The fluoroqinolone grepafloxacin has been associated with tachycardia in animals and humans. 1 2 It was eventually withdrawn from use owing to prolongation of the QT interval. Another fluoroquinolone, moxifloxacin (Avalox, Bayer Vital), was introduced in Germany in September 1999 and two months later in the United States. The chemical structure of moxifloxacin is similar to that of grepafloxacin, and both drugs have …
Tetrahydroliponsaure, Metabolit von Liponsaure, kann durch Chelatbildung einen Vitamin-B12-Mangel verursachen. Bei einem 45-jahrigen gesunden Probanden wurde gezeigt, dass die Serumkonzentrationen von Vitamin B12 bei langfristiger Gabe des Pharmakons in den pathologischen Bereich absinken konnen. Bei Patienten mit Polyneuropathie sollten die Vitamin-B12-Serumkonzentrationen daher vor Beginn sowie unter der Therapie mit Liponsaure in 4-6wochentlichen Abstanden kontrolliert werden. Tetrahydrolipoic acid is a metabolite of lipoic acid which may cause vitamin B12 hypovitaminosis by formation of chelates. It was demonstrated in a 45-year old healthy subject that abnormally low serum levels of vitamin B12 may result from long-term treatment with lipoic acid. Therefore serum concentrations of vitamin B12 should be measured in patients with polyneuropathy before and at four to six-week intervals after the initiation of medication with lipoic acid.
Background We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. Objective The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. Methods Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). Results At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. Conclusions Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. Trial Registration ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.
St. John's wort extract is widely used and advertised as a "natural antidepressant" lacking autonomic side effects. This randomized, double-blind, placebo-controlled study compared the effects of St. John's wort extract on autonomic responses of blood vessels and sweat glands with those of amitriptyline and placebo. A randomized, double-blind, crossover study was performed in healthy male volunteers aged 22 to 31 years (25 +/- 3 years; mean +/- SD) years. Subjects orally received capsules with 255 to 285 mg St. John's wort extract (900 microg hypericin content), 25 mg amitriptyline, and placebo 3 times daily for periods of 14 days each with at least 14 days between. Vasoconstrictory response of cutaneous blood flow (VR) and skin conductance response (SR) following a single deep inspiration were employed as parameters of autonomic function. St. John's wort extract had no effect on VR and SR. In contrast, SR was diminished and the dilation phase of VR was prolonged following multiple dosing with amitriptyline (P < 0.05). Decreased electrodermal reactivity observed with amitriptyline reflects inhibition of acetylcholine at peripheral m3-cholinoreceptors, whereas prolongation of VR induced by the tricyclic drug may be due to sustained activation of central and/or peripheral sympathetic neurons.
