Eperisone and afloqualone act by relaxing both skeletal and vascular smooth muscles to improve circulation and suppress pain reflex. These drugs are typically prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. However, there have been no reports on serious adverse reactions to oral muscle relaxants; and this is the first report to describe three allergic reactions caused by eperisone and afloqualone. All three patients had histories of allergic reactions after oral intake of multiple painkillers, including oral muscle relaxants and NSAIDs, for chronic muscle pain. An open-label oral challenge test was performed with each drug to confirm which drugs caused the systemic reactions. All patients experienced the same reactions within one hour after oral intake of eperisone or afloqualone. The severity of these reactions ranged from laryngeal edema to hypotension. To confirm that the systemic reaction was caused by eperisone or afloqualone, skin prick testing and intradermal skin tests were performed with eperisone or afloqualone extract in vivo, and basophil activity tests were performed after stimulation with these drugs in vitro. In one patient with laryngeal edema, the intradermal test with afloqualone extract had a positive result, and CD63 expression levels on basophils increased in a dose-dependent manner by stimulation with afloqualone. We report three allergic reactions caused by oral muscle relaxants that might be mediated by non-immunoglobulin E-mediated responses. Since oral muscle relaxants such as eperisone and afloqualone are commonly prescribed for chronic muscle pain and can induce severe allergic reactions, we should prescribe them carefully.
Female ; Humans ; Hypersensitivity/*etiology ; Middle Aged ; Muscle Relaxants, Central/*adverse effects ; Propiophenones/adverse effects ; Quinazolines/adverse effects

OBJECTIVETo establish the quality standards of the herbs of Peganum harmala.

METHODAccording to the Chinese Pharmacopoeia (2010 version, volume 1) and its appendix method, the water, total ash, acid insoluble ash, water-soluble extractives, and heavy metal were analyzed for herbs of P. harmala. TLC method was used to separate harmaline, harmine and vasicine from the herb samples by mixture of ethyl acetate-methanol-ammonia (10: 1.5: 0.5) as a developing solvent on high performance silica gel precoated plate (HSGF254) and to identify them inspected under UV 366 nm, visualized by spraying with both Dragendorff reagent, and by bioautographic assay. In the HPLC method, vasicine was separated on a C18 (4.6 mm x 250 mm, 5 microm) column with metnanol-0.1% trifluoroacetic acid (15:85) as the mobile phase and detected at at 280 nm.

RESULTIn the TLC procedures, 254 nm fluorescent and bioautographic assay for the detection of acetylcholinesterase inhibitor can be used for the qualitative identification of the active ingredients. For the HPLC quantitation method, the calibration curve of vasicine displayed ideal linearity over the range of 0.7923-792.3 mg x L(-1) with the regression equation of Y = 18,227X - 24.879 (r = 0.9999). The average recovery of vasicine was 101.6% with a RSD of 1.9%. The RSD values of intra-day and inter-day precision were less than 2%. The content of vasicine in 10 batches of herbs of P. harmala fluctuates between 0.23% and 1.47%.

CONCLUSIONThe results indicated that the limit of vasicine was not lower than 0.6%, and the water, total ash, acid insoluble ash, and water-soluble extractives were not more than 10.0%, 20.0%, 1.7%, and 30.0%, respectively. The heavy metal of plumbum, cadmium, arsenic, mercury, and copper were not more than 5, 3, 2, 2, and 20 mg x kg(-1), respectively. The qualitative and quantitative method established was suitable for the quality evaluation and assessment of herbs of P. harmala.

Alkaloids ; chemistry ; Drugs, Chinese Herbal ; adverse effects ; chemistry ; standards ; Humans ; Metals, Heavy ; chemistry ; Peganum ; chemistry ; Quality Control ; Quinazolines ; chemistry

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.
Acute Disease ; Adrenergic alpha-Antagonists/*adverse effects ; Dysuria/pathology ; Humans ; Liver Diseases/*chemically induced/pathology ; Liver Function Tests ; Male ; Middle Aged ; Prostatic Hyperplasia/drug therapy ; Quinazolines/*adverse effects

Aged ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Disseminated Intravascular Coagulation ; chemically induced ; Female ; Humans ; Quinazolines ; adverse effects ; therapeutic use

The present case is a patient with advanced non-small cell lung cancer (NSCLC) who developed leukoencephalopathy following radiotherapy and gefitinib treatments. There are rarely reports of such incidences because the median survival period of advanced NSCLC is only ten months. The features of leukoencephalopathy in this case were atypical for radiation leukoencephalopathy, so it was suspected that the leukoencephalopathy was associated with gefitinib.
Carcinoma, Non-Small-Cell Lung ; drug therapy ; Female ; Humans ; Leukoencephalopathies ; chemically induced ; diagnosis ; Lung Neoplasms ; drug therapy ; Middle Aged ; Quinazolines ; adverse effects ; therapeutic use

Adenocarcinoma ; drug therapy ; Antibodies, Monoclonal ; adverse effects ; Drug Resistance, Neoplasm ; Female ; Fever ; chemically induced ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; drug therapy ; Middle Aged ; Quinazolines ; therapeutic use

Gefitinib is regarded as a relatively safe agent for the treatment of an advanced non-small cell lung cancer (NSCLC). Pulmonary toxicity such as interstitial lung disease associated with gefitinib is uncommon with an estimated all time incidence around 1% worldwide. Moreover, a case of gefitinib associated with pulmonary cystic changes has not been reported yet. In this report we present a case of progressive multiple air cystic changes in both lungs in a patient with NSCLC and intrapulmonary metastases who underwent a gefitinib therapy.
Antineoplastic Agents/*adverse effects ; Brain Neoplasms/secondary ; Carcinoma, Non-Small-Cell Lung/*drug therapy/secondary ; Cysts/*chemically induced ; Female ; Humans ; Lung/pathology ; Lung Diseases/*chemically induced ; Lung Diseases, Interstitial ; Lung Neoplasms/*drug therapy ; Middle Aged ; Quinazolines/*adverse effects

OBJECTIVETo investigate the protective effects of rutaecarpine (Rut) on right ventricular remodeling in rats with monocrotaline-induced pulmonary hypertension (PH).

METHODForty-eight SD rats were fed adaptively for 1 week and then were randomly divided into the following 4 groups (n = 12): normal control group, monocrotaline (MCT) treatment group, MCT treatment with Rut (20 mg/kg)group and MCT treatment with Rut (40 mg/kg) group. PH rats were induced by a single injection of monocrotaline (60 mg/kg, sc) and were administered with Rut (20 or 40 mg/kg/d) for 4 weeks. At the end of experiment, the right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP) were monitored via the right jugular vein catheterization into the right ventricle. The ratio of right ventricle (RV) to left ventricle (LV) + septum (S) and the ratio of RV to tibial length were calculated. Right ventricular morphological changes were deserved by HE staining. Masson's trichrome staining was used to display collagen deposition. The total antioxidative capacity (T-AOC) and malondialdehyde (MDA) levels in right ventricle were determined according to the manufacturer's instructions. mRNA and protein expression levels of NOX4, collagen I and collagen III were analyzed by immunohistochemisty, real-time PCR and Western blot.

RESULTSThe results showed that Rut treatment for 4 weeks attenuated RVSP, mPAP and right ventricular remodeling index (RV/LV + S and RV/Tibial length) of PH rats induced by monocrotaline. Furthermore, the right ventricular collagen deposition and collagen I and collagen I expression induced by MCT were both significantly suppressed by Rut. The expression levels of NOX4 and MDA were obviously decreased, while the T-AOC was significantly increased in right ventricular from PH rats treated with Rut.

CONCLUSIONThese results suggested that Rut ameliorates the right ventricular remodeling in rats with PH induced by MCT through down-regulating of NOX4 expression and collagen accumulation.

Animals ; Antioxidants ; metabolism ; Heart Ventricles ; metabolism ; Hypertension, Pulmonary ; chemically induced ; drug therapy ; Indole Alkaloids ; pharmacology ; Male ; Malondialdehyde ; metabolism ; Monocrotaline ; adverse effects ; NADPH Oxidase 4 ; NADPH Oxidases ; metabolism ; Quinazolines ; pharmacology ; Rats ; Ventricular Remodeling ; drug effects

OBJECTIVETo evaluate the effect of epidermal growth factor receptor tyrosine kinase inhibitor, gefitinib, on the expression of α-smooth muscle actin (α-SMA) in mice with lung fibrosis induced by bleomycin.

METHODSThirty male BALB/c mice were randomly divided into control, bleomycin, and bleomycin plus gefitinib groups. The mice in the control group were subjected to intratracheal administration of normal saline, those in bleomycin group received bleomycin (3 mg/kg) intratracheally, and those in bleomycin plus gefitinib group received oral gefitinib (20 mg/kg administering) plus intratracheal bleomycin administration. All the mice were sacrificed 14 days after the treatments, and the left lung was examined pathologically with HE staining and Masson staining and also immunohistochemically for assay of the total EGFR, phosphorylated EGFR and α-SMA. The right lungs were sampled for RT-PCR to detect the mRNA levels of α-SMA.

RESULTSGefitinib administration lessened lung fibrosis induced by bleomycin and significantly reduced lung collagen accumulation. The phosphorylation of EGFR in the pulmonary mesenchymal cells and epithelial cells and the expression levels of α-SMA mRNA and protein were inhibited by gefitinib treatment in mice with intratracheal administration of bleomycin (P<0.05).

CONCLUSIONGefitinib offers protection against lung fibrosis induced by bleomycin in mice probably by inhibiting the downstream signals of EGFR and by downregulating the expression of α-SMA.

Actins ; metabolism ; Animals ; Bleomycin ; adverse effects ; Lung ; drug effects ; metabolism ; pathology ; Male ; Mice ; Mice, Inbred BALB C ; Pulmonary Fibrosis ; chemically induced ; metabolism ; pathology ; Quinazolines ; pharmacology ; RNA, Messenger ; genetics ; Receptor, Epidermal Growth Factor ; metabolism

Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum-based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enterocutaneous fistula in a female patient with metastatic non-small cell lung cancer 9 months, following medication with erlotinib as second-line chemotherapy.
Aged ; Antineoplastic Agents/*adverse effects/therapeutic use ; Carcinoma, Non-Small-Cell Lung/complications/*drug therapy ; Female ; Humans ; Intestinal Fistula/*chemically induced/complications/radiography/surgery ; Intestinal Perforation/*chemically induced/complications/radiography/surgery ; Protein Kinase Inhibitors/*adverse effects/therapeutic use ; Quinazolines/*adverse effects/therapeutic use ; Sigmoid Diseases/*chemically induced/complications/radiography/surgery