paresthesia

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paresthesia

 [par″es-the´zhah]
a morbid or abnormal sensation, such as burning, prickling, or formication.
postoperative paresthesia prolonged paresthesia after surgery done with a local anesthetic, especially around the mouth due to injury of the mental nerve or mandibular nerve.

cyclosporine ophthalmic emulsion

Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

Pharmacologic class: Polypeptide antibiotic

Therapeutic class: Immunosuppressant

Pregnancy risk category C

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

FDA Box Warning

• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.

• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.

• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.

• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.

• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).

Action

Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.

Availability

Capsules: 25 mg, 100 mg

Injection: 50 mg/ml

Oral solution: 100 mg/ml

Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)

Indications and dosages

Psoriasis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.

Severe active rheumatoid arthritis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.

To prevent organ rejection in kidney, liver, or heart transplantation

Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.

To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca

Adults: 1 drop in each eye b.i.d. given 12 hours apart

Off-label uses

• Aplastic anemia
• Atopic dermatitis

Contraindications

• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)

Precautions

Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).

Administration

• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.

Adverse reactions

CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

CV: hypertension, chest pain, myocardial infarction

EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring

GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis

GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia

Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis

Musculoskeletal: muscle and joint pain

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats

Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis

Interactions

The following interactions pertain to oral and I.V. routes only.

Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity

Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level

Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level

Digoxin: decreased digoxin clearance

Live-virus vaccines: decreased antibody response to vaccine

Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis

Potassium-sparing diuretics: increased risk of hyperkalemia

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels

Hemoglobin, platelets, white blood cells: decreased values

Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level

High-fat diet: decreased drug absorption (Neoral)

Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection

Patient monitoring

• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.

Patient teaching

• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

par·es·the·si·a

(par'es-thē'zē-ă), Avoid the jargonistic use of the plural of this abstract noun to mean 'episodes or zones of paresthesia'.
A spontaneous abnormal usually nonpainful sensation (for example, burning, pricking); may be due to lesions of both the central and peripheral nervous systems.
Synonym(s): paraesthesia
[para- + G. aisthēsis, sensation]

paresthesia

/par·es·the·sia/ (par″es-the´zhah) morbid or perverted sensation; an abnormal sensation, as burning, prickling, formication, etc.

paresthesia

also

paraesthesia

(păr′ĭs-thē′zhə)
n.
A skin sensation, such as burning, prickling, itching, or tingling, with no apparent physical cause.

par′es·thet′ic (-thĕt′ĭk) adj.

paresthesia

[per′esthē′zhə]
Etymology: Gk, para + erethizein, to excite
any subjective sensation, experienced as numbness, tingling, or a "pins and needles" feeling. Paresthesias often fluctuate according to such influences as posture, activity, rest, edema, congestion, or underlying disease. When experienced in the extremities, it is sometimes identified as acroparesthesia. Also spelled paraesthesia. See also acanthesia.

paresthesia

Neurology An abnormal tactile sensation, described as burning, pricking, tickling, tingling, or creeping, which indicates nerve irritation

par·es·the·si·a

(par'es-thē'zē-ă)
A subjective report of any abnormal sensation; could be experienced as numbness, tingling, or what is colloquially called "pins and needles."
Synonym(s): paraesthesia.
[para- + G. aisthēsis, sensation]

Paresthesia

An altered sensation often described as burning, tingling, or pin pricks.
Mentioned in: Gulf War Syndrome

par·es·the·si·a

(par'es-thē'zē-ă) Avoid the jargonistic use of the plural of this abstract noun to mean 'episodes or zones of paresthesia.'
In dentistry, a temporary or permanent condition of prolonged numbness after effects of an injected local anesthetic have ceased; maybe caused by trauma to nerve sheath during injection, hemorrhage about that sheath, or administration of contaminated anesthetic.
Synonym(s): paraesthesia.
[para- + G. aisthēsis, sensation]

paresthesia (per´esthē´zēə, -zhə),

n an altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury. The patient may report burning, prickling, formication, or other sensations.
paresthesia, oral,
n a numbness or tingling that occurs in the mucosa or tissues of the oral cavity. It may be caused by a deficiency in vitamin B12 (cobalamine), trauma from surgery, or local anesthesia. It may be temporary, but in some cases it can be prolonged or permanent.

paresthesia

morbid or perverted sensation; an abnormal sensation, as burning, prickling, formication, etc. Difficult to define in animals because of its subjectivity. Sensations which give rise to itching or rubbing in animals are probably best classified as pruritus.