NEWS ON DRUG REACTIONS FROM JAPANESE MONITORING HOSPITALS Shock after scopolamine butyl bromide and prifinium bromide injections Scopolamine: Two cases of shock have been reported in patients given scopolamine buty!bromide ('Buscopan' inje-Ction); one 200mg 1M and the other, two 20mg IV injections, for abdominal pain. The first patient (a 41-year-old woman) received the drug as premedication for gastrointestinal examination and had taken no other drugs. Shock symptoms set in within a few minutes, but she recovered when given an adrenocortical hormone IV and by drip infusion. The second patient (a 38-year-old woman with renal insufficiency and hyperkalemia) had also used 2 indomethacin ('Indacin') suppositories, 11/2 of which had been expelled. In spite of cardiac massage, she died of acute heart failure about 3 hours after the onset of shock. Prifinium bromide: A 53-year-old man with acute gastritis developed shock symptoms immediately after IV injection of 7.5mg of prifinium bromide ('Padrin'). He recovered within an hour when treated with an adrenocOrtical hormone and inhaled oxygen. Fluorouracil may cause fulminant diarrhea Two patients given fluorouracil after surgery for gastric cancer developed severe diarrhea. Both eventually died. The 2 women (aged 53 and 45) were both given fluorouracil-(Kyowa) slowly IV 3 times/week (total doses 4000 and 4500mg, respectively). They had also received mitomycin C intraperitoneally (4mg) and IV (8mg) before and 4 days after surgery. Persistent diarrhea st..arted on the 25th and 22nd days of treatment. The first patient developed jaundice, then polypnea and died of respiratory insufficiency on the 40th day. The second died of perforated biliary peritonitis. A case of leukopenia possibly due to penicillamine given for rheumatoid arthritis Rheumatoid arthritis (unsatisfactorily treated with prednisolone and aspirin) in a 68-year-old man was well controlled with penicillamine 300mg/day added to his treatment. However, after starting penicillamine, leukopenia and fever After stopping penicillamine and aspirin the leukocyte count fell to 300, then increased to 600 the next day and to 2000 after 4 more days. The patient had a second myocardial infarction and died. Autopsy showed considerable recovery of bone marrow. Japan Medical Gazette 17: II (May 20, 1980> 6 INPHARMA26JuI1980 0156-2703/80/0726-0006 $00.50/0 @ADISPress

NEWS ON DRUG REACTIONS FROM JAPANESE MONITORING HOSPITALS

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NEWS ON DRUG REACTIONS FROM JAPANESE MONITORING HOSPITALS

Shock after scopolamine butyl bromide and prifinium bromide injections Scopolamine: Two cases of shock have been reported in patients given scopolamine (hyos,~ine) buty!bromide ('Buscopan' inje-Ction); one 200mg 1M and the other, two 20mg IV injections, for abdominal pain. The first patient (a 41-year-old woman) received the drug as premedication for gastrointestinal examination and had taken no other drugs. Shock symptoms set in within a few minutes, but she recovered when given an adrenocortical hormone IV and by drip infusion. The second patient (a 38-year-old woman with renal insufficiency and hyperkalemia) had also used 2 indomethacin ('Indacin') suppositories, 11/2 of which had been expelled. In spite of cardiac massage, she died of acute heart failure about 3 hours after the onset of shock. Prifinium bromide: A 53-year-old man with acute gastritis developed shock symptoms immediately after IV injection of 7 .5mg of prifinium bromide ('Padrin'). He recovered within an hour when treated with an adrenocOrtical hormone and inhaled oxygen.

Fluorouracil may cause fulminant diarrhea Two patients given fluorouracil after surgery for gastric cancer developed severe diarrhea. Both eventually died. The 2 women (aged 53 and 45) were both given fluorouracil-(Kyowa) slowly IV 3 times/week (total doses 4000 and 4500mg, respectively). They had also received mitomycin C intraperitoneally (4mg) and IV (8mg) before and 4 days after surgery. Persistent diarrhea st..arted on the 25th and 22nd days of treatment. The first patient developed jaundice, then polypnea and died of respiratory insufficiency on the 40th day. The second died of perforated biliary peritonitis.

A case of leukopenia possibly due to penicillamine given for rheumatoid arthritis Rheumatoid arthritis (unsatisfactorily treated with prednisolone and aspirin) in a 68-year-old man was well controlled with penicillamine 300mg/ day added to his treatment. However, after starting penicillamine, leukopenia and fever dev~loped. After stopping penicillamine and aspirin the leukocyte count fell to 300, then increased to 600 the next day and to 2000 after 4 more days. The patient had a second myocardial infarction and died. Autopsy showed considerable recovery of bone marrow. Japan Medical Gazette 17: II (May 20, 1980>

6 INPHARMA26JuI1980 0156-2703/80/0726-0006 $00.50/0 @ADISPress