Background: Recent approval of the new oral anticoagulants dabigatran and rivaroxaban has led to rapid changes in anticoagulant prescribing practices. Postmarketing reports have highlighted safety concerns with these agents, and their use outside of evidence-based recommendations was noted at the authors' centre.
Atazanavir should be considered a possible contributor in the development of cholelithiasis or choledocholithiasis, and people with HIV should receive adequate counseling in the recognition of symptoms associated with gallstones. The exact incidence and mechanism still need to be elucidated.
A 10-year-old, 30-kg boy with attention deficit hyperactivity disorder (ADHD) is taking osmoticrelease oral system methylphenidate (Concerta) 36 mg once daily in the morning. Because his ADHD symptoms are only partially controlled with this monotherapy, several attempts have been made to increase the dose. However, each increase has resulted in intolerable gastrointestinal adverse effects. Today, his mother has dropped off a new prescription for atomoxetine 18 mg once daily for 2 weeks, to be followed by 25 mg once daily for an additional 2 weeks. The atomoxetine is to be added to the existing methylphenidate therapy. Is this a safe and effective drug combination? Are there any special precautions related to using this combination? How should the therapy be monitored?
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