Benzodiazepines frequently are administered to patients to induce sedation. Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Most cases are idiosyncratic; however, some evidence suggests that these reactions may occur secondary to a genetic link, history of alcohol abuse, or psychological disturbances. This review evaluates the numerous cases of paradoxical reactions to benzodiazepines in adult and pediatric patients that have been reported in the biomedical literature. It also explores the advantages and disadvantages of the various available treatment options.

Topical application of tranexamic acid and aminocaproic acid to decrease postsurgical bleeding after major surgical procedures is a promising strategy. Further data are needed regarding the safety of this hemostatic approach.

Infant botulism, a disease that results in a blockade of voluntary motor and autonomic functions, was first recognized in the United States in the late 1970s. Since then, more than 1000 cases in this country have been reported to the Centers for Disease Control and Prevention (CDC). Numerous studies have shown that the ingestion of honey is linked with infant botulism. In addition, honey samples across the United States have tested positive for Clostridium botulinum spores and toxins. Such substantial evidence led the CDC to recommend that honey not be given to infants younger than 12 months old. It is important that clinicians be familiar with this risk and should not recommend honey-containing products or supplements or the use of honey as a flavoring agent for infants in this age group.

Prolonged-release tacrolimus was developed as a once-daily formulation with ethylcellulose as the excipient, resulting in slower release and reduction in peak concentration (Cmax ) for a given dose compared with immediate-release tacrolimus, which is administered twice daily. This manuscript reviews pharmacokinetic information on prolonged-release tacrolimus in healthy subjects, in transplant recipients converted from immediate-release tacrolimus, and in de novo kidney and liver transplant recipients. As with the immediate-release formulation, prolonged-release tacrolimus shows a strong correlation between trough concentration (Cmin ) and area under the 24-hour time-concentration curve (AUC24 ), indicating that trough whole blood concentrations provide an accurate measure of drug exposure. We present the pharmacokinetic similarities and differences between the two formulations, so that prescribing physicians will have a better understanding of therapeutic drug monitoring in patients receiving prolonged-release tacrolimus.

FDA approves first interchangeable biosimilar insulinI n July 2021, FDA approved the first interchangeable biosimilar insulin product (Semglee-Viatris/Biocon Biologics, insulin glargineyfgn), which can be substituted for its reference product (Lantus-Sanofi Aventis, insulin glargine) at the pharmacy level, depending on state pharmacy laws. Although FDA first approved Semglee in June 2020 to improve glycemic control in pediatric patients with type 1 diabetes and adults with type 1 or type 2 diabetes, this approval marks the first interchangeable biosimilar designation for insulin from the agency."The approval of an interchangeable insulin glargine may offer cost savings to select patients, as biosimilars have, on average, launched with lower initial prices compared with their branded counterparts," said Daphne Smith Marsh, PharmD, BC-ADM, CDCES, a clinical pharmacist in ambulatory pharmacy services at Mile Square Health Center in Chicago. However, she added there are several other considerations that health care practitioners must keep in mind."Pharmacists should understand that Semglee can be substituted for Lantus without intervention of the prescriber, but currently cannot be interchanged with Basaglar-Lilly, another insulin glargine product on the market," she said. "If patients previously receiving Lantus are given Semglee at the pharmacy, patient education is essential to avoid duplication of therapy, as some patients may not understand that they are the same type of medications and may continue to use both products once they get home." Understanding biosimilars and interchangeabilityMaria G. Tanzi, PharmD, contributing writer. Tanzi is an employee of Incyte Corporation. The opinions expressed in this article are those of the author and do not represent the views of Incyte.