Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 Does anyone know where I can find " The List" of medications/anesthetics that are NOT to be used in people with mitochondrial diseases? Krystena R. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 Krystena, Dr. Bruce Cohen's article on anaesthesia is on the library page at the umdf foundation (clink on top tool bar for the library resources and the link to the article is located about half way down in the right of the library page. Best Wishes, Anita > Does anyone know where I can find " The List " of medications/anesthetics that are NOT to be used in people with mitochondrial diseases? > > > Krystena R. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 I had saved this post from Jean S. awhile back! Holly Hi .. Don't believe there is a formal list of drugs posted anywhere ... other than those which people (Mito folks) have gathered together. The following is taken from a file posted on my AdultMito list and could serve as a start.If people would post drugs that they personally have found problematic ... especially if they have been told by a Mito doc to avoid it ..... or they have found warnings about use with metabolic diseases ..... we could add to the list.I doubt there is a Mito doctor yet who would be prepared to stick his neck out and make a list BECAUSE our Mito conditions are so varied and our responses are equally as varied!!!!! I can't say I can blame them.The same holds true for our Mito cocktail .... although Drs Cohen and Gold have a table of tiers of cocktail and their doseages according to body weight in Kg! I feel they have stuck their necks out to help us since NONE of the cocktail has been proven in any drug trial. You can find this list in a table towards the end of their article "Mitochondrial Cytopathy in Adults: What we KNow so Far". You can download this and print it out if you have Adobe Acrobat Reader on your computer (available as a free download on the same page) if you go to the <umdf.org/> site and then to "Library".So ... here's a start!!!! Some of it was gleaned from the Anaesthesia article on the library page of UMDF site. I take no responsibility for your use of this list because I am NOT a doctor!!!! MEDICATIONS CONTRAINDICATED IN MITOCHONDRIAL DIESASEOn page 269 of the Syllabus for the International Conference on Mito Disease, 1997 you will find the following recommendations:"Treatment remains largely symptomatic and does not significantly alter the course of the disease. It includes avoidance of drugs and procedures known to have a detrimental effect, symptomatic treatments, supplementation with co-factors, prevention of oxygen radical damage to mitochondrial membranes and dietary recommendations.""It is advisable to avoid Sodium Valproate and barbiturates, which inhibit the respiratory chain and have occasionally been shown to precipitate hepatic failure in respiratory enzyme deficient children.Tetracyclines and chloramphenical should be avoided as well, as they inhibit protein synthesis."As well certain types of anesthesia are also contraindicated. There is a wonderful and comprehensive article dealing with the safety of anesthesia in mitochondrial cytopathy patients in the October 98 issueof the United Mitochondrial Disease Federation newsletter, as well as at the UMDF site.It is not always possible to avoid these drugs but at least if you are informed ahead of time and the possibility of an alternative exists, you can make an informed decision. There is no doubt that some folks withmitochondrial cytopathy have used these drugs uneventfully, although the potential is still there. Be an informed consumer! Cohen and Shoffner lists about anaesthetic agents.Barbiturates - Inhibits complex I activity at high levelsBenzodiazepines - Inhibits adenosine nucleotide translocasePropofol and/or lipid carrier - Inhibits mitochondrial functionHalothane - Increased risk for heart rhythm disturbanceNitrous Oxide - Neurotoxic, possibly by increasing nitric oxide production, which inhibits cisacotinase and iron-containing electron transport enzymes: affecting energy productionNon-depolarizing Agents - Increased sensitivity to the paralytic effects and prolonged responses reportedLocal Anaesthetic - Bupivacaine uncouples oxidation and phosphorylationShould never use Lactated Ringer's solution (Ringer's Lactate) because it contains lactic acid.Depolarizing agents (Succinylcholine) bothers some people.****************************Valpro or Epilim (Sodium Valporate) is an anti-convulsant. It is known to be a potential toxin to those with either mitochondrial disorders or metabolic disease. It can cause severe hepatoxicity or liver failure in susceptible persons.Phenobarbital is another potential mitochondrial toxin that can also be dangerous to those with mitochondrial cytopathy. It is wise to always ask your pharmacist for the generic name of any drug being prescribed for someone with mitochondrial cytopathy.Hormonal Birth ControlAminoglycosides are ototoxic for *some forms of Mitochondrial Cytopathies - a specific genetic variation ( Mitochondrial 12S and 16S ribosomal RNA - mutation of A to G in the 12S rRNA at position 1555)*{Hutchins, Cortopassi 1994}. Aminoglycosides are *some* of the antibiotics which end in "_______mycin". Ototoxic means that these drugs can cause hearing loss or deafness. ASK YOUR PHARMACIST ANDPRESCRIBING DOCTOR. Ergotamines due to the impact on hepatic function.Neuroleptic drugs such as Haloperidol, Chlorpromazine, and Thiothixene. Lipitor should not be used by someone with Mitochondrial disease as it depletes CoQ10 from the cells.Steroids can be used but should be used only when absolutely necessary and this should be a very low dosage and not for an extended period of time. Friendly alternatives (?)Lamictal seems to be being used successfully. Topomax also appears to be mitochondrial-friendly for intractable seizures.-----------------AND this one which contains much of the same information .... Valproate or Depakote (Valproic Acid) is an anti-convulsant. It is known to be a potential toxin to those with either mitochondrial disorders or metabolic disease. It can cause severe hepatoxicity or liver failure in susceptible persons. Phenobarbital is another potential mitochondrial toxin that can also be dangerous to those with mitochondrial cytopathy. It is found in other drugs such as Donnatol, Bellatol and can be prescribed under other brand names. It is wise to always ask your pharmacist for the generic name of any drug being prescribed for someone with mitochondrial cytopathy.Hormonal Birth ControlAminoglycosides are ototoxic for *some forms of Mitochondrial Cytopathies - a specific genetic variation ( Mitochondrial 12S and 16S ribosomal RNA - mutation of A to G in the 12S rRNA at position 1555)* {Hutchins, Cortopassi 1994}. Aminoglycosides are *some* of the antibiotics which end in "_______mycin". Ototoxic means that these drugs can cause hearing loss or deafness. ASK YOUR PHARMACIST AND PRESCRIBING DOCTOR.Neuroleptic drugs such as Haloperidol, Chlorpromazine, and Thiothixene.There are a few other drugs that were mentioned in the syllabus from the Mitochondrial Convention in Philadelphia. On page 269 of the Syllabus for the International Conference on Mito Disease, 1997 you will find the following recommendations:"Treatment remains largely symptomatic and does not significantly alter the course of the disease. It includes avoidance of drugs and procedures known to have a detrimental effect, symptomatic treatments, supplementation with co-factors, prevention of oxygen radical damage to mitochondrial membranes and dietary recommendations.""It is advisable to avoid Sodium Valproate and barbiturates which inhibit the respiratory chain and have occasionally been shown to precipitate hepatic failure in respiratory enzyme deficient children. Tetracyclines and chloramphenical should be avoided as well, as they inhibit protein synthesis."As well certain types of anesthesia are also contraindicated. There is a wonderful and comprehensive article dealing with the safety of anesthesia in mitochondrial cytopathy patients in the October 98 issue of the United Mitochondrial Disease Federation newsletter, as well as at the UMDF site.It is not always possible to avoid these drugs but at least if you are informed ahead of time and the possibility of an alternative exists, you can make an informed decision. There is no doubt that some folks with mitochondrial cytopathy have used these drugs uneventfully, although the potential is still there. Be an informed consumer!Friendly alternatives (?)Lamictal seems to be being used successfully. Topomax also appears to be mitochondrial-friendly for intractable seizures.Cohen and Shoffner lists about anaesthetic agents.Barbitrates - Inhibits complex I activity at high levelsBenzodiazepines - Inhibits adenosine nucleotide translocasePropofol and/or lipid carrier - Inhibits mitochondrial functionHalothane - Increased risk for heart rhythm disturbanceNitrous Oxide - Neurotoxic, possibly by increasing nitric oxide production, which inhibits cisacotinase and iron-containing electron transport enzymes: affecting energy productionNon-depolarizing Agents - Increased sensitivity to the paralytic effects and prolonged responses reportedLocal Anesthetics - Bupivacaine uncouples oxidation and phosphorylationShould never use Lactated Ringer's solution (Ringer's Lactate) because it contains lactic acid.Depolarizing agents (Succinylcholine) bothers some people.---------Personally, I can add the Diabetes drug Metformin to this list. There is a warning about the possibility "in rare cases" of lactic acidosis ..... and it has happened to me and to some other adults with Mito.There are adults who claim that if there is the possibility of a side effect "in rare cases" listed on a drug profile ..... chances are Mito is the rare case!Better to be extra cautious with all medications!Jean Shepherd Meds NOT to use "List" Does anyone know where I can find " The List" of medications/anesthetics that are NOT to be used in people with mitochondrial diseases? Krystena R.Please contact mito-owner with any problems or questions. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 Thanks for the lists! Caden is having his ear tubes replaced tomorrow. He's lost some hearing. We are uncertain if it's due to fluid, scaring or just hearing loss. We are hoping the tubes will help. I KNOW he can't take Versed for certain. He gets very mean/violent and out of his head. What med. do they usually use for this? Caden was only 1.5 when he had them in the first time. He'll be 6 next month.. We see pre op tomorrow. Should he still have an IV placed even though it's a really fast procedure? I hate having him under! So scary. Krystena s FOD Mom to: Caden will be 6 July 13th!-GA2 & MCAD Carsen will be 1 YR June 9th!-GA2 & MCAD Warren-9yrs unaffected 12 yrs -step daughter- diabetic Meds NOT to use "List" Does anyone know where I can find " The List" of medications/anesthetics that are NOT to be used in people with mitochondrial diseases? Krystena R.Please contact mito-owner with any problems or questions. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 Thanks for reposting this! Just wanted to make one comment. > Propofol and/or lipid carrier - Inhibits mitochondrial function Dr. Cohen's article about anesthesia says to avoid " prolonged " use of propofol. The meaning of prolonged caused a lot of debate when Emilie had surgery recently. The anesthesiologist ended up using propofol for Emilie's five-hour surgery, and when I check with her mito doc later, he agreed that was ok. Obviously, you'd want to clarify this with your own mito doc, but I wanted to relate our experience. -- Mom to: Emilie (17), mito--complex IV, cp, ld Kaitlin (17), cp, asthma, a few autonomic symptoms Ian (22) migraines ....and wife to Tim, who has a heart of gold Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2004 Report Share Posted June 7, 2004 when they did Caedens 2nd set of tubes they didn't do an IV not worth it for the amount of time they are in there. When he came out and needed pain meds they gave it to him through the nose they squirted fentenol(sp) hope this helps and good luck jennifer Quote Link to comment Share on other sites More sharing options...
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