 6 h.]]> Sat 24 Mar 2018 07:32:21 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26443 Sat 24 Mar 2018 07:27:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26190 Sat 24 Mar 2018 07:24:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24457 Sat 24 Mar 2018 07:17:23 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23362 Sat 24 Mar 2018 07:16:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23107 Sat 24 Mar 2018 07:12:33 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24125 Sat 24 Mar 2018 07:11:42 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44140 P = 0.024). Overweight patients were more frequently underdosed compared to non-overweight patients (P = 0.039). The frequency and proportion of underdosing increased with BMI. Overweight patients spent a smaller fraction of their course within the therapeutic range, although the difference was not statistically significant (difference 7.7%; 95% CI 4% to 19.4%; P = 0.195). The overweight group had longer hospital length of stay (LOS), higher mortality and more treatment failures. Conclusion: Adherence to guideline-based prescription is poor, particularly in overweight patients. Patients who are initially underdosed have fewer therapeutic vancomycin days, regardless of BMI. Overweight patients have increased hospital LOS, hospital mortality and treatment failure.]]> Sat 08 Oct 2022 12:43:32 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37203 Mon 31 Aug 2020 15:02:09 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45072 Mon 29 Jan 2024 18:40:16 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:26752 -1, 5340 l and 130 l h^-1, respectively. The calculated half-life of sertraline following overdose was 28 h (IQR 19.4-30.6h). When given up to 4 h post-overdose, SDAC significantly increased the clearance of sertraline by a factor of 1.9, decreased the area under the curve and decreased the maximum plasma concentration (C_max). Conclusions: Sertraline had linear kinetics in overdose with parameter values similar to those in therapeutic use. SDAC is effective in increasing clearance when given 1.5 to 4 h post-overdose.]]> Mon 23 Sep 2019 11:21:00 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37136 start low and go slow. However, clinicians often prescribe up to maximum tolerated dose (MTD), especially when treating acute and more severe disease, without evidence to show that MTD is more likely to improve outcomes. Cardiovascular guidelines for some indications advocate MTD even in prevention, for example hypercholesterolaemia, without compelling evidence of better outcomes. This review explores the origins and potential problems of prescribing medications at MTD. Oral effective dose 50 (ED50) may be a useful guide for balancing efficacy and safety.]]> Mon 14 Nov 2022 19:04:49 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47198 Fri 30 Jun 2023 10:59:49 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46543 Fri 25 Nov 2022 11:12:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39807 Fri 24 Jun 2022 08:46:01 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49507 Fri 19 May 2023 16:35:01 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41720 Fri 12 Aug 2022 09:15:25 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:43007 Fri 09 Sep 2022 14:24:20 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37135 Fri 01 Apr 2022 09:26:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24299 Fri 01 Apr 2022 09:26:14 AEDT ]]>