losartan-potassium and Headache

This study was performed to evaluate whether increasing hemoglobin before ascent by prophylactic erythropoietin injections prevents acute mountain sickness (AMS). This open-label, randomized, controlled trial involved 39 healthy volunteers with hemoglobin ≤ 15.5 g/dL who were divided randomly into erythropoietin (n=20) and control (n=19) groups. Epoetin alpha 10,000 IU injections were given weekly for four consecutive weeks. On day 1, and 7 days after the last injection (day 29), oxygen saturation (SaO2), and hemoglobin were measured. The subjects departed Seoul on day 30 and arrived at Annapurna base camp (ABC, 4,130 m) on day 34. AMS was diagnosed when headache and Lake Louise score (LLS) of ≥ 3 were present. Immediate descent criteria followed US Army recommendations. Two groups differ in hemoglobin levels on day 29 (15.4 ± 1.1 vs 14.2 ± 1.0 g/dL, P=0.001). At ABC, erythropoietin group had a significantly lower mean LLS, AMS incidence, and number of subjects who met immediate descent criteria. Multiple logistic regression analysis showed that SaO2<87% and control group, but not hemoglobin<15.0 g/dL, independently predicted satisfaction of immediate descent criteria. Erythropoietin-related adverse effects were not observed. In conclusion, erythropoietin may be an effective prophylaxis for AMS.(Clinical Trial Registry Number; NCT 01665781).

Topics: Acute Disease; Adult; Altitude Sickness; Blood Pressure; Drug Administration Schedule; Epoetin Alfa; Erythropoietin; Female; Headache; Hemoglobins; Humans; Incidence; Logistic Models; Male; Middle Aged; Odds Ratio; Oxygen; Recombinant Proteins; Surveys and Questionnaires

Study of the antitumour effects of erythropoietin on metastatic renal cell carcinoma.. After giving their informed consent, 20 patients with histologically proven metastatic renal cell carcinoma received subcutaneous recombinant erythropoietin three times a day at a dose of 150 IU/kg when haemoglobin was less than or equal to 12 g/dL or 75 IU/kg when haemoglobin was higher than 12 g/dL. Treatment was continued for a minimum of 8 weeks before reassessment and was continued thereafter, except in the case of progression or excessive toxicity. A staging assessment was performed every 8 weeks and the response was assessed on the basis of WHO criteria. A clinical and laboratory assessment was performed every two months to evaluate toxicity, graded according to the WHO scale. All but one of the patients had received immunotherapy or chemotherapy prior to inclusion in the study.. One complete response (> 12 months), one partial response (8 months), two minor responses, 10 cases of stabilisation and 6 cases of progression were observed. 15 patients received treatment at full doses. In 5 patients, the duration of treatment was reduced before the 8 weeks initially defined because of tumour progression in one patient and because of haemoglobin persistently greater than 15 g/dL in 4 other patients. Adverse effects consisted of 1 case of moderate headache, 2 cases of transient bone pain, and 1 case of transient hypertension.. Erythropoietin exerts a moderate antitumour effect which needs to be confirmed by a phase II trial of first-line treatment in selected patients.

Topics: Aged; Antineoplastic Agents, Hormonal; Bone and Bones; Carcinoma, Renal Cell; Disease Progression; Erythropoietin; Female; Headache; Hemoglobins; Humans; Hypertension; Injections, Subcutaneous; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Pain; Prospective Studies; Recombinant Proteins; Remission Induction; World Health Organization

Myeloproliferative neoplasms (MPNs) such as polycythemia Vera (PV) and Essential Thrombocythemia (ET) can be associated with a high risk of both venous and arterial thrombosis. However, the co-existence between these two complications is very rare and has never been described before, especially in young adults with no known history of MPNs.. We report the case of a 39 year-old Caucasian Moroccan male patient without cardiovascular risk factors (CVRF), who presented with acute chest pain. He also suffered from a severe headache since 2 weeks. Electrocardiogram (ECG) showed ST segment elevation myocardial infarction in the posterolateral leads. Cerebral Computed Tomography (CT) scan revealed subarachnoid hemorrhage (SAH), and cerebral Magnetic Resonance Angiography (MRA) found a Superior Sagittal Sinus Thrombosis (SSST). Routine blood tests showed raised hemoglobin and hematocrit in addition to leukocytosis and thrombocythemia. His coronary angiography revealed a thrombus in the ostial left circumflex artery (LCX). Further testing revealed positive Janus kinase 2 (JAK2) V617F mutation and low erythropoietin level, confirming the diagnosis of PV according to the 2008 World Health Organization (WHO) criteria. Antithrombotic and anti-ischemic treatments, in addition to myelosuppressive therapy with hydroxyurea, were initiated with a good clinical and biological evolution.. This case shows that MPNs are an important cause of thrombosis, especially in young patients with no other risk factors. Early diagnosis and appropriate management are fundamental before the occurrence of life-threatening complications that can sometimes present in unusual forms associating arterial and venous thrombotic events.

Topics: Adult; Chest Pain; Coronary Vessels; Erythropoietin; Headache; Humans; Janus Kinase 2; Male; Mutation; Polycythemia Vera; Superior Sagittal Sinus; Venous Thrombosis

Topics: Altitude; Brain Injuries; Cell Hypoxia; Erythropoietin; Headache; Humans; Military Personnel; Post-Concussion Syndrome; Stress Disorders, Post-Traumatic

Topics: Anticoagulants; Erythropoietin; Headache; Heparin, Low-Molecular-Weight; Humans; Janus Kinase 2; Male; Middle Aged; Phlebotomy; Polycythemia; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome

A 40-year-old black male with scleroderma lung disease presented with blurry vision and headache. His presenting hemoglobin was 22.3 g/dL and his serum erythropoietin level was surprisingly low. Although nocturnal hypoxemia was evident, his daytime resting arterial oxygen saturation was normal. The patient's symptoms of hyperviscosity improved after phlebotomy, as his hemoglobin gradually decreased to 18.3 g/dL. Repeat serum erythropoietin levels were in normal and high ranges. Patients with chronic interstitial lung disease and erythrocytosis could have normoxemia at rest and a normal or low serum erythropoietin level at the peak of erythrocytosis. A repeat sampling of serum erythropoietin and monitoring of oxygen saturation during sleep and exertion may help in diagnosis. Physicians should prescribe continuous oxygen therapy for patients with chronic interstitial lung disease and erythrocytosis, even if diurnal resting hypoxemia is absent.

Topics: Adult; Chronic Disease; Erythropoietin; Headache; Humans; Lung Diseases, Interstitial; Male; Oxygen Inhalation Therapy; Polycythemia; Scleroderma, Systemic; Vision, Low

To investigate the efficaciousness of recombinant human granulocyte colony-stimulating factor (G-CSF) combined with recombinant human erythropoietin (EPO) in the treatment of patients with myelodysplastic syndrome (MDS), the hematological changes in the blood and bone marrow along with clinical features after treatment with G-CSF and EPO in 15 patients were observed. Patients were subcutaneously injected with G-CSF 300 microg/d for 10 days, then injected with EPO 100 U/(kg x d) for 10 days. The results showed that the obvious improvements in granulocytes of blood were found in 10 patients with MDS, improvements in erythrocytes of blood were observed in 7 patients with MDS. No serious side effects occured is all treated patients. In conclusion, treatment of G-CSF in combination with EPO is effective for patients with MDS.

Topics: Adult; Aged; Drug Therapy, Combination; Erythrocyte Count; Erythropoietin; Female; Fever; Granulocyte Colony-Stimulating Factor; Headache; Humans; Injections, Subcutaneous; Leukocyte Count; Male; Middle Aged; Myelodysplastic Syndromes; Recombinant Proteins; Treatment Outcome

Polycythaemia vera is a chronic myeloproliferative disease with no single diagnostic marker. The Polycythaemia Vera Study Group used a combination of major and minor diagnostic criteria. In the presence of newer diagnostic tools, low serum erythropoietin level has been proposed as an important diagnostic criterion for polycythaemia vera, whereas an elevated erythropoietin value contradicts the diagnosis. We report a case of polycythaemia vera with extreme haemoconcentration in which the serum level of erythropoietin was above the upper reference limit.. A 53-year-old man with erythrocytosis (packed cell volume 0.68, hemoglobin 23.6 g/dl), thrombocytosis, leukocytosis and no underlying disease had a serum level of erythropoietin of 29.0 U/l (normal range 1.3-21.5 U/l).. The patient was treated with venesection. After one month the haemoglobin level had decreased to 15.7 g/dl and packed cell volume to 0.48. The symptoms of polycythaemia disappeared and the serum level of erythropoietin declined to low normal values (2.2 U/l after five weeks and 5.4 U/l after 1.5 year). We propose that local hypoxia in the kidneys might be responsible for the elevated erythropoietin value at the time of diagnosis. The present case shows that high erythropoietin values may not necessarily exclude the diagnosis of polycythaemia vera.

Topics: Attention; Bone Marrow; Erythrocyte Count; Erythropoietin; Headache; Humans; Male; Middle Aged; Phlebotomy; Polycythemia Vera

Therapy with recombinant human erythropoietin (rHuEPO) can reverse anemia and improve the quality of life in anemic hemodialysis patients. However, therapy is costly and must be used efficiently. An initial rHuEPO dose less than 50 U/kg intravenously three times weekly may be adequate to achieve a hematocrit of 30-33% in many patients. Acquired iron deficiency is a common problem during rHuEPO therapy and must be prevented with oral and parenteral iron replacement to maintain the efficacy of rHuEPO. Patients should be monitored carefully for additional problems including: an increase in blood pressure; onset of seizures or headaches; increased blood potassium, phosphate, and creatinine concentrations; enhanced coagulability resulting in dialyzer and vascular access clotting; and myalgias with a 'flu-like' syndrome.

Topics: Anemia; Blood Pressure; Erythropoietin; Headache; Hematocrit; Humans; Iron Deficiencies; Kidney Failure, Chronic; Recombinant Proteins; Seizures