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desloratadina
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desflurane, isoflurane, and sevoflurane anaesthesia. Can J
tolerated in seasonal allergic rhinitis, including relief ofnasal congestion (24).
atadine in 346 patients with seasonal allergic rhinitis, thesymptoms improved significantly and therewasno significant
urticaria, with no adverse electrocardiographic effects (8).References
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Baillie`res Clin Anaesthesiol 1996;10:687715.
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sevoflurane, and propofol. Anesth Analg 1998;86(2):26773.
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actions of desflurane: is desflurane different from isoflur-
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Keykhah MM. Elderly patients recover more rapidly from
desflurane than from isoflurane anesthesia. J Clin Anesth
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and children. Anesthesiology 1992;76(3):3738.
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Desflurane and isoflurane have similar effects on cerebral
blood flow in patients with intracranial mass lesions.
Anesthesiology 1993;79(3):498502.
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muscular function in a patient during desflurane anesthesia.
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Cahalan MK, Freire B, Peterson N, Lockhart SH,
Rampil IJ, Laster M. Desflurane does not produce hepatic
or renal injury in human volunteers. Anesth Analg
1992;74(4):5704.
13. Berghaus TM, Baron A, Geier A, Lamerz R,
Paumgartner G, Conzen P. Hepatotoxicity following des-
flurane anesthesia. Hepatology 1999;29(2):61314.
14. Annila P, Rorarius M, Reinikainen P, OikkonenM, Baer G.
Effect of pre-treatment with intravenous atropine or
glycopyrrolate on cardiac arrhythmias during halothane
anaesthesia for adenoidectomy in children. Br J Anaesth
1998;80(6):75660.
15. Fu ES, Scharf JE, Mangar D, Miller WD. Malignant
hyperthermia involving the administration of desflurane.
Can J Anaesth 1996;43(7):68790.
16. Gold MI, Abello D, Herrington C. Minimum alveolar
concentration of desflurane in patients older than 65 yr.
Anesthesiology 1993;79(4):71014.
17. Moore MA, Weiskopf RB, Eger EI 2nd, Wilson C, Lu G.
Arrhythmogenic doses of epinephrine are similar during
desflurane or isoflurane nesthesia in humans.
Anesthesiology 1993;79(5):9437.
18. Sebel PS, Glass PS, Fletcher JE, Murphy MR, Gallagher C,
Quill T. Reduction of the MAC of desflurane with fentanyl.
Anesthesiology 1992;76(1):529.
1074 Desloratadine19. Eriksson H, Korttila K. Recovery profile after desflurane
with or without ondansetron compared with propofol in
2006 Elsevier B.V. All rights reserved.In healthy volunteers, 12 men and 12 women, there wasno prolongation of the QTc interval after co-administrationof desloratadine with erythromycin (9).
Nervous system
Desloratadine appears to be minimally sedative, giventhat several studies, published in abstract, have shownno impairment in terms of wakefulness or psychomotorperformance (1012). Moreover, in a study in whicheffect on the QTc interval (7).In a multicenter, randomized, double-blind, placebo-
controlled study in 190 patients, desloratadine was effectivein the treatment of moderate to severe chronic idiopathicIn a randomized, open, four-way, crossover study in 20healthy men desloratadine was given as single doses (5,7.5, 10, and 20mg) in four different treatment periodswith 14 days between each dose. The Cmax for all dosesoccurred at 4 hours after administration, with a half-life of2124 hours. There were no dose-related differences indrug absorption rate, and even the 20mg dose was welltolerated (5). The systemic availability of desloratadinewas unaffected by food in healthy adult volunteers (6).
Organs and Systems
Cardiovascular
In a large, multicenter, double-blind, placebo-controlled,parallel-group study of the efficacy and tolerability of deslor-Anaesth 1998;45(6):52632.
Desloratadine
See also Antihistamines
General Information
Desloratadine is the primary metabolite of loratadine,with superior H1 receptor binding, potent antihistaminicactivity compared with the parent compound, and provenefficacy in allergic disease (1). It is effective and wellpatients undergoing outpatient gynecological laparoscopy.
Anesth Analg 1996;82(3):5338.
20. Lowry DW, Mirakhur RK, Carrol MT. Time course of
action of rocuronium during sevoflurane, isoflurane or i.v.
anaesthesia. Br J Anaesth 1998;80:544.
21. Wulf H, Ledowski T, Linstedt U, Proppe D, Sitzlack D.
Neuromuscular blocking effects of rocuronium duringdesloratadine was effective and well tolerated in patientswith seasonal allergic rhinitis there were no clinicallysignificant sedative effects (7).
The effect of co-administration of azithromycin on
Pharmacokinet 2002;41(Suppl 1):16.Grapefruit juice
In an unblinded, randomized, single-dose, crossover studyin 24 healthy adults, grapefruit juice had no effect on thesystemic availability of oral desloratadine (20). Thereplasma concentrations of desloratadine has beenexamined in a randomized third-party-blind, placebo-controlled, parallel-group study in 90 healthy volun-teers (18). An initial loading dose of azithromycin(500mg) was given on day 3, followed by 250mg odfor 4 days. Concomitant azithromycin had little effect(
hydramine and desloratadine on vigilance and cognitive
function during treatment of ragweed-induced allergic rhi-
Desloratadine shows no effect on performance during 6 hat 8,000 ft simulated cabin altitude. Aviat Space Environ
Med 2004;75(5):4338.
16. Affrime M, Banfield C, Gupta S, Cohen A, Boutros T,
Thonoor M, Cayen M. Effect of race and sex on single and
multiple dose pharmacokinetics of desloratadine. Clin
Pharmacokinet 2002;41(Suppl 1):218.
17. Affrime M, Gupta S, Banfield C, Cohen A. A pharmaco-
kinetic profile of desloratadine in healthy adults, including
elderly. Clin Pharmacokinet 2002;41(Suppl 1):1319.
18. Gupta S, Banfield C, Kantesaria B, Marino M, Clement R,
Affrime M, Batra V. Pharmacokinetic and safety profile of
desloratadine and fexofenadine when coadministered with
azithromycin: a randomized, placebo-controlled, parallel-
group study. Clin Ther 2001;23(3):45166.
19. Gupta S, Banfield C, Kantesaria B, Flannery B, Herron J.
Pharmacokinetics/pharmacodynamics of desloratadine and
fluoxetine in healthy volunteers. J Clin Pharmacol
2004;44(11):12529.
20. Banfield C, Gupta S, Marino M, Lim J, Affrime M.
Grapefruit juice reduces the oral bioavailability of fexo-
fenadine but not desloratadine. Clin Pharmacokinet
2002;41(4):31118.
21. Banfield C, Herron J, Keung A, Padhi D, Affrime M.
Desloratadine has no clinically relevant electrocardio-
graphic or pharmacodynamic interactions with ketocona-
zole. Clin Pharmacokinet 2002;41(Suppl 1):3744.
Desmopressin
See also Vasopressin and analogues
General Information
Desmopressin (N-deamino-8-D-arginine vasopressin,dDAVP) is a longer acting analogue of vasopressin. It hasvery little vasoactive effect but is antidiuretic by anaction on vasopressin V2 receptors in the renal tubuleand is used to treat central diabetes insipidus and noc-turnal enuresis.At higher doses desmopressin also has significant
hematological effects and can significantly boost concen-nitis. Ann Allergy Asthma Immunol 2003;91(4):37585.
14. Nicholson AN, Handford AD, Turner C, Stone BM. Studies
on performance and sleepiness with the H1-antihistamine,
desloratadine. Aviat Space Environ Med 2003;74(8):80915.
15. Valk PJ, Van Roon DB, Simons RM, Rikken G.11. Vuurman E, Ramaekers JG, Rikken G, De Halleux F.
Desloratadine does not impair actual driving performance:
a three way crossover comparison with diphenhydramine
and placebo. Allergy 2000;55(Suppl 63):Abstract 263.
12. Valk PJL, Van Roon DB, Simons M, Rikken G, Lether IC,
Staudinger H. No impairment of flying ability with deslor-
atadine use in healthy volunteers under conditions of simu-
lated cabin pressure. Allergy 2001;56(Suppl 68):Abstract
229.
13. Wilken JA, Kane RL, Ellis AK, Rafeiro E, Briscoe MP,
Sullivan CL, Day JH. A comparison of the effect of diphen-
1076 Desmopressintrations of factor VIII and von Willebrand factor (VWF)in the blood. Desmopressin is therefore a valuable agentfor the treatment of mild and moderate hemophilia
2006 Elsevier B.V. All rights reserved.A (congenital or acquired) and type 1 von Willebranddisease, in which the VWF protein structure is normalbut the plasma concentration is reduced (1). By contrastwith conventional coagulation factor concentrates, des-mopressin is cheap and is free from the risk of transmis-sion of viral infections, which have proved such a problemin the past. It is also very useful in the treatment ofcarriers of hemophilia A, many of whom have significantreductions in the baseline concentration of factor VIII. Bycontrast, desmopressin has no effect on the concentrationof factor IX, and is thus of no value in hemophilia B(Christmas disease). It is also of little value in type 2(abnormal VWF structure) von Willebrands disease,which accounts for about 1520% of all cases. The admin-istration of desmopressin to patients with type 2B vonWillebrands disease can be hazardous, as it is likely tocause thrombocytopenia (2). The use of desmopressin inbleeding disorders has been reviewed (3). Tachyphylaxisdevelops if desmopressin is used for prolonged periods tocontrol bleeding disorders, because desmopressin causesrelease of stored factor VIII and von Willebrand factor,after which it takes time for them to accumulate again.Intravenous injection is the most common route
although subcutaneous injection may also be used. Aconcentrated nasal spray formulation has been proved tobe efficient for home treatment of patients with bleedingepisodes or even minor surgical procedures and has alsobeen used prophylacticly (4). The nasal spray used totreat diabetes insipidus (Desmospray) is too dilute foruse in disorders of hemostasis. Similarly, desmopressinin tablet form (Desmotabs) is intended for treatment ofnocturnal enuresis in children and is of no use in thetreatment of hemostatic disorders.Desmopressin also shortens the prolonged skin bleed-
ing time in patients with renal insufficiency (5,6), hepaticcirrhosis (7,8), and congenital or acquired defects ofplatelet function (911), including aspirin-induced plate-let dysfunction (12).Desmopressin reduces blood loss in patients without
bleeding disorders during surgical procedures, includingcardiac surgery (13,14). However, similar benefits havealso been observed with other agents, including aprotinin,tranexamic acid, and aminocaproic acid. Meta-analyseshave confirmed the efficacy of these agents and haveshown that aprotinin is the most effective of these agentsin reducing blood loss, while desmopressin was the leasteffective (15,16).Children with nocturnal enuresis treated with desmo-
pressin have fewer wet nights per week, but this effectdoes not persist after therapy is stopped. A meta-analysisshowed an overall rate of 7.1 adverse events per 100children (17). These were almost all local nasal reactions,including nasal irritation and epistaxis.In an open trial of high-dose desmopressin 1.5mg intra-
nasally to control bleeding in 278 patients with congenitalbleeding disorders, headache occurred in 3.6% and flush-ing in 3.2% of patients (18). Dizziness and nausea werereported in 11.5% and edema in 0.3% of patients.
General adverse effectsThe adverse effects of desmopressin include headache,tachycardia, facial flushing, abdominal pain, tremor, and
DesloratadineSee alsoGeneral InformationOrgans and SystemsCardiovascularNervous systemPsychological, psychiatric
Susceptibility FactorsGenetic factorsAgeSex
Drug-Drug InteractionsAzithromycinErythromycinFluoxetineGrapefruit juiceKetoconazole
References
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