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Drug-induced Photosensitivity

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64. Treatment of Hepatitis C

be tested for other hepatotropic viruses, particularly hepatitis B virus (HBV), and for human immunode?ciency virus (HIV). Alcohol consumption should be assessed and quanti?ed, and speci?c counselling to stop any use of alcohol should be given. Possible comorbidities, including alcoholism, autoimmunity, genetic or metabolic liver diseases (for instance genetic hemochromatosis, diabetes or obesity) and the possibility of drug-induced hep- atotoxicity should be assessed. Assessment of liver disease (...) removal of simeprevir. Adverse reactions with at least 3% higher frequency in patients receiving simeprevir in combination with PegIFN-a and ribavirin were rash (including photosensitivity), pruritus and nausea. Because simeprevir is an inhibitor of the hepatic transporters OATP1B1 and MRP2 [23], mild, transient hyper- bilirubinaemia not accompanied by changes in other liver parameters was observed in approximately 10% of cases. Because the primary enzyme involved in the metabolism of simeprevir

2015 European Association for the Study of the Liver

65. Acne vulgaris

of androgen excess to identify an underlying cause [ ; ; ; ]. Differential diagnosis What else might it be? The differential diagnosis for acne includes: Rosacea — for more information, see the CKS topic on . Perioral dermatitis . Folliculitis and boils — for more information, see the CKS topic on . Drug-induced acne — some drugs can cause or exacerbate acneiform eruptions including dioxins (chloracne), corticosteroids, anti-epileptics (phenytoin and carbamazepine), lithium, isoniazid, vitamins B1, B6 (...) antibiotics Prescribing issues If acne fails to respond adequately to topical preparations alone an oral antibiotic such as lymecycline or doxycycline (for a maximum of 3 months) can be added. Minocycline is not recommended for use in acne as it is associated with an increased risk of adverse effects such as drug-induced lupus, skin pigmentation and hepatitis. Macrolide antibiotics (such as erythromycin) should generally be avoided due to high levels of P. acnes resistance but can be used if tetracyclines

2018 NICE Clinical Knowledge Summaries

66. Urticaria

ESR with normal CRP may indicate paraproteinaemia. Full blood count (FBC) — eosinophil count may be elevated in parasitic infections and in some drug-induced reactions. An elevated neutrophil count may be associated with . Helicobacter pylori testing (if gastrointestinal symptoms are present) — there is some evidence that H. pylori infection is significantly, though weakly, associated with an increased risk of chronic urticaria. Allergy testing — this may include patch testing or skin prick

2018 NICE Clinical Knowledge Summaries

67. Obsessive-compulsive disorder

(skin-picking) disorder — suggested by recurrent picking of skin, resulting in skin lesions. Substance-induced or medication-induced obsessive-compulsive disorder — suggested by OCD-type symptoms that are attributable to effects of medication or drug of abuse, and develop during or soon after substance intoxication or withdrawal or after exposure to substance. ICD-10 and DSM-5 criteria for OCD ICD-10 and DSM-5 criteria for the diagnosis of obsessive-compulsive disorder International Classification

2018 NICE Clinical Knowledge Summaries

68. Angio-oedema and anaphylaxis

published by the British Society for Allergy and Clinical Immunology (BSACI) [ ], the British National Formulary (BNF) [ ], and a review article on urticaria and angio-oedema [ ]. The management of angio-oedema generally depends on the cause, duration, and severity [ ; ]. For example: Angio-oedema with urticaria is usually mast cell- or histamine mediated and responds well to avoidance of triggers and treatment with oral antihistamines and corticosteroids [ ; ]. Drug-induced angio-oedema requires (...) of angio-oedema generally depends on the cause, duration, and severity [ ; ]. For example: Angio-oedema with urticaria is usually mast cell- or histamine mediated and responds well to avoidance of triggers and treatment with oral antihistamines and corticosteroids [ ; ]. Drug-induced angio-oedema requires identification and cessation of the drug responsible. Antihistamines, corticosteroids, and adrenaline have traditionally been used to manage this condition, but their efficacy remains unproven

2018 NICE Clinical Knowledge Summaries

69. Nausea/vomiting in pregnancy

, migraine, central nervous system tumours. Other pregnancy-related conditions — acute fatty liver of pregnancy, pre-eclampsia. Drug-induced vomiting — for example iron or opioids. Psychological disorders — for example eating disorders. Basis for recommendation Basis for recommendation Findings suggesting an alternative diagnosis This information is based on a Royal College of Obstetricians and Gynaecologists (RCOG) guideline: The management of nausea and vomiting of pregnancy and hyperemesis gravidarum (...) , vomiting, and diarrhoea; stomach pain; and loss of appetite. Hepatobiliary disorders — hepatic dysfunction, hypersensitivity hepatitis, cholestatic jaundice, and cholestatic hepatitis. Skin and tissue disorders — urticaria, rash, angio-oedema, allergic skin reactions, and fixed drug eruption photosensitivity. Musculoskeletal and connective tissue disorders — twitching and muscle spasms. Others — tinnitus, blurred vision and oculogyric crisis, and urinary retention. [ ; ] Contraindications and cautions

2018 NICE Clinical Knowledge Summaries

70. Palliative care - oral

* Drug-induced dry mouth is often caused by the anticholinergic properties of drugs. This is not a comprehensive list of drugs that are associated with dry mouth, as many other drugs can cause these symptoms. Data from manufacturers' summary of products monograph data ( ). Painful mouth Painful mouth The causes of a painful mouth include: Ulceration: Viral (zoster, herpes simplex) ulcers. Aphthous ulcers. Neutropenic ulcers. Inflammation due to: Oral candidiasis. Dental abscess. Dental pain (dentine (...) and cracking at the corners of the mouth may accompany the chronic atrophic form. Hyperplastic candidiasis (candidal leukoplakia) adherent white plaques on the oral mucosa. This is a premalignant lesion, and oral cancer occurs in 9–40% of people. Clinical features of types of mouth ulcers Clinical features of types of mouth ulcers Common types of mouth ulcers in people with cancer include: Mucositis Drug-induced and radiation-induced mucositis most commonly affects the cheeks, soft palate, lips, ventral

2018 NICE Clinical Knowledge Summaries

72. Cutaneous Lupus Erythematosus (CLE), Treatment

patients in Europe confirmed that smoking influences disease severity and the efficacy of antimalarials [13]. However, other studies investigating the relationship between smoking and the efficacy of antimalarials in CLE patients indicate that cigarette smoking might not have any significant influence on the response to hydroxychloroquine (HCQ) and/or chloroquine (CQ) [14-16]. Drug-induced lupus erythematosus (DILE/DIL) in its classical form shows all features of idiopathic SLE with arthralgia, myalgia (...) , serositis, and fever. The involvement of skin and systemic organs (e.g., lupus nephritis) is rare [17, 18]. In contrast, drug-induced CLE (DI- CLE) shows all typical signs of the various disease subtypes (Table 1) [19, 20]. DI-CLE was reported to have the highest prevalence in SCLE patients [5, 21]. The “Koebner phenomenon“ in CLE is described following traumas, scratching effects, operation scars, contact dermatitis, pressure from sock tops, application of liquid nitrogen, infections, heat, and other

2016 European Dermatology Forum

73. Guideline for the Treatment of Acne

diseases. These include acne fulminans, drug induced acne, gram- negative folliculitis, rosacea fulminans, vasculitis, mechanical acne, oil/ tar acne, chloracne, acne in neonates and infants and late onset, persistent acne, sometimes associated with genetic or iatrogenic endocrinopathies. The current guideline do not lend themselves to comprehensive management of all of these variants. 8 2 Assessment, comparability of treatment outcomes Finlay/ Layton 2.1 Acne grading Acne can be largely assessed from

2016 European Dermatology Forum

75. Lymphangioleiomyomatosis Diagnosis and Management Part I: An Official ATS/JRS Clinical Practice Guideline

in patients with LAM. It also reduced the volume of angiomyolipomas, lymphangioleiomyomas, and chylous accumulations. Harms In general,sirolimus was well tolerated, and adverse effects were mild. The most common adverse events were mucositis, diarrhea, nausea, hypercholesterolemia, acneiform rash, and swelling in the lower extremities. Additional toxicities that are encountered with mTOR inhibitors include ovarian cyst formation, dysmenorrhea, proteinuria, elevated liver function tests, drug-induced (...) / kPa-min, respectively), or quality of life. More adverse effects were reported by the doxycycline group, but only dyspepsia and photosensitivity were attributed to the drug. Bene?ts No bene?cial effects due to doxycycline therapy were con?rmed in patients with LAM who had respiratory impairment. Harms Potential adverse effects due to doxycycline include dyspepsia, photosensitivity, and possibly also nausea and diarrhea. Other Considerations The guideline panel’s judgments regarding the effects

2016 American Thoracic Society

76. Diagnosis, Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults

etiology for AMH. Nephropathies and nephritis are the most common causes of microhematuria in this category. The processes may be immunological, infectious or drug-induced. The literature on nephrologic findings in AMH patients is not as extensive as the literature on urological malignancies and the finding of renal malignancy is less common than the finding of bladder malignancy. 73 However, studies report high rates of nephrologic disease in specialized patient groups, including patients

2016 American Urological Association

79. Jardiance - empagliflozin

) oxidants, and under UV irradiation. The following parameters were tested: appearance, impurities (HPLC), diaseteromer (chiral HPLC), assay (HPLC), water content (KF) and particle size (laser diffraction). The analytical methods used were the same as for release. No changes to any test parameters were observed under long term or accelerated conditions. Empagliflozin is neither photosensitive, nor affected by high temperature or humidity in the solid state. In solution, empagliflozin is prone

2014 European Medicines Agency - EPARs

80. Evolocumab (Repatha)

ULN or INR > 1.5: one case occurred 3 days after the participant admitted himself to rehabilitation for alcohol detoxification; one case had a normal bilirubin but an elevated INR due to warfarin and the transaminases declined despite continuation of evolocumab treatment; and in the last case, the participant was being treated for a urinary tract infection with nitrofurantoin and was also on simvastatin. Liver biopsy in this participant was consistent with drug-induced hepatitis. LFTs eventually

2014 FDA - Drug Approval Package

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