Oseltamivir
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Tongue and lip swelling: case report A 22-year-old woman developed tongue oedema associated with oseltamivir treatment. The woman was admitted with productive cough, fever and shortness of breath, worsening over a period of four weeks. She was treated with IV cefuroxime and clarithromycin. Seventy-two hours after admission, she was transferred to the intensive care unit (ICU) with increasing respiratory distress, hypoxia and hypotension, and was intubated and mechanically ventilated. Oseltamivir 75mg twice daily was administered by nasogastric tube, commencing on the day of intubation and continued for 9 days. Antibacterial therapy was continued with clarithromycin and cefepime, and vancomycin was added on day 7 for 4 days. On day 2 of ICU admission, influenza virus H1N1 RNA was detected. Tongue swelling began on day 3 of ICU admission and increasing over the next 6 days with moderate lip swelling also noted. As the size and firmness of the tongue increased, it was unable to retract into the mouth. Contact with the endotracheal tube and incisors caused pressure and ulceration, impairing venous drainage. The woman’s tongue was kept moist, and dental blocks were used to relieve pressure on the tongue. Oseltamivir was stopped after 9 days, and the swelling reduced over the next few days. Tracheostomy was performed on day 16, by which time swelling was significantly reduced. Her condition continued to improve in intensive care with a prolonged period of ventilation, though oxygen and pressure support requirements were slow to reduce. Decannulation of the trachea occurred at day 31, with discharge from the ICU on day 32 and discharge from hospital on day 40. Author comment: "While it is difficult to determine the exact cause of tongue and lip swelling in this patient, the onset and regression of symptoms were closely related to the course of oseltamivir. The oseltamivir data sheet describes this as a rare side-effect reported during postmarketing surveillance." Scott A, et al. Tongue swelling complicating management of a ventilated patient with acute respiratory distress syndrome secondary to novel influenza A (H1N1). Anaesthesia and Intensive Care 38: 370-372, No. 2, Mar 2010 - New 803018139 Zealand
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Reactions 5 Jun 2010 No. 1304
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