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and aspirin 75

150 mg at the same time, concomitant consumption of

omeprazol and clopidogrel.

Key conclusions:

Due to the potential inappropriateness of pharma-

cological treatment among elderly the system of pharmaceutical care

in geriatrics seems to be one of the core element of healthcare system.


Colistin: an unknown adverse drug reaction in an elderly patient

E. Zafra, M. Martínez, W. López, A. Rodríguez.

Hospital Virgen del Valle


Interest in colistin use has increased dramatically in

recent times because of the emergence of bacterial strains resistant to

other clinically available antibiotics. Colistin has demonstrated an

excellent activity against various Gram-negative rod-shaped bacteria,

including multidrug-resistant Pseudomona aeruginosa, Acinetobacter

baumannii and Klebsiella pneumoniae.

Case report:

An 86 year-old male patient was medicated with

colistimethate sodium 2 MU/24 h (160 mg of colistimethate), adjust-

mented to renal function, because of an Acinetobacter baumannii

pneumonia, developing leukopenia (0.8 × 10^9/l) and neutropenia

(0.1 × 10^9/l) six days after treatment was began. Both were reversible

eleven days on discontinuation of treatment. No other treatments

were involved, and it was reported that the renal function did not get

worse. This unknowed adverse drug reaction was reported to the

Regional Pharmacovigilance Centre.


Colistin became available for clinical use in the 1960s, but

was replaced in the 1970s with other antibiotics owing to its toxicity.

The optimal treatment dose according to the most recent pharmaco-

kinetic data for systemic infections in adults ranges widely between

240 and 720 mg daily in two or four divided doses. Nephrotoxicity and

neurotoxicity are the most common adverse effects. Toxicity is dose

dependent and reversible on discontinuation of treatment. Clinicians

should be careful about the adverse effect of colistin use. The

usefulness of colistin has been clearly documented and we believed

that colistin will be the

last line

therapeutic drug against Multiple-

Drug-Resistant Gram-negative pathogens in the 21st century.


Occurrence of a serotonin syndrome on escitalopramand tramadol

in a porphyria patient

M. Boulé


, M. Cloutier


, M. Waththuhew


, A. Lefevre-Fouach


, A. Proux



A. Zulfiqar


, J. Doucet




CHU de Rouen


Tramadol is associated with serotonin syndrome (SS), a

potentially lethal side effect, and is contraindicated in porphyria

patients. Here is the case of a porphyria patient that suffered SS

following tramadol administration. Case presentation: An 83 year-old

male with history of porphyria, depression, ischemic cardiopathy and

atrial fibrillationwas hospitalised for dyspnea and falls. His treatments

were escitalopram 10 mg, fluindione, pantoprazole, perindopril,

bisoprolol, spironolactone, rosuvastatin, paracetamol and furosemide.

January 19th: prescription and administration of one dose of tramadol

extended-release 100 mg, no escitalopram received. January 20th: he

presented clonic seizures without loss of consciousness, postictal

state, drowsiness, myoclonic seizures, stiffness, Babinski signs and

fever. SS was suspected. Escitalopram and tramadol were discon-

tinued. Provided care was active surveillance, EEG and CT scan.

Complete symptom resolution occurred by January 22th.

Key conclusions:

The association of escitalopram and tramadol led to

a SS. Tramadol introduction was the only treatment modification prior

to symptoms. Although he did not receive escitalopram on January

19th, its half-life of 30 hours meant that it could still interact with

tramadol. Fast recovery at drug discontinuation increased the

iatrogenic suspicion. The patient did not experience any porphyria

crises even though he received different treatments that could have

triggered one (tramadol, spironolactone and IV paracetamol). They

were discontinued on January 20th. Considering the symptoms began

after a standard dose of tramadol, it is likely that its interaction with

escitalopram was responsible for the SS. It is not possible to confirm

the increased susceptibility of SS in porphyric patients due to a lack of



Consequences of the angiotensin-converting-enzyme inhibitors

on kidneys in high-risk elderly patients

A. Lefèvre Fouache


, M. Waththuhewa


, A.A. Zulfiqar


, R. Bolis


, A. Jego



B. Heurtaux


, M. Boulé


, M. Cloutier


, J. Doucet




CHU de Rouen, Rouen,



Many medicines are nephrotoxic. Among them,

angiotensin-converting-enzyme inhibitors (ACEI) are known to

induce functional acute renal failure (ARF). They are widely used in

geriatric population.


Here is a case of an ACEI-induced nephropathy aggravated

by left-kidney artery thrombosis and right-kidney artery stenosis.


A 90 year-old female patient with history of hypertension

and transient ischemic attack, was hospitalized for an acute degrad-

ation of general state. Biological tests were normal and renal clearance

was at 47 mL/min. Due to hypertension, ramipril was prescribed at

5 mg and reported well tolerated beforehand. She was transferred to

after-care where the patient experienced nausea and vomiting.

Discovery of an acute renal failure with renal clearance at 17 mL/min.

Digoxin and ramipril were discontinued. RC degradation at 9 mL/min

led to dialysis sessions. The echography revealed

normal kidneys


Pharmacovigilance experts imputed the functional ARF to ramipril

with one similar case reported in France. The Doppler ultrasound

showed a left-kidney artery thrombosis and a right-kidney artery

stenosis. Progressive improvement followed with RC at 13 mL/min on


Key conclusions:

We identified avoidable mistakes: No biologic

monitoring at ramipril initiation nor the following 11 days despite

patient transfer No pharmaceutical analysis Non-avoidable mistakes

and contributory factors include: Potentially nephrotoxic drugs have

been administrated before discovery of the nephropathy Old, diabetic

and dehydrated patient No recommendation on systematic nephro-

pathy research by imaging at ACEI initiation Many contributory factors

and malfunctions led to this incident with important consequences. It

is important to follow recommendations on nephrotoxic drug

monitoring in high risk patients.


Duodenal ulcer perforation linked to long-term nicorandil-

acetylsalicylic acid association

B. Heurtaux


, M. Waththuhewa


, A.A. Zulfiqar


, A. Hoffmann



E. Delbende


, S. Quitadamo


, A. Lefèvre Fouache


, A. Proux


, J. Doucet




CHU de Rouen


Duodenal ulcer (DU) is a disease affecting 8% of the

active population and its incidence has been decreasing in the past

years. The most well-known drug causing DU are NSAIDs. Here is the

case of a patient suffering from a duodenal bulb perforation (DBP)

while being treated by acetylsalicylic acid (AA) and nicorandil, also

known to worsen DU.


A 93 year-old woman was admitted for a confusional

syndrome. Her medical history include Alzheimer

s disease, hyper-

cholesterolemia, high blood pressure and acute coronary syndrome

(ACS) in 2003 with the introduction of AA 160 mg and nicorandil

10 mg. Between 2012 and 2014, omeprazole (proton pump inhibitor,

PPI) was started for epigastric pain. In February 2016, she was

hospitalised for a generalised peritonitis due to a DBP. One month

later, she was hospitalised and a recurrence of DU was suspected,

which justified nicorandil discontinuation. Gastric disorders were

resolved thirty days later.

Key conclusions:

The patient may have experienced two occurrences

of DU. Nicorandil-AA long-term association probably led to a DBP, a

serious and rare DU complication. ACS history meant that AA

s risk-

benefit ratio was in favour of its maintenance. Considering that

nicorandil-only discontinuation led to symptoms resolution, it is likely

Poster presentations / European Geriatric Medicine 7S1 (2016) S29