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Clinical pharmacology consultations: consultation requests may be misleading -- an organized approach to drug-induced hepatitis.

https://arctichealth.org/en/permalink/ahliterature184347
Source
Can J Clin Pharmacol. 2003;10(2):59-62
Publication Type
Article
Date
2003
Author
Maria Valois
Mary Anne Cooper
Neil H Shear
Author Affiliation
Division of Clinical Pharmacology, Sunnybrook & Women's College Health Science Centre, University of Toronto Medical School, Toronto, Canada.
Source
Can J Clin Pharmacol. 2003;10(2):59-62
Date
2003
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Dalteparin - adverse effects
Diagnosis, Differential
Drug-Induced Liver Injury - diagnosis - etiology
Histamine H2 Antagonists - adverse effects
Humans
Liver - enzymology - pathology
Male
Middle Aged
Ontario
Pharmaceutical Services
Ranitidine - adverse effects
Referral and Consultation
Abstract
The present case report describes a consultation with the Clinical Pharmacology Consultation Service at the Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, for drug-induced hepatitis in a patient with multiple drug exposures. The original question to be addressed was whether dalteparin was responsible for an acute rise in liver transaminases. The approach involved establishing a best possible diagnosis of the adverse event, obtaining a comprehensive history of drug exposure and evaluating the possible contributory role of alternate etiologies supported by a literature search. On balance, based on temporal relationships and previous case reports, ranitidine was considered to be the most likely causal agent. The initial consultation request was to investigate the likelihood that daltaperin caused hepatitis; however, a systematic and comprehensive approach led to the conclusion that it was more likely to be ranitidine-induced hepatitis.
PubMed ID
12879142 View in PubMed
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Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis.

https://arctichealth.org/en/permalink/ahliterature168090
Source
Fertil Steril. 2006 Sep;86(3):658-63
Publication Type
Article
Date
Sep-2006
Author
Cameron Gilbert
Maria Valois
Gideon Koren
Author Affiliation
Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada.
Source
Fertil Steril. 2006 Sep;86(3):658-63
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Abnormalities, Drug-Induced - epidemiology
Canada
Comorbidity
Female
Humans
Hypoglycemic Agents - administration & dosage
Incidence
Metformin - administration & dosage
Polycystic Ovary Syndrome - drug therapy - epidemiology
Pregnancy
Pregnancy Outcome - epidemiology
Pregnancy Trimester, First - drug effects
Prenatal Exposure Delayed Effects - epidemiology
Risk Assessment - methods
Risk factors
Abstract
To conduct a systematic review and meta-analysis of pregnancy outcome after metformin use for polycystic ovary syndrome (PCOS), because the efficacy of metformin has been demonstrated in the treatment of infertility caused by PCOS, whereas the fetal safety of metformin has received very little attention, and the few studies addressing this issue are limited by small sample sizes.
Meta-analytic review.
All pertinent studies in MEDLINE and EMBASE from 1966 to September 2004.
Women with PCOS or diabetes.
Exposure to metformin in the first trimester of pregnancy.
Major malformations.
Eight studies were included in the meta-analysis, with an odds ratio of 0.50 (95% confidence interval, 0.15, 1.60). After adjustment for publication bias, metformin treatment in the first trimester was associated with a statistically significant 57% protective effect. After pooling the studies, the malformation rate in the disease-matched control group was approximately 7.2%, statistically significantly higher than the rate found in the metformin group (1.7%).
On the basis of the limited data available today, there is no evidence of an increased risk for major malformations when metformin is taken during the first trimester of pregnancy. Large studies are needed to corroborate these preliminary results.
Notes
Comment In: Fertil Steril. 2007 May;87(5):1240; author reply 124017400214
PubMed ID
16879826 View in PubMed
Less detail