FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1574506997> ?p ?o ?g. }

• W1574506997 endingPage "907" @default.
• W1574506997 startingPage "906" @default.
• W1574506997 abstract "Opioids and fluoroquinolones have both individually been reported in the literature to be associated with myoclonus as a rare adverse effect 1. Opioid induced neuroexcitatory effects like allodynia, hyperalgesia and myoclonus have been reported with morphine and hydromorphone in larger doses 2 as their active metabolites can cross the blood–brain barrier. There are case reports of fluoroquinolone induced myoclonus due to possible activation of a neurological generator that resolves promptly when the drug is ceased 3. However there are no reports about myoclonus when these drugs are prescribed together. We report a case of drug induced myoclonus in an older patient prescribed ciprofloxacin with oxycodone to highlight an uncommon adverse event and potential caution with concomitant use in older patients. Ethics approval was obtained from the Human Research Ethics Committee (TQEH/LMH/MH). An 80-year-old Caucasian lady presented to hospital with a hip fracture following a fall. Past medical history included osteoporosis, osteoarthritis, previous heavy ethanol intake, recurrent urinary tract infections and cognitive impairment. She had no past history of cerebrovascular disease, epilepsy, significant family history or drug allergies. She underwent short gamma nail insertion and was admitted to the orthopaedic ward for further input. On day 3 she became febrile with rigors and developed patchy chest X-ray changes. She was commenced on vancomycin, cefazolin and three doses of gentamicin for a presumed hospital acquired pneumonia. On day 6 after specialist review, intravenous antibiotics were ceased and oral ciprofloxacin 500 mg twice daily was started based on the urine culture sensitivity pattern which was continued until day 13 of admission. She was also commenced on regular Oxycontin® 5 mg twice daily on day 7 and this was increased to 10 mg twice daily on day 11 due to inadequate pain control. All her usual medications including paracetamol, solifenacin, aspirin, thiamine, calcium, cholecalciferol and metoprolol were continued without dose adjustments during admission. On day 13 of admission, she was noted to have new onset intermittent myoclonic jerks involving both arms. She was conscious during these episodes and had no focal neurological deficits elicited on complete neurological examination. On day 17, myoclonus induced by Oxycontin® was considered since symptoms had persisted more than 4 days after cessation of ciprofloxacin (half-life of around 3 to 8 h in normal to end stage renal disease and current creatinine clearance 63 ml min−1) 4. On day 17, fentanyl 12 μg h−1 was started while Oxycontin® was reduced to a bridging dose of 10 mg daily and ceased on day 19. Myoclonus fully resolved on day 21. During admission she had no symptoms on the alcohol withdrawal scale, normal ECG and blood tests. CT brain showed small vessel changes. An EEG was not performed as myoclonus completely resolved after the opioid switch. The close temporal relation of the myoclonus with commencement of the two implicated drugs, prompt resolution after the opioid switch, normal investigations and no other precipitating factors strongly suggest the likelihood of an adverse drug event. It is unclear whether ciprofloxacin, Oxycontin® or the combination was responsible. Symptoms of myoclonus presented on the last day of ciprofloxacin treatment (7 days total) and a day after the dose increase of Oxycontin®. Myoclonus persisted for 8 days after ciprofloxacin was ceased and resolved within 3 days of stopping Oxycontin®. One review suggested that CNS adverse events due to fluoroquinolone use generally develop within a few minutes or during the first days of treatment (1–8 days) 5. Risk factors for fluoroquinolone induced neurological adverse events such as myoclonus include age, renal impairment, polypharmacy (e.g. concomitant NSAID use) and past history of epilepsy 5. Apart from age, our patient did not have any other risk factor. To date, oxycodone induced myoclonus has not been reported. The major metabolites of oxycodone, like noroxymorphone and noroxycodone, have not been shown to cross the blood–brain barrier in significant amounts 6. Though oxycodone clearance may be reduced in the elderly, it is difficult, however, to fully attribute the myoclonus to oxycodone alone in this case despite the minor dose increase. However, it is pertinent to note that blood–brain barrier permeability may increase with small vessel disease and our patient had confirmed small vessel disease on the CT scan of the brain 7. Opioid-related myoclonus occurs more frequently in patients receiving antidepressants, antipsychotics, anti-emetics or NSAIDS 8 but our patient was not prescribed any of these medications. There is no reported literature on the incidence of myoclonus when ciprofloxacin and oxycodone are prescribed simultaneously. A possible mechanism is a synergistic reduction in the threshold for myoclonic jerks due to active metabolites crossing the blood–brain barrier in older patients with concomitant use of the above drugs. This has implications for clinical geriatric practice with the need for greater caution when the two drugs are used together and increased awareness of myoclonus as a possible adverse effect especially in this frail elderly cohort of patients. All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work." @default.
• W1574506997 created "2016-06-24" @default.
• W1574506997 creator A5017983967 @default.
• W1574506997 creator A5050088991 @default.
• W1574506997 creator A5083235631 @default.
• W1574506997 date "2014-04-22" @default.
• W1574506997 modified "2023-09-26" @default.
• W1574506997 title "Myoclonus associated with concomitant ciprofloxacin and oxycodone in an older patient" @default.
• W1574506997 cites W1985038074 @default.
• W1574506997 cites W1986453489 @default.
• W1574506997 cites W2076428797 @default.
• W1574506997 cites W2152083433 @default.
• W1574506997 cites W2157863665 @default.
• W1574506997 cites W2321585154 @default.
• W1574506997 cites W4245497458 @default.
• W1574506997 cites W4361806722 @default.
• W1574506997 doi "https://doi.org/10.1111/bcp.12213" @default.
• W1574506997 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/4004412" @default.
• W1574506997 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/23879446" @default.
• W1574506997 hasPublicationYear "2014" @default.
• W1574506997 type Work @default.
• W1574506997 sameAs 1574506997 @default.
• W1574506997 citedByCount "11" @default.
• W1574506997 countsByYear W15745069972013 @default.
• W1574506997 countsByYear W15745069972014 @default.
• W1574506997 countsByYear W15745069972015 @default.
• W1574506997 countsByYear W15745069972016 @default.
• W1574506997 countsByYear W15745069972019 @default.
• W1574506997 countsByYear W15745069972020 @default.
• W1574506997 countsByYear W15745069972023 @default.
• W1574506997 crossrefType "journal-article" @default.
• W1574506997 hasAuthorship W1574506997A5017983967 @default.
• W1574506997 hasAuthorship W1574506997A5050088991 @default.
• W1574506997 hasAuthorship W1574506997A5083235631 @default.
• W1574506997 hasBestOaLocation W15745069971 @default.
• W1574506997 hasConcept C126322002 @default.
• W1574506997 hasConcept C170493617 @default.
• W1574506997 hasConcept C197934379 @default.
• W1574506997 hasConcept C2776029756 @default.
• W1574506997 hasConcept C2776538686 @default.
• W1574506997 hasConcept C2779384505 @default.
• W1574506997 hasConcept C2781063702 @default.
• W1574506997 hasConcept C42219234 @default.
• W1574506997 hasConcept C71924100 @default.
• W1574506997 hasConceptScore W1574506997C126322002 @default.
• W1574506997 hasConceptScore W1574506997C170493617 @default.
• W1574506997 hasConceptScore W1574506997C197934379 @default.
• W1574506997 hasConceptScore W1574506997C2776029756 @default.
• W1574506997 hasConceptScore W1574506997C2776538686 @default.
• W1574506997 hasConceptScore W1574506997C2779384505 @default.
• W1574506997 hasConceptScore W1574506997C2781063702 @default.
• W1574506997 hasConceptScore W1574506997C42219234 @default.
• W1574506997 hasConceptScore W1574506997C71924100 @default.
• W1574506997 hasIssue "5" @default.
• W1574506997 hasLocation W15745069971 @default.
• W1574506997 hasLocation W15745069972 @default.
• W1574506997 hasLocation W15745069973 @default.
• W1574506997 hasLocation W15745069974 @default.
• W1574506997 hasOpenAccess W1574506997 @default.
• W1574506997 hasPrimaryLocation W15745069971 @default.
• W1574506997 hasRelatedWork W1964841359 @default.
• W1574506997 hasRelatedWork W2109011965 @default.
• W1574506997 hasRelatedWork W2138094753 @default.
• W1574506997 hasRelatedWork W2170795606 @default.
• W1574506997 hasRelatedWork W2362169642 @default.
• W1574506997 hasRelatedWork W2793262122 @default.
• W1574506997 hasRelatedWork W283690665 @default.
• W1574506997 hasRelatedWork W2942694439 @default.
• W1574506997 hasRelatedWork W3032713066 @default.
• W1574506997 hasRelatedWork W3185240436 @default.
• W1574506997 hasVolume "77" @default.
• W1574506997 isParatext "false" @default.
• W1574506997 isRetracted "false" @default.
• W1574506997 magId "1574506997" @default.
• W1574506997 workType "article" @default.