digoxin and Lupus-Erythematosus--Systemic

The isoprenoid pathway produces three key metabolites--digoxin (membrane Na(+)-K+ ATPase inhibitor, regulator of neurotransmitter transport, and immunomodulatory agent), dolichol (regulatory of N-glycosylation of proteins), and ubiquinone (free-radical scavenger). The pathway was assessed in systemic lupus erythematosis with neuropsychiatric manifestations, slow viral diseases (subacute sclerosing panencephalitis [SSPE], and Creutzfeldt-Jakob disease [CJD]) and patients with recurrent respiratory infections. This was also studied for comparison in patients with right hemispheric and left hemispheric dominance. The isoprenoid pathway was upregulated with increased digoxin synthesis in patients with neurolupus, SSPE, and CJD, and in those with right hemispheric dominance. The tryptophan catabolites were increased and the tyrosine catabolites reduced. In these patients the dolichol and glycoconjugate levels were elevated and lysosomal stability was reduced. The ubiquinone levels were low and free-radical levels increased in these patients. The membrane cholesterol:phospholipid ratios were increased and membrane glycoconjugates reduced. On the other hand, in patients with recurrent respiratory infection and left hemispheric dominance, the reverse patterns and hypodigoxinemia with a downregulated isoprenoid pathway were noticed. The isoprenoid pathway is important in the pathogenesis of neurolupus, CJD, SSPE, and recurrent respiratory infections. Hypothalamic digoxin and chemical hemispheric dominance play an important role in the regulation of immunity.

Topics: Creutzfeldt-Jakob Syndrome; Digoxin; Dolichols; Erythrocyte Membrane; Functional Laterality; Glycosaminoglycans; Humans; Hydroxymethylglutaryl CoA Reductases; Hypothalamus; Lupus Erythematosus, Systemic; Mental Disorders; Neuroimmunomodulation; Recurrence; Respiratory Tract Diseases; Sodium-Potassium-Exchanging ATPase; Subacute Sclerosing Panencephalitis; Tryptophan; Tyrosine; Ubiquinone

The clinical pharmacology of ibuprofen (Motrin, Upjohn) in relation to the pathophysiologic aspects of various diseases is explained. An understanding of prostaglandin's numerous effects can help the clinician to expand the use of ibuprofen (as in Barttern's syndrome) and to exercise caution as warranted, as when treating patients with renal disease. Knowledge of ibuprofen's clinical pharmacology may also enable practitioners to prescribe the drug rationally in situations not well represented in the literature, as in the elderly or in individuals with bleeding diatheses or severe liver disease. The use of ibuprofen in multiple-drug therapy with aspirin, warfarin, phenytoin, digoxin, or lithium is explored. Perusal of the literature enables the clinician to gain an awareness of patient subpopulations warranting careful use of medication, including the elderly or individuals with systemic lupus erythematosus, mixed connective tissue disease, or aspirin-induced asthma.

Topics: Arthritis, Rheumatoid; Aspirin; Bartter Syndrome; Cyclooxygenase Inhibitors; Digoxin; Drug Hypersensitivity; Drug Interactions; Ductus Arteriosus, Patent; Humans; Ibuprofen; Indomethacin; Kidney; Kinetics; Lithium; Liver; Lupus Erythematosus, Systemic; Mixed Connective Tissue Disease; Phenytoin; Platelet Aggregation; Prostaglandins E; Warfarin

Topics: Digoxin; Humans; Hydrochlorothiazide; Lupus Erythematosus, Systemic; Male; Middle Aged; Procainamide

Procainamide-induced systemic lupus erythematosus (SLE) is a well recognized clinical syndrome believed to be characterized by normocomplementemia. However, in 7 cases of drug-induced SLE recorded in the literature, hypocomplementemia was found. The present report concerns a well documented case of procainamide-induce SLE with hypocomplementemia. The patient improved and complement values returned to normal after procainamide therapy was discontinued and replaced by digitalis and steroid therapy.

Topics: Aged; Complement System Proteins; Digoxin; Female; Humans; Lupus Erythematosus, Systemic; Prednisone; Procainamide

A 56-year-old male patient diagnosed as a case of procainamide-induced systemic lupus erythematosus (SLE) was found to have a lymphoproliferative disorder at postmortem examination.Contrary to other immune disorders, the association of SLE with neoplasia is a rare occurrence. The present case raises the question of whether a relationship exists between the lupus diathesis and lymphoreticular neoplasia. The study of the incidence of neoplasia in families of patients with SLE may prove helpful in establishing this relationship.

Topics: Aortic Diseases; Autopsy; Blindness; Bone Marrow; Digoxin; Drug Therapy, Combination; Heart Diseases; Heparin; Humans; Immunologic Deficiency Syndromes; Kidney; Lupus Erythematosus, Systemic; Lymph Nodes; Lymphoma; Male; Middle Aged; Procainamide; Quinidine; Retinal Artery; Spleen; Thromboembolism; Warfarin

Topics: Arrhythmias, Cardiac; Autoimmune Diseases; Coombs Test; Diagnosis; Digoxin; Drug Therapy; Geriatrics; Humans; Joint Diseases; Lupus Erythematosus, Systemic; Prednisone; Procainamide; Splenomegaly; Toxicology

Topics: Acetylcholine; Blood Pressure; Blood Vessels; Cardiac Catheterization; Cardiomegaly; Digoxin; Familial Primary Pulmonary Hypertension; Humans; Hypertension; Hypertension, Pulmonary; Infusions, Parenteral; Lung; Lupus Erythematosus, Systemic; Metabolism; Prednisone; Pulmonary Heart Disease; Tolazoline