KAVA

Scientific name: Piper methysticum Family: Piperaceae Trade and other common names: Ava; Awa; Intoxicating Pepper; Kavosporal; Kew;

Sakau; Tonga Category: Anxiolytic; Sedative Purported indications and other uses: Psychosis, depression, headache, migraines,

colds, rheumatism, cystitis, vaginal prolapse, otitis, abscesses, antistress, analgesic, local anesthetic, anticonvulsant

Half-life: N/A Clinically important, potentially hazardous interactions with: alcohol, alprazolam,

benzodiazepines, escitalopram, levodopa ‘Products containing herbal extracts of kava have been implicated in cases of severe

liver toxicity in Germany and Switzerland’ says the FDA letter. ‘Approximately 25 reports of [liver] toxicity associated with the use of products containing kava extracts have been reported in these countries. Serious adverse effects include hepatitis, cirrhosis and liver failure. At least one patient required a liver transplant.’ In both Switzerland and Germany, regulatory agencies have prohibited the sale of kava extract-containing products. The FDA is investigating whether the use of kava-containing dietary supplements poses a similar health hazard in the U.S., according to the letter. The agency has received several reports of serious injury allegedly associated with the use of kavacontaining dietary supplements

Note: Products containing kava have been implicated in cases of severe liver toxicity. Serious adverse effects include hepatitis, cirrhosis and liver failure. At least one patient required a liver transplant. Kava has now been banned in many countries

Reactions

Skin Adverse effects (sic)

(2003): Bent S+, Ann Intern Med 138(6), 468 (2002): Denham A+, J Altern Complement Med 8(3), 237 (2002): Ernst E, Ann Intern Med 136(1), 42 (2002): Haller CA+, Adverse Drug React Toxicol Rev 21(3), 143 (2002): Stevinson C+, Drug Saf 25(4), 251 (2000): Ernst E, Br J Dermatol 143(5), 923 Dermopathy (pellagra-like syndrome) (2003): Cairney S+, Neuropsychopharmacology 28(2), 389 (2003): Clough A, Drug Alcohol Rev 22(1), 43

(2002): Singh YN+, CNS Drugs 16(11), 731 Lymphocytic inflammation of the dermis (sic) Photosensitivity Pigmentation (yellow) Pruritus Rash (sic) Scaly rash (sic) Seborrheic dermatitis (2000): Caro I, Skin & Aging 80 Xerosis

Hair Hair-pigmentation

Nails Nails-pigmentation

Other Death

(2003): Gow PJ+, Med J Aust 178(9), 442 Dizziness (2001): Wheatley D, Phytother Res 15(6), 549 Hypersensitivity (2000): Schmidt P+, Contact Dermatitis 42(6), 363 Mouth numbness (sic) Parkinsonism (2002): Meseguer E+, Mov Disord 17(1), 195 Seizures (2003): Cairney S+, Neuropsychopharmacology 28(2), 389 Side effects (sic) (2001): Kava R, Pac Health Dialog 8(1), 115 (2000): Ernst E, Br J Dermatol 143(5), 923 (1999): Tinsley JA, Minn Med 82(5), 29 Note: Kava was discovered by Captain Cook, who named the plant ‘intoxicating

pepper.’ In the South Pacific, kava is a popular social drink, similar to alcohol in Western societies

Trade name: Ketalar (Monarch) Other common trade names: Calypsol; Ketalin; Ketanest; Ketolar; Petar Indications: Induction of anesthesia

Category: Anesthetic; Sedative-hypnotic Half-life: 2-3 hours

Reactions

Skin Erythema

Exanthems Pruritus (2001): Burstal R+, Anaesth Intensive Care 29(3), 246 (2001): Subramaniam K+, J Clin Anesth 13(5), 339 (with morphine) Rash (sic) (1-10%)

Other Injection-site erythema

Injection-site pain (1-10%) Sialorrhea (<1%) (2001): Green SM+, Pediatr Emerg Care 17(4), 244 Tremor (>10%)

Trade name: Nizoral (Janssen) (McNeil) Other common trade names:Aquarius; Fungarest; Fungoral; Ketoderm; Ketoisidin;

Nazoltec Indications: Fungal infections Category: Imidazole antifungal Half-life: initial: 2 hours; terminal: 8 hours Clinically important, potentially hazardous interactions with: alcohol, almotriptan,

alprazolam, amphotericin B, anisindione, anticoagulants, aprepitant, aripiprazole, benzodiazepines, bosentan, chlordiazepoxide, cimetidine, clorazepate, cyclosporine, dicumarol, didanosine, dofetilide, eplerenone, gastric alkanizers, HMG-CoA reductase inhibitors, imatinib, midazolam, nevirapine, non-sedating antihistamines, pimozide, proton pump inhibitors, rifampin, ritonavir, saquinavir, sildenafil, sucralfate, tacrolimus, triazolam, vinblastine, vincristine, warfarin

Reactions

Skin Allergic reactions (sic)

(1983): van Ketel WG, Contact Dermatitis 9, 313 Angioedema (1994): Gonzalez-Delgado P+, Ann Allergy 73, 326 (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1983): van Dijke CPH+, BMJ 287, 1673 Chills (1-3%) Dermatitis (1993): Lodi A+, Contact Dermatitis 29, 97 (1993): Valsecchi R+, Contact Dermatitis 29, 162 (1992): Santucci B+, Contact Dermatitis 27, 274 Dry skin (2002): Harris KA+, J Urol 168(2), 542 Eczema (generalized) (1989): Garcia-Bravo B+, Contact Dermatitis 21, 346 Exanthems (1985): Bradsher RW+, Ann Intern Med 103, 872 (2%) (1985): Study Group, Ann Intern Med 103, 861 (9.7%) (1984): Ford GP+, Br J Dermatol 111, 603 (5%) (1984): Kahana M+, Arch Dermatol 120, 837 (1983): Dismukes WE+, Ann Intern Med 98, 13 (4%) (1983): Rand R+, Arch Dermatol 119, 97 (1982): Heel RC+, Drugs 23, 1(0.7%) Exfoliative dermatitis (1984): Parent D+, Ann Dermatol Venereol (French) 111, 339 (1983): Rand R+, Arch Dermatol 119, 97 Fixed eruption (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1988): Bharija SC+, Int J Dermatol 27, 278 Jarisch-Herxheimer reaction Photosensitivity (1988): Mohamed KN, Clin Exp Dermatol 13, 54 Pigmentation (1992): Gallais V+, Ann Dermatol Venereol (French) 119, 471 (1990): Poizot-Martin I+, Int Conf AIDS 6, 357 (1985): Tucker WS+, JAMA 253, 2413 Pruritus (1.5%) (1994): Gupta AK+, J Am Acad Dermatoil 30, 677 (passim) (1988): Mohamed KN, Clin Exp Dermatol 13, 54 (passim) (1985): Study Group, Ann Intern Med 103, 861 (9.7%) (1983): Rand R+, Arch Dermatol 119, 97 (1.5%) (1982): Heel RC+, Drugs 23, 1 (1.7%) Purpura (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1982): Heel RC+, Drugs 23, 1 Rash (sic) (1-3%)

(1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) Urticaria (1-3%) (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1985): Bradsher RW+, Ann Intern Med 103, 872 (2%) Vasculitis (1982): Heel RC+, Drugs 23, 1 Xerosis (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1985): Study Group, Ann Intern Med 103, 861

Hair Hair-alopecia

(1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1990): Venturoli S+, J Clin Endocrinol Metab 71, 335 (1985): Study Group, Ann Intern Med 103, 861 (3.7%) (1982): Heel RC+, Drugs 23, 1 (0.2%) Hair-trichoptilosis (1993): Aljabre SH, Int J Dermatol 32, 150

Nails Nails-pigmentation

(1985): Dreessen K, Z Hautkr (German) 60, 679 (black longitudinal bands)

Other Anaphylactoid reactions

(1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1983): van Dijke CPH+, BMJ 287, 1673 Death (2001): Duman D+, Am J Med 111(9), 737 Depression (2002): Harris KA+, J Urol 168(2), 542 Fatigue (2002): Harris KA+, J Urol 168(2), 542 Gingival hyperplasia (1988): Veraldi S+, Int J Dermatol 27, 730 Gingivitis (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1983): Dismukes WE+, Ann Intern Med 98, 13 Gynecomastia (1-3%) (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1993): Thompson DF+, Pharmacotherapy 13, 37 (1982): Moncada B, J Am Acad Dermatol 7, 557 (1981): DeFelice R+, Antimicrob Agents Chemo 19, 1073 Headache Hypersensitivity (1994): Gonzalez-Delgado P+, Ann Allergy 73, 326

(1992): Verschueren GL+, Contact Dermatitis 26, 47 (1989): Garcia-Bravo B+, Contact Dermatitis 21, 346 Myopathy (1991): Garty BZ+, Am J Dis Child 145, 970 Oral lichenoid eruption (1993): Ficarra G+, Oral Surg Oral Med Oral Pathol 76, 460 (1986): Markitziu A+, Mykosen (German) 29, 317 Oral mucosal lesions (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) (1985): Study Group, Ann Intern Med 103, 861 (1-5%) (1983): Dismukes WE+, Ann Intern Med 98, 13 (2%) Oral pigmentation (1991): Poizot-Martin I+, Presse Med (French) 20, 632 (1989): Langford A+, Oral Surg Oral Med Oral Pathol 67, 301 (in HIV-infected

patients) Paresthesias (1994): Gupta AK+, J Am Acad Dermatol 30, 677 (passim) Tongue pigmentation (1982): Heel RC+, Drugs 23, 1

Trade names: Orudis (Wyeth); Oruvail (Wyeth) Other common trade names:Alrheumat; Alrheumun; Aneol; BiProfenid; Gabrilen

Retard; Keduril; Novo-Keto; Rhodis; Rhovail Indications: Arthritis Category: Nonsteroidal anti-inflammatory (NSAID) analgesic Half-life: 1.5-4 hours Clinically important, potentially hazardous interactions with: aspirin,

methotrexate, probenecid

Reactions

Skin Allergic reactions (sic) (<1%)

Angioedema (<1%) (1978): Frith P+, Lancet 2, 847 Bullous eruption (<1%) Dermatitis (2001): Preisz K+, Orv Hetil 142(51), 2841 (1998): Baudot S+, Therapie (French) 53, 137

(1997): Lakartidningen (Swedish) 94, 2664 (1996): Jeanmougin M+, Ann Dermatol Venereol (French) 123, 251 (1996): Pigatto P+, Am J Contact Dermat 7, 220 (1995): Gebhardt M+, Z Rheumatol (German) 54, 405 (1995): Navarro LA+, Contact Dermatitis 32, 181 (1994): Mastrolonardo M+, Contact Dermatitis 30, 110 (1994): Oh VM, BMJ 309, 512 (1993): Ophaswongse S+, Contact Dermatitis 29, 57 (1990): Mozzanica N+, Contact Dermatitis 23, 336 (1990): Tosti A+, Contact Dermatitis 23, 112 (1990): Valsecchi R+, Contact Dermatitis 21, 345 (1989): Lanzarini M+, Contact Dermatitis 21, 51 (1989): Romaguera C+, Contact Dermatitis 20, 310 (1987): Mozzanica N, Contact Dermatitis 17, 325 (1985): Camarasa JG, Contact Dermatitis 12, 121 (1983): Angelini G+, Contact Dermatitis 9, 234 (1983): Valsecchi R+, Contact Dermatitis 9, 163 Diaphoresis (<1%) (1989): Roth DE+, Med Clin North Am 73, 1275 Eczema (sic) (<1%) (1990): Tosti A+, Contact Dermatitis 23, 112 (1987): Mozzanica N, Contact Dermatitis 17, 325 Erythema multiforme (<1%) Exanthems (1975): Hingorani K+, Curr Med Res Opin 3, 407 Exfoliative dermatitis (<1%) Facial edema (<1%) Hot flashes (<1%) Pemphigus (localized) (2001): Kanitakis J+, Acta Derm Venereol 81(4), 304 Peripheral edema (1-3%) Photoallergic reaction (2002): Vigan M+, Ann Dermatol Venereol 129(10 Pt 1), 1125 (11%) Photodermatitis (2002): Valenzuela N+, Contact Dermatitis 47(4), 237 (2002): Vigan M+, Ann Dermatol Venereol 129(10), 1125 (2001): Milpied-Homsi B, Presse Med 30(12), 605 (from gel) (2001): Sugiyama M+, Am J Contact Dermat 12(3), 180 (2000): Matsushita T+, Photodermatol Photoimmunol Photomed I7(1), 26(from gel)

(5cases) (1998): Baudot S+, Therapie (French) 53, 137 (1998): Le Coz CJ+, Contact Dermatitis 38, 245 (1997): Bastien M+, Ann Dermatol Venereol (French) 124, 523 (5 cases) (1997): Leroy D+, Photodermatol Photoimmunol Photomed 13, 93 (1997): Mirande-Romero A+, Contact Dermatitis 37, 242 (connubial)

(1996): Jeanmougin M+, Ann Dermatol Venereol (French) 123, 251 (1995): Nabeya R+, Contact Dermatitis 32, 52 (1993): Ophaswongse S+, Contact Dermatitis 29, 57 (phototoxic and photoallergic) (1992): Serrano G+, J Am Acad Dermatol 27, 204 (passim) (1990): Black AK+, Br J Dermatol 123, 277 (1990): Mozzanica N+, Contact Dermatitis 23, 336 (1989): Roth DE+, Med Clin North Am 73, 1275 (1987): Cusano F+, Contact Dermatitis 17, 108 (1987): Cusano F+, Contact Dermatitis 27, 50 (1985): Alomar A, Contact Dermatitis 12, 112 Photosensitivity (<1%) (2001): Kawada A+, Contact Dermatitis 44(6), 370 Pigmentation (<1%) Pruritus (1-10%) (1975): Hingorani K+, Curr Med Res Opin 3, 407 Psoriasis (1992): Shelley WB+, Cutis 51, 23 (observation) Purpura (<1%) (1989): Roth DE+, Med Clin North Am 73, 1275 Rash (sic) (>10%) Side effects (sic) (1989): Le-Loet X, Scand J Rheumatol Suppl 83, 21 (0.7%) Stevens-Johnson syndrome (<1%) Toxic epidermal necrolysis (<1%) (1995): Tijhuis GJ+, Dematology 190, 176 Urticaria (<1%) (1978): Frith P+, Lancet 2, 847

Hair Hair-alopecia (<1%)

(1989): Roth DE+, Med Clin North Am 73, 1275

Nails Nails-onycholysis (<1%)

(1989): Roth DE+, Med Clin North Am 73, 1275

Other Acute intermittent porphyria

Anaphylactoid reactions (<1%) (1985): O’Brien WM+, J Rheumatol 12, 13 (1978): Frith P+, Lancet 2, 847 Aphthous stomatitis Dysgeusia (<1%) Gynecomastia (<1%) Headache Myalgia (<1%)

Oral mucosal lesions (1975): Hingorani K+, Curr Med Res Opin 3, 407 Oral mucosal numbness (2001): Passali D+, Clin Ther 23(9), 1508 Oral mucosal paresthesias (2001): Passali D+, Clin Ther 23(9), 1508 Paresthesias (<1%) Pseudolymphoma (2001): Werth V, Dermatology Times 18 Pseudoporphyria (1992): Breathnach SM+, Adverse Drug Reactions and the Skin Blackwell, Oxford

(passim) (1987): Taylor BJ+, N Z Med J 100, 322 Sialorrhea (<1%) Stomatitis (<1%) Tinnitus Xerostomia (<1%) (2001): Passali D+, Clin Ther 23(9), 1508

Trade names: Acular (Allergan); Toradol (Roche) Other common trade names: Dolac; Kelac; Ketonic; Nodine; Topadol; Torolac;

Torvin Indications: Pain Category: Nonsteroidal anti-inflammatory (NSAID) Half-life: 2-8 hours Clinically important, potentially hazardous interactions with: aspirin,

methotrexate, probenecid, salicylates

Reactions

Skin Allergic reactions (sic)

(2000): Reinhart DI, Drug Saf 22, 487 Angioedema (1994): Shapiro N, J Oral Maxillofac Surg 52, 626 Dermatitis (sic) (3-9%) Diaphoresis (1-10%) (1990): Buckley MMT+, Drugs 39, 86 Edema (3-9%)

Exanthems (3-9%) (1990): Buckley MMT+, Drugs 39, 86 Excoriations (1994): Shelley WB+, Cutis 53, 235 (observation) Exfoliative dermatitis (<1%) Flushing (<1%) Pruritus (3-9%) Purpura (>1%) (1994): Shelley WB+, Cutis 54, 149 (palpable) (observation) Rash (sic) (>1%) Side effects (sic) (0.7%) (1990): Buckley MMT+, Drugs 39, 86 Stevens-Johnson syndrome (<1%) Stinging (from topical) (2000): Shiuey Y+, Ophthalmology 107, 1512 Toxic epidermal necrolysis (<1%) Urticaria (1990): Buckley MMT+, Drugs 39, 86

Other Anaphylactoid reactions (<1%)

Aphthous stomatitis (<1%) (1990): Buckley MMT+, Drugs 39, 86 Dysgeusia Headache Hypersensitivity (2000): Reinhart DI, Drug Saf 22, 487 Injection-site pain (1-10%) Myalgia Paresthesias Stomatitis (>1%) Tinnitus Tongue edema (<1%) Xerostomia (1990): Buckley MMT+, Drugs 39, 86

Trade name: Zaditor (Novartis) Indications: Allergic conjunctivitis Category: Ophthalmic antihistamine H1-blocker Half-life: 22 hours

Reactions

Skin Allergic reactions (sic) (1-10%)

Burning (1-10%) (2003): Ganz M+, Adv Ther 20(2), 79 Photosensitivity Pityriasis rosea (1985): Wolf R+, Dermatologica 171, 355 Pruritus (1-10%) (2003): Sowunmi A, Ann Trop Med Parasitol 97(2), 103 Rash (sic) (1-10%) Stinging (1-10%)

Other Headache

(2003): Ganz M+, Adv Ther 20(2), 79 Xerophthalmia (1-10%)