Drug treatment in the polymorbid elderly should focus on the more important symptoms. Pharmacokinetic differences should be considered, e.g. a reduced volume of distribution and decreased liver and renal function. Special alterations in the pharmacodynamics with respect to the central nervous system and other organs are important. Drug therapy in the elderly has to be done very cautiously. The indication, dosage and duration of therapy has to be evaluated again and again. Antirheumatics in the elderly should improve the quality of life avoiding untowanted side effects, especially of the gastrointestinal tract, the renal function and bone marrow. Non-narcotic analgesics and opioids may be helpful, when antirheumatics were not tolerated.

Aged↗

PubMedDate not supplied

Isolated extremity perfusion with DTIC. An experimental and clinical study.

Dacarbazine (DTIC) was used for isolated perfusion of extremities in dogs and man. In the animal experiment perfusions with DTIC at dosages up to 100 mg per kg of extremity weight were well tolerated. The concentration of DTIC in the perfusate ranged from 70 to 400 micrograms/ml without evidence for formation of metabolites. Electron microscopy, performed 14 days later, revealed a decrease of glycogen in striated muscle cells. Vascular damage was not observed. Five patients with advanced malignant melanoma or soft tissue sarcoma of the extremities were treated by isolation perfusion with 75 to 133 mg DTIC per kg of extremity at 40 degrees C for 60 minutes. A tumor regression of at least 30% was observed.

Animals↗

PubMedDate not supplied

[Drug-induced liver damage caused by antirheumatic drugs--antirheumatic therapy in pre-existing liver damage].

In about 1% of patients treated longterm with nonsteroidal antiinflammatory drugs severe liver damage occurs with an increase of transaminases of more than eightfold. Therefore, measurement of the liver enzymes every 4 to 8 weeks is mandatory. When the transaminase values are greater than 60 U/l, the therapy must be discontinued. Methotrexate may also induce an increase of the transaminases, especially within the first 3 months of therapy. Severe hepatotoxicity, however, rarely occurs. Therefore, transient increases up to 60 U/l may be tolerable, but persistent transaminases higher than 60 U/l require termination of methotrexate therapy.

Anti-Inflammatory Agents, Non-Steroidal↗