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General information The protein C pathway serves as a natural defence mechanism against thrombosis. Patients with severe sepsis have a very low concentration of activated protein C compared with healthy individuals. Protein C is available as either a concentrate prepared from human plasma or as recombinant human activated protein C (drotrecogin alfa). The latter increased the risk of bleeding in patients with severe sepsis [ ].…

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See also Neuroleptic drugs General information Droperidol is a butyrophenone with actions similar to those of haloperidol. Of 20 volunteers who took droperidol 5 mg orally in orange juice, none had a neutral or pleasant experience [ ]. All reported restlessness, 17 felt sedated, and 11 reported dysphoria, the onset being relatively immediate; one subject broke down in tears within an hour of taking droperidol. Suicidal…

See also Antihistamines ; Dicycloverine General information Doxylamine is an antihistamine, a monoethanolamine derivative, with antimuscarinic and pronounced sedative effects. Organs and systems Nervous system Giddiness and drowsiness were reported in adults taking Vicks Medinite syrup (doxylamine + dextromethorphan + ephedrine + paracetamol) [ ]. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

See also Tetracyclines General information Doxycycline and minocycline are more lipophilic tetracyclines. They are well absorbed after oral administration. Their half-lives are 16–18 hours. Their higher affinity for fatty tissues improves their effectiveness and changes their adverse effects profile. Local gastrointestinal irritation and disturbance of the intestinal bacterial flora occur less often than with the more hydrophilic drugs, which have to be given in higher oral…

See also Cytotoxic and immunosuppressant drugs General information Doxifluridine is a derivative of 5-fluorouracil. It has been used to treat a variety of solid tumors, including cancers of the breast, pancreas, stomach [ ], and large bowel. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

See also Tricyclic antidepressants General information Doxepin is a tricyclic antidepressant that has also been used topically in the treatment of atopic dermatitis and other forms of eczematous dermatitis. It causes the adverse effects that one would expect, and systemic effects can result from absorption after topical administration. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

See also Alpha-adrenoceptor antagonists General information The α 1 -adrenoceptor antagonist doxazosin has similar adverse effects to those of prazosin. In a review of its clinical pharmacology and therapeutic uses, reports of tolerability included an update from previously unpublished pooled data on file [ ]. In 339 patients treated with doxazosin for hypertension compared with 336 treated with placebo, adverse effects were essentially the same as…

General information Generalized stimulation of the central nervous system has been observed with doxapram, particularly in large doses. Adverse reactions have included hyperactivity, tachycardia, increased deep tendon reflexes and muscle twitching, and laryngospasm. Raised blood pressure can also occur. Doxapram is contraindicated in epilepsy and other convulsive disorders and in hypertension. Doxapram has been used to treat post-anesthetic shivering; in one study it was effective […

General information Doxacurium chloride is a long-acting non-depolarizing neuromuscular blocking agent. It is a bisquaternary benzylisoquinolinium derivative (a diester). It is subject to minimal hydrolysis by plasma cholinesterase (at about 6% of the rate of hydrolysis of suxamethonium when incubated with purified pooled human plasma cholinesterase) [ ]. Antagonism by edrophonium (1 mg/kg) was considered inadequate in one study, whereas no difficulties were experienced with neostigmine…

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General information Dornase alfa is human recombinant deoxyribonuclease. Daily therapy with dornase alfa in patients with cystic fibrosis can reduce the frequency of respiratory infections and improve lung function in patients with bronchiectasis. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

General information Dopexamine, which is related structurally to dopamine, is a potent β 2 -adrenoceptor agonist and dopamine D 1 receptor agonist, which is a vasodilator at low doses, with beneficial effects on splanchnic blood flow, and a vasconstrictor at high doses [ , ]. It has been used to treat circulatory failure [ ] and after cardiac [ ] and gastrointestinal surgery [ ]. Reported…

General information Dopamine is a naturally occurring catecholamine and central neurotransmitter capable of raising cardiac output, reducing peripheral resistance, and specifically increasing renal blood flow. Infusions (generally up to 10 micrograms/kg/hour) have proven valuable in shock and congestive heart failure. Common adverse reactions during infusion include extra beats, tachycardia, and palpitation. Angina pectoris, bradycardia, altered cardiac conduction, nausea and vomiting, headache, and dyspnea can occur. Piloerection…

General information The approval of donepezil in several countries in America and Europe has been hailed as a major milestone, because it has met regulatory guidelines for the approval of anti-dementia drugs [ ]. Donepezil belongs to a piperidine class of reversible acetylcholinesterase inhibitors, chemically unrelated to either tacrine or physostigmine. It is highly specific for acetylcholinesterase and does not inhibit butyrylcholinesterase. The incidence of adverse…

General information Domperidone is a neuroleptic antiemetic, a dopamine receptor antagonist. It produces the expected range of dystonic and extrapyramidal adverse effects [ ], which seem, as with metoclopramide, to be more likely to occur in children [ ]. It is difficult to accept that claims for lower frequencies than with metoclopramide are justified, particularly when one reads a report of neuroleptic malignant syndrome [ ].…

General information Dofetilide is a pure Class III antidysrhythmic drug, without actions of any other class. It was developed following the observation that bis(arylalkyl)amines with methanesulfonamido moieties on both aryl groups prolong the cardiac action potential without significantly altering the maximum rate of depolarization [ ]. The pharmacology, clinical pharmacology, uses, adverse effects, and interactions of dofetilide have been reviewed [ ]. Cardiovascular adverse effects of…

See also Cytotoxic and immunosuppressant drugs General information Docetaxel is a taxane that is used in combination with doxorubicin in the treatment of metastatic breast cancer and as a single agent in metastatic lung cancer. Organs and systems Respiratory Interstitial pneumonitis has been attributed to docetaxel in four cases [ ]. None of the patients had lung disease and they all had normal liver function. Within…

General information Dobutamine is a relatively selective β 1 -adrenoceptor agonist with only slight β 2 – and α-adrenoceptor activity. It has been developed as a positive inotropic agent that is less vasoconstrictive than high doses of dopamine. Organs and systems You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in…