Vedolizumab-induced acute pancreatitis: the first reported clinical case.

BMJ Case Rep. 2018 Jan 05;2018:

Authors: Picardo S, So K, Venugopal K, Chin M

Abstract
Drug-induced acute pancreatitis (DIAP) is a rare, but clinically significant diagnosis. Vedolizumab, an α4β7 integrin inhibitor, which was approved in 2015 for treatment of moderate to severe inflammatory bowel disease, is a well-tolerated medication with a favourable safety profile and minimal serious adverse events in premarketing clinical trials. We present the first reported case of acute pancreatitis directly attributable to vedolizumab.

PMID: 29305366 [PubMed - in process]

13 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2018/01/06

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

13 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2018/01/06

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Polypharmacy in Cardiovascular Medicine: Problems and Promises!

Cardiovasc Hematol Agents Med Chem. 2017 Nov 08;15(1):31-39

Authors: Abolbashari M, Macaulay TE, Whayne TF, Mukherjee D, Saha S

Abstract
BACKGROUND: Polypharmacy is now a frequent aspect and reality of current medicine practice, driven by managing multiple comorbidities, especially in older adults. However and unfortunately, polypharmacy can expose patients to adverse drug reactions, and drug-drug or drug-disease interactions. On the other hand, clinicians are often hesitant to add new drugs to complex regimens even when recommended by evidence-based medicine and guidelines. In addition, there is frequently a failure to assess which medications might not be beneficial and may therefore be stopped.
METHOD: Cardiovascular disease prevalence is increasing despite the efforts to prevent this with pandemics of obesity and diabetes as leading causes. The healthcare system is facing an increasing number of cardiovascular diseases in older patients with multiple comorbidities. New cardiovascular guidelines encourage multiple drug use to control these conditions and improve mortality and morbidity. However, use of multiple drugs can lead to inappropriate drug interactions and increased adverse outcomes. On the other hand, the so-called polypill has been proposed as a means to decrease the burden of multiple medications as well as increase cardiovascular disease prevention.
CONCLUSION: This review discusses multiple issues of polypharmacy and its challenges, with a focus on cardiovascular diseases.

PMID: 28552061 [PubMed - indexed for MEDLINE]

Myasthenia Gravis After Nivolumab Therapy for Squamous Cell Carcinoma of the Bladder.

J Immunother. 2017 Apr;40(3):114-116

Authors: Chang E, Sabichi AL, Sada YH

Abstract
Checkpoint inhibitors have become standard therapy for multiple cancers, and their use will increase in the next year as regulatory approvals for additional indications are expected. It is essential for clinicians to be aware of the potential for rare immune-related adverse effects. Here, we report the case of a new diagnosis of myasthenia gravis (MG) after the use of nivolumab for squamous cell carcinoma of the bladder. A review the literature identified 10 cases of MG diagnosed after programmed cell death protein 1 inhibitor therapy. This is the first case, to our knowledge, reported in association with bladder cancer. The precise diagnosis of MG has important implications on management, as treatment with steroids can transiently worsen myasthenia in nearly 50% of cases.

PMID: 28234667 [PubMed - indexed for MEDLINE]

Efficacy of tenuigenin and β-asarone as augmentations for memantine in the treatment of Alzheimer's disease.

Neuroreport. 2018 Jan 02;:

Authors: Dong H, Wu S, Hu N, Xing G

Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease that has no cure at present. This study was carried out to evaluate whether the combination of β-asarone and tenuigenin could improve the efficacy of memantine as a monotherapy in the treatment of AD. Patients with AD were recruited and assigned to two groups. Patients in the control group received memantine (5-20 mg/day) and those in the experimental group received memantine (5-20 mg/day), β-asarone (20 mg/day), and tenuigenin (20 mg/day). The Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Clinical Dementia Rating Scale (CDR) scores and drug-related side-effects were assessed. Treatment was continued for 12 weeks. In total, 93 AD patients (45 in the control group and 48 in the experimental group) were recruited. Before treatment, both the groups had similar average MMSE scores, ADL scores, and CDR scores, whereas all the average scores improved significantly after treatment. However, compared with the control group, the experimental group had a significantly higher average MMSE score (P=0.00001) and lower average ADL (P=0.00604) and CDR (P=0.00776) scores after treatment. Moreover, the two groups had similar rates of drug-related side-effects. These results indicated that the combination of β-asarone and tenuigenin was an effective augmentation for memantine in the treatment of AD and did not cause more drug-related side-effects. This novel method is worthy of further investigation.

PMID: 29298173 [PubMed - as supplied by publisher]

A case of probable Amiodarone-induced pancreatitis in the treatment of atrial fibrillation: a literature review and case report.

J Community Hosp Intern Med Perspect. 2017;7(6):369-371

Authors: J Mercogliano C, Khan M, Ahmad M

Abstract
Amiodarone is an effective medication used in the treatment of several different arrhythmias. Its most well-known adverse effects include pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity. A less common side effect is acute pancreatitis. A 67-year-old male being treated for atrial fibrillation in rapid ventricular response with Amiodarone developed acute epigastric abdominal pain 24 hours after initiation of therapy. He was diagnosed as having acute pancreatitis based on characteristic findings seen on an abdominal CT scan. Commonly encountered etiologies of pancreatitis were ruled out through a combination of the history, laboratory values, and imaging results. Based on the temporal association of the acute presentation and initiation of Amiodarone therapy, in conjunction with a lack of support for any other etiology, the diagnosis of Amiodarone-induced pancreatitis was made. Within 7 days following the cessation of Amiodarone therapy, the patient's symptoms had completely resolved. Amiodarone-induced pancreatitis is an often overlooked medication association and is one that has been infrequently reported throughout the literature. Given the substantial morbidity and mortality associated with acute pancreatitis, and the ease of treatment (withdrawing Amiodarone), this is a critical side effect that should be recognized in the appropriate clinical setting.

PMID: 29296251 [PubMed]

Adverse Drug Event Monitoring with Clinical and Laboratory Data Using Arden Syntax.

Stud Health Technol Inform. 2017;245:1123-1127

Authors: Rappelsberger A, Adlassnig KP, de Bruin JS, Plössnig M, Schuler J, Hofer-Dückelmann C

Abstract
In times of steadily increasing numbers of administered drugs, the detection of adverse drug events (ADEs) is an important aspect of improving patient safety. At present only about 1-13% of detected ADEs are reported. Raising the number of reported ADEs will result in greater and more efficient support of pharmacovigilance. Potential ADE's must be identified early. In the iMedication system, which is a rule-based application, triggers are used for computerized detection of possible ADEs. Creating a pilot system, we defined the relevant use cases hyperkalemia, hyponatremia, renal failure, and over-anticoagulation; knowledge bases were implemented in Arden Syntax for each use case. The objective of these knowledge bases is to interpret patient-specific clinical data and generate notifications based on a calculated ADE risk score, which may indicate possible ADEs. This will permit appropriate monitoring of potential ADE situations over time in the interest of patient care, quality assurance, and pharmacovigilance.

PMID: 29295277 [PubMed - in process]

Detecting Adverse Drug Event Signals from a Clinical CaseBase.

Stud Health Technol Inform. 2017;245:549-553

Authors: Qin W, Zeng X, Jia Z, Zheng X, Duan H, Lu X, Li H

Abstract
With the rapid development of medical information systems in Chinese hospitals over the last two decades, many of these organizations have accumulated astronomical amounts of structured and unstructured clinical data, including patient diagnostic data, treatment data, lab test data, etc. Secondary use of these data for research, such as Real World Evidence (RWE) studies, has the potential to improve medical quality and safety in daily clinical practice. In this study, we describe CaseBase, a Clinical Data Warehouse (CDW) that extracts structured clinical symptoms or findings and related temporal information from narrative clinical documents and integrates medication information from the CPOE system. An Adverse Drug Event (ADE) signals detection platform has also been developed based on CaseBase to analyze and visualize drug-symptom relations in clinical data. A prototype of this platform has been evaluated in a 2,000-bed hospital and some initial results are reported here.

PMID: 29295155 [PubMed - in process]

Constructing a Gene-Drug-Adverse Reactions Network and Inferring Potential Gene-Adverse Reactions Associations Using a Text Mining Approach.

Stud Health Technol Inform. 2017;245:531-535

Authors: Sui M, Cui L

Abstract
Our objective was to identify and extract gene-drug and drug-adverse drug reaction (ADR) relationships from different biomedical literature collections, and to predict the possible association between gene and ADR. The drug, ADR and gene entities were recognized by a CRF model with multiple features. Logistic regression models were constructed for each drug-ADR and drug-gene pair based on its frequency, Mesh Rule association and similarity with known association etc. Using predicted score to generate drug-ADR matrix and drug-gene matrix, and then calculating for gene-ADR matrix. Network and clustering analysis were applied to verify and interpret the relationship between them. A total of 78014 potential gene-ADR associations were predicted. Part of the predicted results can be explained by the network-clustering-pathway analysis, and verified in the literature. The gene-drug-ADR network constructed in this study can provide a reference for the possible association between the gene and ADR.

PMID: 29295151 [PubMed - in process]

Patient safety incident reports related to traditional Japanese Kampo medicines: medication errors and adverse drug events in a university hospital for a ten-year period.

BMC Complement Altern Med. 2017 Dec 21;17(1):547

Authors: Shimada Y, Fujimoto M, Nogami T, Watari H, Kitahara H, Misawa H, Kimbara Y

Abstract
BACKGROUND: Kampo medicine is traditional Japanese medicine, which originated in ancient traditional Chinese medicine, but was introduced and developed uniquely in Japan. Today, Kampo medicines are integrated into the Japanese national health care system. Incident reporting systems are currently being widely used to collect information about patient safety incidents that occur in hospitals. However, no investigations have been conducted regarding patient safety incident reports related to Kampo medicines. The aim of this study was to survey and analyse incident reports related to Kampo medicines in a Japanese university hospital to improve future patient safety.
METHODS: We selected incident reports related to Kampo medicines filed in Toyama University Hospital from May 2007 to April 2017, and investigated them in terms of medication errors and adverse drug events.
RESULTS: Out of 21,324 total incident reports filed in the 10-year survey period, we discovered 108 Kampo medicine-related incident reports. However, five cases were redundantly reported; thus, the number of actual incidents was 103. Of those, 99 incidents were classified as medication errors (77 administration errors, 15 dispensing errors, and 7 prescribing errors), and four were adverse drug events, namely Kampo medicine-induced interstitial pneumonia. The Kampo medicine (crude drug) that was thought to induce interstitial pneumonia in all four cases was Scutellariae Radix, which is consistent with past reports. According to the incident severity classification system recommended by the National University Hospital Council of Japan, of the 99 medication errors, 10 incidents were classified as level 0 (an error occurred, but the patient was not affected) and 89 incidents were level 1 (an error occurred that affected the patient, but did not cause harm). Of the four adverse drug events, two incidents were classified as level 2 (patient was transiently harmed, but required no treatment), and two incidents were level 3b (patient was transiently harmed and required substantial treatment).
CONCLUSIONS: There are many patient safety issues related to Kampo medicines. Patient safety awareness should be raised to prevent medication errors, especially administration errors, and adverse drug events in Kampo medicine.

PMID: 29268743 [PubMed - indexed for MEDLINE]

Safety and effectiveness of interferon β-1a intramuscular therapy: results of the postmarketing drug surveillance in Japan.

Rinsho Shinkeigaku. 2017 10 27;57(10):553-561

Authors: Makioka H, Nakaya F, Ling Y, Torii S, Saida T, Kira JI

Abstract
To investigate the safety and effectiveness of the interferon β-1a intramuscular injection under clinical conditions in Japan, we conducted an all-case postmarketing surveillance with a 2-year follow-up of patients who were registered during the period between November 2006 (product launch) and December 2010. Case reports were collected from 397 institutions. The safety analysis included 1,476 patients, and the effectiveness analysis included 1,441 patients. Of the patients included in the safety analysis, 86.3% had relapsing-remitting multiple sclerosis. The most common adverse drug reaction was pyrexia (19.24%). Serious adverse events included multiple sclerosis relapse (26 cases) and abnormal hepatic function (10 cases). In the effectiveness analysis, the annualized relapse rate improved significantly from 1.07 to 0.29 (P < 0.001). There was also a significant improvement in in the expanded disability status scale from 3.08 to 2.94 (P < 0.001). The results of the safety and effectiveness profile were consistent with those in previous reports.

PMID: 28966229 [PubMed - indexed for MEDLINE]

Real life experience with direct-acting antivirals agents against hepatitis C infection in elderly patients.

J Clin Virol. 2017 Mar;88:58-61

Authors: Rodríguez-Osorio I, Cid P, Morano L, Castro Á, Suárez M, Delgado M, Margusino L, Meijide H, Pernas B, Tabernilla A, Pedreira JD, Mena Á, Poveda E

Abstract
BACKGROUND: New direct-acting antivirals agents (DAAs) are very safe and well tolerated.
OBJECTIVES: The purpose of this study is to analyse the efficacy and safety of DAAs in elderly patients, who have co-morbidities and are on chronic medications.
STUDY DESIGN: All HCV-infected patients over 65 years old in clinical follow-up at two Hospitals in Spain who initiated anti-HCV therapy were included (August 2012-October 2015).
RESULTS: A total of 120 HCV mono-infected patients were recorded. Mean age of patients was 72.6±7.4years. There were 53.3% women and GT1b was the most frequent (83.3%); 64.2% had cirrhosis and 42.5% were treatment experienced. Ombitasvir+Paritaprevir/r±Dasabuvir±Ribavirin (RBV) and sofosbuvir/ledipasvir±RBV were the most frequently used regimens. Weight-adjusted dosing of RBV was included in 61.7% and 43.6% of them required a dose reduction. Most of the patients (86.7%) had concomitant chronic medication and in 35.8% adjustment was necessary. Adverse events (AE) were seen in 65% of the patients; more frequent when a protease inhibitor (PI) was being used. The sustained virological response (SVR12) per ITT was 88.3%. Only 3 patients discontinued treatment and 2 patients died.
CONCLUSIONS: High rates of SVR12 (88.3%) were observed among elderly patients with DAAs-based regimens. The presence of AE was frequent (65%). The majority of these patients (86.7%) had concomitant medication that required adjustment in 1/3 of them. These findings highlight the high rates of response to DAAs in the elderly HCV-population. However, special caution must be taken when using RBV and a PI.

PMID: 28183063 [PubMed - indexed for MEDLINE]

Clinical characteristics of laboratory-confirmed leptospirosis in Okinawa, Japan, 1974-2015: high incidence of Jarisch-Herxheimer reaction.

Trans R Soc Trop Med Hyg. 2016 Sep;110(9):558-565

Authors: Tsuha S, Taniguchi T, Shiiki S, Narita M, Leung DT

Abstract
BACKGROUND: Leptospirosis is a zoonotic disease known to have wide-ranging clinical manifestations. Despite a number of published case series, culture-confirmed series are few and there is a paucity of data on Jarisch-Herxheimer reaction (JHR) associated with treatment of leptospirosis. Our objective was to describe the clinical and epidemiological factors associated with leptospirosis in an endemic area of Japan, with a focus on the occurrence of JHR, an often unrecognized and likely underestimated phenomenon.
METHODS: We performed a retrospective observational study of laboratory-confirmed leptospirosis at a single center over a 40-year period.
RESULTS: We report 100 leptospirosis cases in 99 patients during the period 1974-2015. Seventy-four cases were diagnosed by culture, representing eight different serovars. JHR was seen in 23 (82%) of 28 cases, including 19 (90%) of 21 cases treated with bactericidal antibiotics compared to 4 (57%) of seven cases with bacteriostatic antibiotics (p=0.08).
CONCLUSIONS: We found a wide variety of clinical manifestations, epidemiological exposures, and causative serovars of disease in an endemic region of Japan. We also found that JHR occurs frequently, and its recognition may be important for the diagnosis and management of leptospirosis in the early stage when laboratory confirmation is pending.

PMID: 27744340 [PubMed - indexed for MEDLINE]

Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity.

Curr Opin Infect Dis. 2016 Dec;29(6):561-576

Authors: Konvinse KC, Phillips EJ, White KD, Trubiano JA

Abstract
PURPOSE OF REVIEW: Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs.
RECENT FINDINGS: Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs.
SUMMARY: In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.

PMID: 27753687 [PubMed - indexed for MEDLINE]

17 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2018/01/03

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Dynamic change of fatigue of pemetrexed maintenance treatment in the JMEN trial.

Lung Cancer. 2018 Jan;115:121-126

Authors: Zhang L, Belani CP, Zhang PH, Wang X, Yang L, Orlando M, Wu YL

Abstract
OBJECTIVES: In the JMEN trial, patients with advanced non-squamous non-small cell lung cancer (NSCLC) without progression after platinum-based first-line therapy derived extended survival, delayed disease progression, and maintained overall quality of life (QoL) from pemetrexed maintenance therapy. However, fatigue was the most common physician-reported non-hematological toxicity in the pemetrexed group. This post hoc analysis investigated dynamic change of fatigue.
MATERIALS AND METHODS: Analysis of the overall safety population with squamous and non-squamous NSCLC subgroups included Common Terminology Criteria for Adverse Events to summarize adverse event (AE) rates by cycle and AE investigator-reported severity. Worsening of fatigue, defined as +15mm or more from baseline on a 100mm scale, evaluated QoL using the patient-reported Lung Cancer Symptom Scale. Patients with worsening fatigue and time-to-worsening of fatigue symptoms were also analyzed.
RESULTS: Drug-related fatigue occurred more frequently with pemetrexed than placebo. The drug-related grade 3/4 fatigue was also higher in the overall population on pemetrexed than with placebo. Fatigue incidence during pemetrexed maintenance after induction was not altered with cumulative exposure. Percentage of patients who experienced worsening of fatigue based on patient-reported LCSS scores was comparable between the two arms in cycles 1-10. The time-to-worsening of fatigue was similar between the pemetrexed arm and the placebo arm in the overall population; however, the East Asian subpopulation patients taking pemetrexed experienced a longer median time-to-worsening of fatigue than patients taking placebo.
CONCLUSION: Analyses suggest that despite higher incidence of any grade drug-related fatigue compared with placebo in patients with advanced NSCLC, pemetrexed maintenance does not impair patient-reported QoL.

PMID: 29290253 [PubMed - in process]

Optimising the use of medicines to reduce acute kidney injury in children and babies.

Pharmacol Ther. 2017 Jun;174:55-62

Authors: Oni L, Hawcutt DB, Turner MA, Beresford MW, McWilliam S, Barton C, Park BK, Murray P, Wilm B, Copple I, Floyd R, Peak M, Sharma A, Antoine DJ

Abstract
The majority of medications in children are administered in an unlicensed or off-label manner. Paediatricians are obliged to prescribe using the limited evidence available. The 2007 EU regulation on the use of paediatric drugs means pharmaceutical companies are now obliged to (and receive incentives for) contributing to paediatric drug data and carrying out paediatric clinical trials. This is important, as the efficacy and adverse effect profiles of medicines vary across childhood. Additionally, there are significant age-related changes in the pharmacodynamic and pharmacokinetic activity of many drugs. This may be related to physiological (differential expressions of cytochrome P450 enzymes or variable glomerular filtration rates at different ages for example) and psychological (increasing autonomy and risk perception in teenage years) changes. Increasing numbers of children are surviving life-threatening childhood conditions due to medical advances. This means there is an increasing population who are at risk of the consequences of the long-term, early exposure to nephrotoxic agents. The kidney is an organ that is particularly vulnerable to damage as a consequence of drugs. Drug-induced acute kidney injury (AKI) episodes in children and babies are principally due to non-steroidal anti-inflammatory drugs, antibiotics or chemotherapeutic agents. The renal tubules are vulnerable to injury because of their concentrating ability and high-energy hypoxic environment. This review focuses on drug-induced AKI and the methods to minimise its effect, including general management plus the role of child-specific pharmacokinetic data, the use of pharmacogenomics and early detection of AKI using urinary biomarkers and electronic triggers.

PMID: 28202365 [PubMed - indexed for MEDLINE]

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

BMJ Open. 2017 Jan 10;7(1):e013224

Authors: Carrasco-Garrido P, Hernández-Barrera V, Esteban-Hernández J, Jiménez-Trujillo I, Álvaro-Meca A, López de Andrés A, de Miguel Diez J, Rodríguez Barrios JM, Muñoz Robles JA, Jiménez-García R

Abstract
OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs.
DESIGN: A retrospective, descriptive, epidemiological study.
SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period.
PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period.
MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI.
RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93).
CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

PMID: 28073793 [PubMed - indexed for MEDLINE]

Cognitive adverse effects and brain deterioration associated with use of anticholinergic activity medicines in older adults.

Evid Based Med. 2016 12;21(6):235

Authors: Nishtala PS, Salahudeen MS

PMID: 27815304 [PubMed - indexed for MEDLINE]