Sunday September 03, 2006


Q; 74 year old male admitted with Alzheimer's related dementia to ICU with uncontrolled hypertension. Patient was initially started on Nitroprusside drip in ER and later weaned to oral antihypertensives. You decide to choose lopressor and cardizem as oral antihypertensives and noted to have good blood pressure control. Before transferring to floor you resumed his only home medication for his Alzheimer's related dementia - RAZADYNEtm ER (galantamine hydrobromide). 12 hours later, just before transfer, patient coded and on bedside note to be in 3rd degree AV block with barely palpable blood pressure ?.


A; RAZADYNE (galantamine hydrobromide), formerly known as Reminyl, is a commonly used drug for Alzheimer's related dementia. One of the major side effect of this medicine is bradycardia due to vagotonic effects on the sinoatrial and atrioventricular nodes. FDA has also issued warning for its use in patients with supraventricular cardiac conduction disorders and those receiving concomitant treatment with other drugs that significantly slow heart rate.

Objective of this question is to bring awareness of this side effect as this is a commonly used drug in geriatric population and B-blockers and calcium channel blockers always remained the first line of drug for BP control.

It is advisable to avoid or atleast be cautious of concomitant use of B-blockers and calcium channel blockers with RAZADYNE (galantamine hydrobromide).


Note: The company changed the drug's name from Reminyl to Razadyne in an effort to avoid confusion between it and glimepiride (Amaryl).



References: click to get article

1. razadyne - rxlist.com

Saturday September 02, 2006
Prescribing vitamin B6 with linezolid


Linezolid is found to be associated with 2 major side effects: cytopenias and peripheral neuropathy 1. When Vitimain B6 (PYRIDOXINE) was prescribed for peripheral neuropathy, interestingly it was found to help in reversing cytopenias more than peripheral neuropathy 2 . Dose of vitamin B6 used was 50 mg PO once a day.

So far we have only few case reports but Vitamin B6 is safe and inexpensive and most experts don't see any harm in prescribing it along with linezolid.



References: click to get article

1. Severe sensory neuropathy associated with long-term linezolid use - Neurology.2005; 64: 926-927

2. Reversal of linezolid-associated cytopenias, but not peripheral neuropathy, by administration of vitamin B6 - Journal of Antimicrobial Chemotherapy 2004 54(4):832-835