Adynamic Ileus and Nortriptyline

Abstract

SIR,-We would like to comment briefly on Dr. J. M. Sowa's letter (2 April, p. 858) dealing with the immunosuppressive therapy of systemic lupus erythematosus (S.L.E.).We published the results we obtained with 2,3,5 -tris -ethylenimino -p -benzoquinone (triaziquone) in three cases of S.L.E., and since then we treated another patient with the same cytostatic agent.Since in these cases the steroid therapy gave little advantage or serious side-effects, we tried the triaziquone therapy, which gave very good results: the sedimentation rate promptly fell to almost normal values, both the L.E. cell test and the L.E. factor test became negative, the electrophoretic pattern and the renal clearances and the urine analysis showed a marked improvement, the latter leaving only a residual slight albuminuria. The longest remission period was of two and a half years, and up to now a second cycle of treatment has not been necessary. The side-effects were negligible and promptly subsided on discontinuing the therapy.In our opinion the newer immunosuppressive drugs are of definite value in the treatment of S.L.E., provided that the following criteria are observed:(1) Their use should be limited to cases which either do not respond to doses of 50-60 mg. of prednisone daily or show some side-effect. In our experience doses of 100-120 mg. of prednisone daily almost always produce serious side-effects.(2) The dosage should be kept as low as possible (for triaziquone 2-3 mg. in all), and the therapy should be discontinued when the clinical condition and the laboratory tests show a marked improvement.(3) It is advisable that the cytostatic agents should be administered together with as little as 5-10 mg. of prednisone daily.Though more data, obtained possibly with a controlled study, are required, we strongly suggest the treatment of patients with S.L.E. who do not promptly respond to steroid therapy with triaziquone or other immunosuppressive drugs.-We are, etc., FRANCO PACINI. ANTONIO MORETTINI.

Ischaemic colitis associated with psychotropic drugs

“…Paralytic ileus and distension of the colon have been well described in relation to the use of both tricycic antidepressant drugs and chloropromazine (Milner and Hills, 1966;Ritama, 1969). With the former drug the mechanism is thought to be anticholinergic, but in the latter the mechanism is not as clear cut as chlorpromazine affects the whole auto-nomic nervous system.…”

Atropine and paralytic ileus

“…Anti-cholinergic activity is a property of many drugs and most notably the tricyclic anti-depressants have been reported as causing paralytic ileus (Milner and Buckler, 1964;Milner and Hills, 1966).…”

Pharmacokinetic Optimisation of Tricyclic Antidepressant Therapy

“…TCAs may reduce or abolish the antihypertensive effect of clonidine (Hui 1983;Checkley et al 1981;Lacomblez et al 1988). Anticholinergic effects of TCAs may combine with those of phenothiazines resulting in severe constipation, paralytic ileus (Burkitt & Sutcliffe 1961;Milner & Hills 1966;Warnss et al 1967) or in the enhancement of central nervous system (CNS) toxicity. The mechanism ofthe TCA-clonidine interaction is not fully understood, whereas that involved in the interaction with guanethidine and bethanidine is thought to relate to inhibition of their transport into adrenergic nerve endings by TCAs (Mitchell et al 1970).…”