Annals of Pharmacotherapy

Although information concerning the attainment of goal blood pressure for patients commencing antihypertensive therapy is available from controlled trials, no studies have examined this issue in the context of typical clinical practice.

To examine attainment of blood pressure control over time in patients initiating antihypertensive therapy in clinical practice.

Using an electronic medical records database, we identified all adults with systolic blood pressure (SBP}/diastolic blood pressure (DBP) ol 140/90 mm Hg or higher who initiated antihypertensive drug therapy. Subjects were stratified into subgroups based on the presence of high-risk conditions or characteristics described by the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in their seventh report as “compelling indications” (eg, diabetes) or “special situations” (eg. obesity). Blood pressure control was examined in terms of goal attainment and reductions in blood pressure using last available readings at days 90. 180, and 360, following therapy initiation.

Among the 10,345 study subjects, 47% had compelling indications and 39% had special situations. In the former group, 62% (95% CI 61 to 64) of patients with Stage 1 hypertension (140–159/90–99 mmHg) attained blood pressure less than 140/90 mmHg by day 360; among those with Stage 2 hypertension (≥160/100 mm Hg), the corresponding figure was 48% (95% CI 46 to 50). In the latter group, 64% (95% CI 61 to 66) and 55% (95% CI 53 to 57) of patients with Stage 1 and Stage 2 hypertension, respectively, attained blood pressure less than 140/90 mm Hg by day 360. Among those without high-risk conditions, these percentages were 63% (95% CI 59 to 67) and 55% (95% CI 52 to 59), Among patients with diabetes or chronic kidney disease. 25% (95% CI 24 to 26) attained blood pressure less than 130/80 mm Hg by day 360.

Many patients starting antihypertensive therapy in clinical practice fail to achieve blood pressure control within the first year. Control is no better, and perhaps worse, among patients at highest risk of adverse outcomes.

Given the widespread use of antidepressants and the negative consequence of cerebrovascular events (CVEs), an evaluation of the risk of CVEs associated with antidepressants is warranted.

To examine the association between the use of an antidepressant and risk of CVEs among patients diagnosed with depression.

A case-control study was performed using a managed care medical claims database from 1998 through 2002. A total of 1086 cases with CVEs were identified and matched with 6515 controls by age, sex, and the year ol the index date of depression Case patients were categorized by stroke type: hemorrhagic stroke, ischemic stroke, and other CVEs. Diagnoses of depression, CVEs, and other medical comorbidities were identified based on International Classification of Diseases, Ninth Revision, codes. Patients were defined as current users (antidepressant ended ≤30 days before CVE). recent users (31–60 days before CVE), past users {61–90 days before CVE), and remote/nonusers (≥91 days before CVE or nonuse). Cox proportional hazards regression analysis was conducted to estimate the risk of CVEs associated with antidepressant use.

A 24% increased risk of a CVE was noted in patients with current exposure to selective serotonin-reuptake inhibitors (SSRIs; adjusted hazard ratio [HR) 1.24; 95% CI 1.07 to 1.44), 34% increased risk for current exposure to tricyclic antidepressants (HR 1.34; 95% CI 1.10 to 1.62), and 43% increased risk for current exposure toother antidepressants (HR 1.43; 95% CI 1.21 to 1.69). The risk of ischemic stroke in current SSRI users was significantly higher (HR 1.55; 95% CI 1.00 to 2.39) compared with remote/nonusers.

Current users of antidepressants may be at increased risk of a CVE. Clinicians should consider the relationship of antidepressants with the occurrence of CVEs when determining the risk-benefit profile of pharmacologic treatment in patients with depression, particularly those with existing risk factors for a CVE.

Concerns surrounding the potential extra gut complication of gastric acid suppression are becoming increasingly realized.

To determine whether chronic antisecretory treatment with a proton pump inhibitor (PPI) or histamine₂-receptor antagonist (H₂RA) is associated with the presence of Candida spp. in cases of complicated intraabdominal infection.

We conducted a case-controlled study of adult surgical intensive care unit patients with complicated intraabdominal infection during a 5-year period. Exclusion criteria consisted at primary peritonitis, diagnosis of intraabdominal infection more than 72 hours before hospital admission, or a stay in the intensive care unit of less than 72 hours. Patients were categorized into either the antisecretory group (H₂RA or PPI therapy prior to admission) or control group (no prior antisecretory therapy).

One hundred eighteen patients met inclusion criteria. Chronic antisecretory (n = 41) and control (n = 77) patients were similar except in median age (69.0 vs 59.0 y; p = 0.026) and preadmission antibiotic use (36.6% vs 15.6%; p = 0.010). The 2 groups had a similar proportion of patients with Candida (30.3% vs 32.1%; p = 0.857); the cultures included C, albicans, C. glabrata, and C. parapsilosis. Yeast was recovered more often in patients diagnosed with community-acquired intraabdominal infection and in patients who had used PPIs before hospital admission (p = 0.066). Additionally, Candida was cultured more often in antisecretory patients with a history ol prior abdominal surgery than in control patients (91.7% vs 62.5%; p = 0.066).

No significant difference was found in the number of patients in the antisecretory and control groups from whom peritoneal Candida was recovered. However, patients with prior abdominal surgery and those in the community with chronic PPI use may be predisposed to Candida-associated intraabdominal infections.

The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, β-blockers. angio-tensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs ptay a role in adherence.

To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG.

Adults were surveyed 6–24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables).

Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and have undergone 1- or 2-vessel CABG procedures compared with 3- or 4-vessel procedures. Subjects were primarily English-speaking, white, and male. Adherent behavior was reported in 73 of 132 patients (55%). The average period between CABG and the survey was 16 months. Nonadherent patients were in stronger agreement on the General Overuse (p = 0.01) and General Harm (p = 0.04) scales. The adjusted odds of adherent behavior were significantly lower, with an increasing General Overuse score (OR 0.83; 95% CI 0.72 to 0.95; p = 0.007); an annual income of $50,000 to $100,000 relative to less than $20,000 (OR 0.36; 95% CI 0.14 to 0.91; p = 0.031), and a living status of “alone” compared with “with adults and no children” (OR 0.20; 95% CI 0.06 to 0.65; p = 0.007). The odds ratio of self-reported adherence was higher with increasing age (OR 1.05; 95% CI 1.01 to 1.09; p = 0.023).

In summary, patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help explain differences in self-reported adherence to standard drug therapy following CABG.

Heallh-relaled quality or lire (HRQL) is an important outcome, especially for chronic diseases with no cure such as cardiovascular diseases.

To investigate the comparability of 2 HRQL instalments, the Short Form-12 (SF-12) survey and the MacNew Heart Disease HRQL survey (MacNew) in patients with cardiac diseases.

A nonexperimental cross-sectional study was conducted in a lipid clinic in the Houston metropolitan area. Patients with a prior cardiac disease were requested to complete the SF-12 and the MacNew scales while waiting to see the physician during their regular clinic visit, Cronbach's u values were estimated to evaluate internal consistency. Spearman's correlation was performed to examine the correlation between the SF-12 and the MacNew scale domains,

A total of 118 patients were enrolled in this study. High Cronbach's a (from 0.89 to 0.94) were observed from all component scores in the MacNew scales. Physical component scores from the SF-12 and from the MacNew were highly correlated (r = 0.74; p < 0.001), as were the mental component score from the SF-12 and the emotional component score from the MacNew (r = 0.68; p < 0.001).

The SF-12 and the MacNew appeared to be strongfy correlated to each other for predicting a patient's HRQL in patients with a cardiac disease.

Infections caused by extended-spectrum β-lactamase (ESBL)-producing gram-negative organisms are becoming increasingly common and present significant challenges in terms of treatment. Carbapenems is the antibiotic class of choice for treatment of these types of infections. Ertapenem is the newest carbapenem, capable of being dosed once daily, and has some in vitro but little in vivo evidence supporting its use for the treatment ol these resistant infections.

To examine the clinical and microbiologic outcomes associated with ertapenem therapy of ESBL-producing Escherichia coli, Klebsiella pneumoniae. and Proteus mirabilis infections.

This was a retrospective case series that examined the clinical and microbiologic outcomes of 22 patients who received ertapenem for treatment of an ESBL infection at Rush University Medical Center in Chicago. IL, during 2003–2005.

The majority (16/22) of patients received ertapenem (or consolidation rather than initial therapy. Different antibiotics most commonly used were other carbapenems, piperacillin/tazobactam, and aminoglycosides. The most common infections treated were lower urinary tract infections and osteomyelitis. Clinical efficacy was determined in all 22 patients, with 20 (91%) patients having a positive outcome, defined as either clinical improvement or clinical cure. The best clinical cure rate was seen with wound infections, where all 3 patients examined were found to be clinically cured. Microbiologic efficacy was determined in 7 patients, with 6 {85.7%) defined as microbiologic cure. One patient was found to be both a clinical and microbiologic failure and was also found to have developed an ertapenem-resistant strain of E. coli.

These results demonstrate potential microbiologic and clinical efficacy of ertapenem for treatment of ESBL-producing infections and the need for a prospective, randomized study examining its efficacy versus that of other carbapenems.

Septic arthritis is considered a rheumatologic emergency that can lead lo joint destruction and tong-term impairment of joint function, Daptomycin is bactericidal in vitro against Staphylococcus aureus, the primary pathogen associated with septic arthritis.

To describe the use of daptomycin in patients with septic arthritis,

Data were collected as part of the Cubicin Outcomes Registry and Experience (CORE) program, a retrospective, observational, multicenter study, to describe the clinical use of daptomycin. Efficacy at the end of daptomycin therapy was determined by each center's investigator(s) as cure, improved, failure, or nonevaluable. Patients who had a diagnosis of septic arthritis, excluding concomitant osteomyelitis, as well as a positive culture by needle aspirate or deep tissue biopsy, were selected from the combined 2005 and 2006 CORE database.

Twenty-two patients were included in this analysis. S. aureus was the most common pathogen isolated, with the majority resistant lo methicillin. All patients received an antibiotic prior to daptomycin; in 7 patients, at least one of the prior antibiotics was continued with daptomycin. Almost two-thirds of patients received an antibiotic with daptomycin; rifampin was the most common. The median final dose and duration of daptomycin therapy were S mg/kg (range 3–6.3) and 22 days (range 3–52), respectively. Eighty-two percent of patients received daptomycin while admitted to a hospital; however, 68% received at least part ol their daptomycin therapy as an outpatient. The outcomes of cure or improved were reported in 41% and 50% of the patients, respectively. Two adverse events were reported; neither was considered to be related to daptomycin.

Daptomycin appeared to be effective when used as part of a treatment regimen for septic arthritis. These results require verification via a prospective clinical trial.

Studies have shown that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy, apparently not accepting treatment.

To determine characteristics and reasons associated with nonacceptance of selective serotonin-reuptake inhibitor (SSRf) treatment,

A retrospective study was conducted in 37 community pharmacies in the Netherlands; patients who presented a prescription from a general practitioner (GP) for a newly started SSRI treatment were selected, Nonaccepters were defined as patients who filled only one SSRI prescription; patients who received at least 3 fills of an SSRI prescription were defined as accepters. Patient characteristics were obtained from automated dispensing records and from questionnaires. Areas of evaluation included sociodemographics, disease, and treatment. Nonaccepters were asked their reasons for not filling second prescriptions.

Of the patients who started SSRI treatment, 22.0% were nonaccepters, filling only a single prescription. Fifty-seven nonaccepters and 128 accepters were included in our analysis. Nonacceptance was more common among patients with a low level of education (OR 2.6; 95% CI 1.1 to 5.9) and in patients who reported nonspecific symptoms like fatigue, stress, and restlessness as the reason for SSRI use (OR 2.7; 95% CI 1.4 to 5.5). Of the nonaccepters, 29.8% (n = 17) did not start SSRI use, and 70.2% (n = 40) discontinued SSRI use within 2 weeks. Fear of adverse effects and the actual occurrence of adverse effects were main reasons for not accepting SSRI treatment. Of the nonaccepters, 55.0% discontinued treatment without informing their GPs.

Acceptance of SSRI treatment is a decisive moment in a patient's adherence to treatment initiated by his or her GP and deserves more attention; GPs and pharmacists should address treatment issues, especially in groups at risk for nonacceptance.

To review the epidemiology, clinical features, diagnosis, and treatment of syphilis.

Studies and reviews were abstracted from MEDLINE (1950–April 2007) using the search term syphilis. AN papers were cross-referenced to identify additional studies and reviews for inclusion.

Pertinent original research articles, review articles, and book chapters were evaluated.

Syphilis is a spirochetal disease that has plagued mankind for centuries. Following a low incidence of syphilis in the US for the last 2 decades, rates are now increasing both in the US and other parts of (he world. Once acquired, syphilis can pass through 4 distinct stages of disease: primary syphilis. secondary syphilis, latent syphilis, and tertiary syphilis, with each stage being characterized by different symptoms and levels of infectivity. Diagnosis is made primarily by serologic assays with nontreponemal tests such as the Venereal Disease Research Laboratory and the Rapid Plasma Reagin assay used for screening. Treponemal tests including the Treponema pallidum particle agglutination and the fluorescent treponemal antibody absorption test are then used for confirmation. Recommended treatment regimens are based largely on uncontrolled trials and clinical experience. Penicillin is the treatment of choice, with the preparation and treatment duration varying for different stages. Benzathine penicillin is the treatment of choice lor all stages of syphilis except neurosyphilis, for which aqueous crystalline penicillin or procaine penicillin is used due to the central nervous system penetration of these formulations. Coinfection with both syphilis and HIV occurs frequently due to common risk factors. These 2 diseases interact with each other, making both diagnosis and treatment more complicated.

Clinicians should be aware of the signs and symptoms of syphitis as well as current guidelines for the management and treatment of this disease.

To increase awareness of the widespread environmental prevalence of the chemical warfare agent mustard gas, examine the acute and chronic toxic effects to exposed humans, and discuss medical treatment guidelines for mustard gas exposures.

Literature retrieval of medical case reports and clinical studies was accomplished using PubMed and the Cochrane Database (1919–March 2007). Search terms included mustard, mustard gas, sulfur mustard, chemical warfare, blister agents, vesicants, and war gas. Historical information and current events were accessed through military field manuals and Internet searches.

All articles in English identified from the data sources were evaluated. Adult and pediatric populations were included in the review.

Mustard gas and other chemical weapons are feared for their use as weapons of terror; however, the major threat of mustard gas lies elsewhere. Tons of this chemical agent were produced for war, then subsequently buried in landfills, disposed of at sea, or teft to decay in storage lacrlities. There are documented and anecdotal reports of chemical weapon buriat sites and ocean dumps across the globe spanning from the Arctic Circle to Australia. Numerous accidental exposures have occurred over the past decade. Mustard gas is corrosive to the skin, eyes, and respiratory tract. Extensive exposures can also affect other organ systems. Its ability to cause harm to multiple organ systems at extremely low doses in virtually any environmental condition makes it an extremely dangerous agent. Immediate decontamination of people exposed to mustard gas liquids and vapors is paramount. Supportive care and long-term followup is necessary for exposed persons. Research is under way to find antidotes or treatment methods for mustard gas exposure, but currently there are no definitive treatment guidelines.

Mustard gas is a weapon, but also a prevalent environmental threat. Recognizing the immense environmental presence of mustard gas disposal sites and the signs and symptoms of exposure will help speed treatment to those accidentally or purposefully exposed.

To determine the role of amantadine therapy tor early arousal and improved cognition in traumatic brain injury (TBI).

Literature was accessed through MEDLINE (1950–August 2007) using the MeSH terms amantadine, brain injuries, cognition, and arousal. PubMed (through August 2007) terms included amantadine, traumatic brain injury, and cerebral injury.

All studies ol amantadine (used <6 mo after injury) for enhancement of arousal or cognition in patients with TBI were reviewed.

Many cases of TBI are associated with frontal lobe injury. As a dopamine agonist, amantadine is thought to be involved in frontal lobe stimulation. Two case reports, 3 retrospective studies, and 2 randomized, double-blind, controlled trials of amantadine therapy for early arousal in TBI were identified and reviewed. Limitations of the available studies include open design, retrospective design, and heterogeneous brain injury types. Results have been inconsistent between studies, largely due to variability in designs, heterogeneity in patient populations, time following injury, and use of numerous different outcome measures. Despite these limitations, improvements in arousal and cognition, as documented by the Glasgow Coma Scale and olher measures, have been observed in patients with TBI when amantadine has been initiated 3 days to 5 months after injury.

At doses of 200–400 mg/day, amantadine appears to safely improve arousal and cognition in patients with TBI. Additional prospective controlled studies with homogeneous patient populations will better define the role of amantadine for early arousal.

To review the published literature evaluating the effectiveness of statin therapy for preventing postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery,

A MEDLINE search was performed (1950–October 2007) using the search terms statins, HMG-CoA reductase inhibitors, coronary artery bypass graft, cardiac surgery, and atrial fibrillation,

All articles published in English describing or evaluating the use of statins in humans to prevent atrial fibrillation (AF) were included. Additional pertinent articles were identified from reference lists.

POAF is a common complication following CABG surgery that is associated with significant morbidity. Current preventive strategies include the use of β-blockers and antiarrhythmic drugs such as amiodarono and Sotalol. Accumulating evidence suggests that statins may also reduce the risk of POAF. Numerous studies in nonsurgical cardiovascular patients have found reduced rates of AF with statins. In patients who have undergone CABG, several observational studies have also documented benefit. One randomized controlled trial reported a significant reduction in the risk of POAF and reduced length of hospital stay in patients given preoperative atorvastatin beginning 7 days before surgery. Ongoing research suggests that statins may reduce the risk of AF through pleiotropic effects independent of cholesterol lowering such as reductions in inflammation, oxidative damage, neurohormonal activation, and thrombosis.

While the current evidence evaluating the use of statins to prevent POAF is encouraging, definitive conclusions cannot be drawn. However, because statins are widely used in cardiac patients for other indications and are not associated with the risks inherent to antiarrhythmic drugs, their value as an adjunct to current preventive strategies (or POAF deserves further study. Additional research is needed to examine the effectiveness of statins in risk-stratified patients undergoing CABG surgery and the impact on patient outcomes and attributed costs.

To discuss new therapeutic options available in the treatment of chronic myelogenous leukemia (CML) in patients who (ailed or were intolerant to imatinib therapy.

Literature was accessed via MEDLINE (1966–May 2007). EMBASE (199l–3rd quarter 2007). the Proceedings of the American Society of Hematology (2000–2006), and the Proceedings of the American Society of Clinical Oncology (2000–2007). Search terms included imatinib, dasatinib, nilotinib. and chronic myelogenous leukemia.

Meeting abstracts and studies that reported preclinical and Phase 1, 2, and 3 trials published in English are included.

Imatinib is the standard of care for CML; however, some patients develop resistance or are intolerant to the drug. Phase 1 and 2 clinical data for the more potent tyrosine kinase inhibitors, dasatinib and nilotinib, are promising. Hematologic and cytogenetic responses are reported with both. There does not appear to be cross-resistance between the drugs, although neither is effective against all mutations ol the hallmark molecular marker, the Philadelphia chromosome. Novel agents are also being examined for the treatment of patients with CML, including aurora kinase and farnesyl transferase inhibitors, as well as combination therapies.

Dasatinib and nilotinib are second-tine options for patients who have CML and are resistant or intolerant to imatinib. Toxicity profiles between agents may differ. Clinical trials with these drugs and others are ongoing.

To evaluate the role of Multi-Matrix System (MMX) mesalamine in the treatment of ulcerative colitis (UC).

Literature was obtained through searches of MEDLINE (1966–October 2007) and a bibliographic review of published articles. Key terms used in the searches included ulcerative colitis, mesalamine, MMX, SPD476, and Lialda.

All English-language articles that were identified through the search were evaluated. All primary literature was included in the review.

The standard treatment for the induction and maintenance of remission in patients with mi Id-to-moderate UC is aminosalicylate products (mesalamine, sulfasalazine, batasalazide, olsalazine). Current mesalamine formulations are not idea) for long-term treatment due to issues with patient adherence secondary to complex dosing regimens and high pill burden. Clinical studies show that MMX mesalamine achieves clinical and endoscopic remission more frequently compared with placebo or mesalamine enema. Patients receiving MMX mesalamine achieved statistically significant clinical and endoscopic remission when compared with those taking placebo (34.1% vs 12.9%; p < 0.001 with 2.4 g/day vs placebo, and 29.2% vs 12.9%; p = 0.009 with 4.8 g/day vs placebo). Similarly, in another study, significantly more patients achieved remission in the MMX mesalamine groups compared with patients in the placebo group (40.5% vs 22.1% with 2.4 g/day vs placebo; p = 0.01, and 41.2% vs 22.1% with 4.8 g/day vs placebo; p = 0.007). MMX mesalamine is well tolerated, with headache, flatulence, and abdominal pain being the most frequently reported adverse events.

Current evidence supports the use of MMX mesalamine for treatment of mi Id-to-moderate UC by demonstrating that MMX mesalamine 2.4–4.8 g daily induces remission. It has the advantage of once-daily dosing regimens with lower pill burden than comparable products and, as an oral agent, may have better patient acceptability compared with topical mesalamine formulations. Therefore, MMX mesalamine is an option in patients with UC. The cost of MMX mesalamine is comparable to that of oral and rectal formulations of mesalamine. Further pharmacoeconomic studies are warranted to examine the cost impact of MMX mesalamine.

TO describe a case of QT interval prolongation, syncope, and delirium associated with galantamine use and to analyze similar cases related to acetylcholinesterase inhibitors (AChls) reported to the Australian Adverse Drug Reaction Advisory Committee (ADRAC).

An 85–year-old man with dementia was treated with prolonged release galantamine 8 mg daily for 1.5 years. Three months prior to the current admission, he had a syncopal episode with low blood pressure and bradycardia. Two months later, galantamine was withdrawn, but within 2 weeks, the man developed marked cognitive, behavioral, and functional deterioration and galantamine was restarted. Three weeks later, he developed syncope, delirium, hypotension, and prolonged QT interval with serious cardiac arrhythmias, in addition to vomiting and diarrhea. A complete blood cell count and biochemistry panel performed on admission were normal. No infection was detected. Galantamine and irbesartan were ceased. The delirium fully resolved in 6 days, and the QT interval shortened from 503 to 443 msec (corrected by Bazett's formula) 4 days after discontinuation of galantamine and remained normal.

In the ADRAC reports, galantamine was associated with 18 cases of delirium/confusion. 8 of syncope, 13 of bradycardia, 6 of other arrhythmias or conducton abnormalities, and 6 of hypotension. Donepezil was associated with 56, 15, 26, 15, and 5, and rivastigmine with 21, 8, 6, 2, and 2, respectively, of these reactions. Five fatal outcomes were reported in association with galantamine, 11 with donepezil, and 3 with rivastigmine, including 3, 6, and 0 sudden deaths, respectively. This case, along with previously published reports and cases identified from the ADRAC database, illustrates that AChls may lead to delirium, syncope, hypotension, and life-threatening arrhythmias. The Naranjo probability scale indicated that galantamine was the probable cause of QT interval prolongation, syncope, and delirium in this patient.

Administration of galantamine and other AChls requires vigilance and assessment of risk (actors that may precipitate QT interval prolongation, syncope, and delirium.

To report a case of erythema nodosum (EN) and related inflammatory arthropathy in a patient on cabergoline therapy for a microprolactinoma.

A 25-year-old white female, who had been receiving cabergoline 0.5 mg orally once per week for the preceding 2 months for a microprolactinoma, developed classic skin lesions of EN (proved by histology) and an associated acute inflammatory arthropathy of her left ankle joint in the absence of any other identifiable causes of EN. She improved substantially (skin lesions of EN and inflammatory arthropathy disappeared) after cessation of cabergoline therapy, Rechallenge with cabergoline in a lower dose of 0, 25 mg orally once per week led to a milder recurrence of EN lesions that once again disappeared after withdrawal of the drug. She had not had a recurrence at a 3 month follow-up visit.

Although possible autoimmune adverse effects (pleuropulmonary and cardiac) have been reported with the use of cabergoline. to the best of our knowledge, this is the first case report of EN (panniculitis) associated with cabergoline therapy. Causality assessment using the Naranjo probability scale revealed that the adverse drug event was probable.

Cabergoline was probably associated with EN (panniculitis) and the related arthritis in a patient being treated for a microprolactinoma. Panniculitis, like EN, needs to be considered a possible but reversible adverse effect of cabergoline therapy for microprolactinoma of the pituitary gland.