Crushed Tablets Research Articles

Self-administered intraurethral chlorpromazine: An unusual cause of priapism

Priapism is a prolonged, painful penile erection unaccompanied by sexual desire and not alleviated by ejaculation. The etiologies of priapism are numerous and diverse. Priapism can be a serious adverse effect of psychotropic medications. The case of a 36-year-old man who demonstrated priapism, 48 hours after inserting a crushed chlorpromazine tablet into the urethral meatus of his penis, is reported. Priapism induced by this route of drug administration has not been previously described. The pathophysiology and treatment of priapism are reviewed.

Talc lung in a drug abuser

We report a case of intravenous talcosis in a 36 year old woman. Although she initially denied drug abuse clinical suspicion was aroused by the finding of obliterated peripheral veins, a pleural rub and a peripheral nodular lesion on chest x-ray. Diagnosis of intravenous talcosis was confirmed by finding birefringent particles on transbronchial biopsy. Confronted with this evidence the patient admitted long-standing drug abuse, including intravenous injection of crushed methadone tablets which contain talc filler.

Applesauce and Isoniazid

In Reply.— Abernathy indicates that she has achieved favorable results with chemotherapy of tuberculosis using a crushed isoniazid tablet admixed with a teaspoon of applesauce, jelly, or jam (flavor not specified). Citing historical controls, she also implies that the generally favorable response to antituberculous therapy in children supports the use of isoniazid preparations that have not undergone rigorous pharmaceutical scrutiny, including tests of gastrointestinal absorption. In our study,1 the isoniazid was mixed with a tablespoon of applesauce rather than a teaspoon as used by Abernathy.

Effect of Dose Formulation on Isoniazid Absorption in Two Young Children

In an 8-month-old infant with tuberculous meningitis treatment with isoniazid was unsuccessful and was associated with lower than expected plasma concentrations of isoniazid (measured concentration 0.1 microgram/mL). The infant had received isoniazid as a crushed tablet admixed with apple sauce. Oral administration of the parenteral solution of isoniazid (Nydrazid, Squibb) mixed in apple juice produced a higher isoniazid concentration (2.9 micrograms/mL) and the child improved clinically. Pharmacokinetic studies in two subjects were performed following intramuscular injection of isoniazid and oral administration of (1) an isoniazid tablet crushed and mixed with apple sauce, (2) parenteral isoniazid solution mixed with apple juice, and (3) a commercially available syrup containing isoniazid and pyridoxine (P-I-N Forte, Lannett). Of the three oral preparations, the syrup produced the highest peak concentrations (8.3 and 6.9 micrograms/mL). The crushed tablets in apple sauce produced the lowest peak concentrations (1.4 and 2.4 micrograms/mL). Administration of crushed isoniazid tablets with food may be associated with impaired gastrointestinal absorption, lower than expected isoniazid concentrations, and treatment failure.

Gangrene of the Upper Extremity Following Intra-arterial Injection of Drugs

A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited.

DOSE FORMULATION AFFECTS ORAL BIOAVAILABILITY OF ISONIAZID (INH)

Children too young to ingest an intact tablet of INH are frequently given untested formulations of the drug, since the commercial liquid syrup (P-I-N Forte, Lannett: INH 50 mg & pyridoxine HCL 2.5 mg in 5 ml) (SYR) is neither widely available nor frequently mentioned in pediatric literature. INH has been orally administered after mixing crushed tablets with foodstuffs, or placing the parenteral dosage form (a clear solution) in a vehicle of fruit juice. The oral bioavailability of these formulations has not been previously studied. We examined 4 children (5-20 months) with tuberculosis. Each received 10 mg/kg test doses of different INH preparations on successive days:1)IM injection(IM,N=4); 2)Oral syrup(SYR, N=3); 3)Crushed tablet mixed with applesauce(TAB,N=4); 4)parenteral solution in applejuice(SOL,N=3). The serum concentration of INH was determined at several intervals after the test doses. For each formulation, the range and means (x) of peak concentrations (ug/ml) were: 1)IM 5.8-11.4 x=7.7; 2)SYR 5.6-8.3, x=6.9; 3)TAB 0.9-3.7, x=2.1; 4)SOL 2.5-3.3, x=3.0. After TAB, peak concentration occurred later (about 2 hours) than after SYR (1 hour or less). The mean area under time-concentration curve (AUC) was lower after TAB (12 ug/ml· hrs)than after IM (21 ug/ml· hrs), indicating limited absorption of this preparation.

Pharmacology of ketoconazole suspension in infants and children

The pharmacokinetics of ketoconazole administered as either a commercially prepared suspension or as a crushed tablet in applesauce were studied in 12 children. The mean peak plasma concentration of ketoconazole and the area under the plasma time-concentration curve were approximately twofold greater with the suspension than with the crushed tablets.

Transient Pulmonary Hypertension from the Intravenous Injection of Crushed, Suspended Pentazocine Tablets

We describe a patient with biopsy-proven pulmonary talc granulomas (secondary to the long-term intravenous injection of crushed tablets of pentazocine) who had two episodes of transient pulmonary hypertension following the injection of this oral medication. We established a canine model and measured the right lymph duct flow, mean pulmonary arterial pressures, and pulmonary vascular resistance to determine the short-term effects on hemodynamics and the flow of lymph after intravenous administration of crushed pentazocine tablets (3 to 4 mg/kg of body weight) or pure talc (2.5 to 3 mg/kg). A typical response to both agents consisted of short-term elevations of mean pulmonary arterial pressure and pulmonary vascular resistance to approximately twice baseline values, with a slow decrement over 30 to 45 minutes. The average flow of lymph tripled, peaking at approximately two hours after injection. The lymph contained high levels of albumin. We concluded that the talc filler in oral tablets of pentazocine induces the pulmonary hypertension, probably by mechanical obstruction of the pulmonary vasculature. Association with this transient pulmonary hypertension is an increase in the permeability of the pulmonary microvasculature.

INADVERTENT INTRAARTERIAL INJECTION: A PROBLEM OF DRUG ABUSE

Peripheral ischaemia related to the inadvertent intra-arterial injection of crushed tablets in suspension, was seen in five drug addicts. Characteristic clinical, features were observed including pain, discolouration, oedema, immediate and delayed sensory and motor deficits, and pregangrenous and gangrenous changes distal to the site of injection. Definitive treatment remains to be established, but an approach to management, based upon probable pathophysiological mechanisms, is proposed.

Pentazocine reclassified in Illinois

In the brief space of three months, a mild-to-potent analgesic has been made a schedule 2 (high potential for abuse) drug and given designated product status in the State of Illinois. Why the turnabout? Certainly the fault does not lie with Winthrop Laboratories, maker of pentazocine (Talwin) hydrochloride. Instead, the whole affair shows what can happen when a perfectly legitimate drug falls under the purview of clever addicts. No one knows who thought of it first but, particularly in Chicago, crushed pentazocine tablets are being mixed with crushed tablets of tripelennamine (Pyribenzamine), an antihistamine. The mixture is dissolved in water and the solution injected intravenously. The combination, known on the street as Ts and Blues, gives a cheap, heroin-like rush. It is so popular that, according to Peter Bensinger, administrator for the US Drug Enforcement Administration, US Department of Justice, 3 to 6 million doses of pentazocine have been

Demonstrating Effectiveness of Antibiotics against Known Bacteria Strains

Demonstrating Effectiveness of Antibiotics against Known Bacteria Strains

FORMULA FOR A STABLE FRUSEMIDE MIXTURE

Summary Frequently in pharmacy practice an oral liquid preparation of frusemide is prescribed. Since no commercial preparation is available various formulations are used based upon crushed frusemide tablets, which have no stability data available. An investigation was therefore conducted to develop a stable palatable oral liquid formulation of frusemide of known shelf life.

Pulmonary Function Studies in Ex-Heroin Users

Pulmonary function tests were performed on a group of 22-ex-heroin addicts with no known pulmonary disease or symptoms. Vital capacity and total lung capacity were normal in all but four patients. Only two patients had evidence of moderately severe airway obstruction. However, the single breath diffusing capacity (Dco) was significantly reduced in many of the patients and averaged 81 percent of predicted for the entire group. Patients with most severe reduction of Dco also had reduction of lung volumes. In addition, six patients had increased lung recoil force (Pmax) and decreased lung compliance. There was no correlation between degree of functional impairment and duration or amount of durg use, incidence of overdose or intravenous injection of crushed tablets. Followup studies in four patients after several months on methadone maintenance showed improvement in lung volumes and/or Dco. Possible etiologic considerations to explain these abnormalities were previous subclinical pneumonias, foreign body granulomas, previous pulmonary edema or other direct toxic effect on alveolocapillary membrane as the result of use of drugs.

Microangiopathic hemolytic anemia. Another complication of drug abuse

THE intravenous abuse of drugs intended for oral use can lead to a diverse spectrum of medical complications.¹Some of these complications are caused not by the drug itself, but rather by the concomitant injection of tablet filler, nonsterile diluents, or materials acquired while filtering tablet contents. A patient with a long history of intravenous use of crushed barbiturate tablets was first seen with pulmonary hypertension. He subsequently developed a microangiopathic hemolytic anemia (MAHA). <h3>Report of a Case</h3> A 32-year-old white man was admitted to Harbor General Hospital (Torrance, Calif) in March 1972 with hematemesis, shortness of breath, and confusion of several days' duration. He admitted to the abuse of many drugs taken orally, as well as the intravenous use of heroin, amphetamines, and crushed barbiturate tablets that he strained through cotton or cigarette filters. The results of physical examination were normal except for an increased pulmonic component of

Microangiopathic Hemolytic Anemia

THE intravenous abuse of drugs intended for oral use can lead to a diverse spectrum of medical complications.¹Some of these complications are caused not by the drug itself, but rather by the concomitant injection of tablet filler, nonsterile diluents, or materials acquired while filtering tablet contents. A patient with a long history of intravenous use of crushed barbiturate tablets was first seen with pulmonary hypertension. He subsequently developed a microangiopathic hemolytic anemia (MAHA). <h3>Report of a Case</h3> A 32-year-old white man was admitted to Harbor General Hospital (Torrance, Calif) in March 1972 with hematemesis, shortness of breath, and confusion of several days' duration. He admitted to the abuse of many drugs taken orally, as well as the intravenous use of heroin, amphetamines, and crushed barbiturate tablets that he strained through cotton or cigarette filters. The results of physical examination were normal except for an increased pulmonic component of

Pentazocine Addiction causing Bacterial Endocarditis and Pulmonary Embolism

An emotionally unstable medical technician, without prior history of drug dependence who developed pentazocine addiction, is described. Chronic, unsupervised, intravenous use of crushed tablets of pentazocine caused bacterial endocarditis, pulmonary embolism, and pulmonary edema-like picture. Our patient illustrates that even in the absence of past history of drug dependence, the use of pentazocine should, at best, be avoided in emotionally unstable patients, and patients with easy access to the drug.

Lipoid Pneumonia Caused By Methenamine Mandelate Suspension

Two senile individuals with dysphagia developed lipoid pneumonia subsequent to the administration of methenamine mandelate (Mandelamine) suspension, 250 mg methenamine mandelate/teaspoon. Methenamine suspension forte (double strength) contains oil of sesame (USP) and hydrogenated castor oil. Methenamine mandelate suspension contains these two ingredients plus champagne cider oil. Methenamine mandelate should be given to dysphagic patients in the form of crushed tablets mixed with semisolid food.

Talc and Cornstarch Emboli in Eyes of Drug Abusers

A characteristic type of retinopathy due to talc and cornstarch emboli was observed in 17 drug addicts following repeated intravenous injections of crushed methylphenidate hydrochloride tablets taken for their stimulatory effects. Ophthalmoscopic examinations revealed tiny glistening crystals largely concentrated in the small vessels about the macula. Two patients with pulmonary hypertension had reduced vision, presumably from retinal edema. Histologic examination confirmed the presence of talc and cornstarch particles in the retina and choroid as well as in the lung and brain. The presence of these particles in the eye is an indication that considerable foreign-body damage has occurred in the lung.

Talc and cornstarch emboli in eyes of drug abusers

A characteristic type of retinopathy due to talc and cornstarch emboli was observed in 17 drug addicts following repeated intravenous injections of crushed methylphenidate hydrochloride tablets taken for their stimulatory effects. Ophthalmoscopic examinations revealed tiny glistening crystals largely concentrated in the small vessels about the macula. Two patients with pulmonary hypertension had reduced vision, presumably from retinal edema. Histologic examination confirmed the presence of talc and cornstarch particles in the retina and choroid as well as in the lung and brain. The presence of these particles in the eye is an indication that considerable foreign-body damage has occurred in the lung.

Comparison of human serum, parotid and mixed saliva levels of phenoxymethylpenicillin, ampicillin, cloxacillin and cephalexin.

1. A study has been made of serum, mixed and parotid salivary levels attained in normal volunteers following oral dosage of 500 mg phenoxymethylpenicillin tablets, 500 mg crushed phenoxymethylpenicillin tablets in capsules, 500 mg ampicillin, 500 mg cloxacillin and 500 mg cephalexin.2. High mixed saliva levels were obtained with phenoxymethylpenicillin tablets and it is considered that these were due to rapid intra-oral dissolution of surface powder from friable tablets. No saliva levels were detected when tablets from the same batch were put into capsules.3. Low or no saliva levels were achieved with ampicillin, cloxacillin and cephalexin.4. The mode of action of antibiotics in oral infections is discussed.