Hospital Pharmacy - May 2017 - 332

332
malaria infection; hepatitis A, B, and C; dengue fever; and
chikungunya.
The patient refused to remain in the hospital but promised
to return in 2 days for follow-up. Two days later, his CK had
normalized at 176 U/L and his serum creatinine was 0.97
mg/dL. He also reported he felt well and was able to resume
his usual activities. The patient was followed for 3 months
via telephone calls, and he remained in good health.
Comelli et al3 concluded, "When evaluating a patient
returning from a journey or staying in tropical counties, antimalarial drugs, such as mefloquine, should be considered
among the potential causes of rhabdomyolysis, especially in
patients complaining for nonspecific symptoms, like malaise
and fatigue."

Methimazole-Induced Cholestatic
Hepatitis
Zou et al4 reported 2 cases of cholestatic hepatitis caused by
methimazole (Tapazole). The first case occurred in a 50-yearold female who described a change in urine color, severe pruritus, diarrhea, and weight loss for 8 days. She reported that 8
days prior, she initiated methimazole 10 mg daily and propranolol 10 mg 3 times daily for recently diagnosed hyperthyroidism.
She had not received any other medications and did not report
abdominal pain, fever, history of alcohol use, or history of liver
disease. She demonstrated severe icterus of the sclerae and skin.
Laboratory results revealed an abnormally high free thyroxin (FT4) of 56.33 pmol/L (normal range, 11-25 pmol/L) and
a low thyroid stimulating hormone (TSH) of <0.005 mU/L
(normal range, 0.5-5 mU/L). Hepatic function tests revealed a
total bilirubin of 105.86 µmol/L (normal range, 3.4-25 µmol/L),
direct bilirubin of 54.21 µmol/L (normal range, 0-8 µmol/L),
alkaline phosphatase (ALP) of 200 U/L (normal range, 34-104
U/L), gamma-glutamyl transferase (GGT) of 104 U/L (normal
range, 0-60 U/L), aspartate aminotransferase (AST) of 17 U/L
(normal range, 0-50 U/L), and alanine aminotransferase (ALT)
of 120 U/L (normal range, 5-64 U/L). The patient's albumin,
prothrombin time, partial thromboplastin time, and blood cell
counts were within normal limits. Serology for hepatitis viruses
A, B, C, D, and E; Epstein-Barr; and cytomegalovirus were all
negative. Autoantibody profiles for primary biliary cirrhosis
and autoimmune hepatitis were also negative. An abdominal
ultrasound was unremarkable. Treatment with methimazole
was stopped, and propranolol therapy was continued for symptomatic relief. The patient's AST, ALT, and bilirubin were
nearly normal 4 weeks after methimazole discontinuation. The
patient refused thyroidectomy or radioactive iodine treatment
for her hyperthyroidism and was started on propylthiouracil 50
mg daily. The patient's thyroid function tests and hepatic function tests normalized after initiation of propylthiouracil
therapy.
The second patient was a 42-year-old female who was
started on methimazole 30 mg daily for the treatment of
hyperthyroidism. Two weeks after starting methimazole,

Hospital Pharmacy 52(5)
the patient experienced pruritus that she considered a drug
allergy. The patient decreased her methimazole dosage to
15 mg daily and continued to take her mediation until her
appetite decreased. She presented with severe pruritus after
27 days of methimazole therapy. The patient had no medical history except for hyperthyroidism, and she had no history of alcohol use. She had severe icterus of the sclerae
and skin.
Laboratory tests revealed an FT4 of 24.48 pmol/L and
TSH of 0.008 mU/L. Hepatic function test results were total
bilirubin of 268.87 µmol/L, direct bilirubin of 116.8 µmol/L,
ALP of 353 U/L, GGT of 255 U/L, AST of 105 U/L, and ALT
of 135 U/L. Concomitant liver diseases, such as viral hepatitis A, B, C, D, and E, autoimmune hepatitis, and primary biliary cirrhosis, were excluded by serological analysis. The
patient's methimazole was discontinued at this time; however, after 2 weeks, the patient had progressive worsening of
nausea, anorexia, itching, and jaundice. The patient's total
bilirubin peaked at 348.2 µmol/L and direct bilirubin of
262.12 µmol/L. Intravenous methylprednisolone was then
administered for 6 days, and her total bilirubin and direct
bilirubin both fell to 183.21 µmol/L and 157.9 µmol/L,
respectively. The patient was continued on a methylprednisolone taper for the next 16 weeks, and her liver function tests
returned to normal.
Zou et al concluded, "In rare cases within the first few
weeks of therapy, methimazole can cause severe and reversible cholestatic jaundice. Physicians and patients should be
aware of this rare but serious adverse effect. Meanwhile it is
essential that patients are informed about the earliest symptoms of serious adverse effects of antithyroid drugs, such as
agranulocytosis and hepatic toxicity, and that they are
advised to stop taking the drug immediately and contact their
physician of such symptoms occur."

Decitabine-Induced Hand and Foot
Syndrome
A 61-year-old Caucasian male was diagnosed with acute
myeloid leukemia that had been treated with chemotherapy and
relapsed twice. The patient was deemed inappropriate for further aggressive chemotherapy. The patient was started on
decitabine (Dacogen) 20 mg/m2 daily for 5 days. On the third
day of decitabine therapy, the patient developed a burning and
tingling sensation in his palms. The patient's symptoms did not
warrant discontinuation of decitabine therapy, and he received
the full 5-day course as prescribed. A few days after his chemotherapy course was complete, the patient progressed to symmetric well-defined swelling and erythema. The patient's erythema
was most prominent on the lateral aspects of the fingers and
distal fat pads. The patient was evaluated and considered to
have grade II hand and foot syndrome (HFS). The patient was
not receiving any other medications known to cause HFS or
interact with decitabine.



Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
Hospital Pharmacy - May 2017 - 384
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