Enalapril
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Non-productive cough in an elderly patient: case report An 88-year-old woman developed non-productive cough during treatment with enalapril [frequency not stated; duration of therapy to reaction onset not clearly stated]. The woman, who had a history of hypertension and was receiving enalapril 10mg for several months, presented with a dry non-productive cough, which had been present for several days and severe diarrhoea for 2 days. She was acutely confused. She reported having a non-productive cough for several weeks and that her doctor had prescribed a codeinecontaining cough syrup. Several days later, she had reported increased cough and lethargy to her doctor. She then received an antibacterial for presumptive pneumonia. However, she developed diarrhoea and presented to the hospital. She was diagnosed with Clostridium difficile and a chest x-ray revealed aspiration pneumonia. At this time, her medications included levofloxacin, enalapril and guaifenesin/codeine. The woman received metronidazole and piperacillin/ tazobactam. Over the following 24 hours, her fever resolved, but her cough persisted. Enalapril and guaifenesin/codeine were discontinued. Following enalapril cessation, her cough improved and she was discharged to a rehabilitation centre. Author comment: "This case represents an example of a prescribing cascade. A prescribing cascade exists when there is a misinterpretation of an adverse drug reaction that results in the prescription of a second inappropriate drug to treat the symptoms caused by the first drug." Argento VS, et al. A case of falling dominos: prescribing cascade in a geriatric patient. Journal of the American Geriatrics Society 56 (Suppl.): 122-123 abstr. 801112831 C34, No. 4, Apr 2008 - USA
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Reactions 31 May 2008 No. 1204
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