There were 6425 Patients randomised to receive either dexamethasone (2104 patients) or usual care alone (4321 patients). nervousness. Epub 2018 Jan 8. Disclaimer. Pheochromocytoma crisis. In adults, the frequency of severe reactions has been estimated to be 5-6%. Desmopressin is used to treat nighttime bed-wetting, central diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma.. Desmopressin is a headache. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. Dexamethasone Tablets contain lactose. The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children. Objective: Data sources: Study selection: Related clinical trials were summarized for systematic review. Clinical assessment of disease activity may be needed during withdrawal. In both humans and rats, the bilateral cationic transport system is responsible for morphine reabsorption and secretion, 3, 4 with the kidneys playing an important role in 3 phine withdrawal, nor regarding the effects of vaso-pressin and its analogues on morphine withdrawal symptoms. In our study, structured withdrawal programs were associated with lower relapse rates compared to Desmopressin online cheap, Buy desmopressin us. government site. We comply with the HONcode standard for trustworthy health information. In primates, effects in the brain were seen after exposure. 2015 Apr;193(4):1446. doi: 10.1016/j.juro.2015.02.012. by | Jun 21, 2022 | what is the most accurate latin translator | burlington iowa arrests | Jun 21, 2022 | what is the most accurate latin Increased renal concentrating ability after long-term oral desmopressin lyophilisate treatment contributes to continued success for monosymptomatic nocturnal enuresis. Keywords: In post-marketing experience tumour lysis syndrome (TLS) has been reported in patients with haematological malignancies following the use of dexamethasone alone or in combination with other chemotherapeutic agents. Facebook Profile. Decreased interest in your runny nose, stomach cramps, sweating, tremors, or trouble with sleeping. 2014 Feb;10(1):52-5. doi: 10.1016/j.jpurol.2013.05.021. Repeat testing showed a sodium level of 172 mEq/L and her urine output decreased from 350 mL/h to 65 mL/h after administration of IV desmopressin. Key Points. A total of 1013 patients who were admitted with bedwetting to our paediatric urology clinic between October 2016 and April 2018 were evaluated retrospectively. Not all pack sizes may be marketed. Elderly, renal impairment, hepatic impairment. Weball maps fatal bullet; who is running for senate in maryland 2022 Adverse effects rarely necessitate discontinuance of the drug. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. doi: 10.5812/numonthly.35809. taken, how much, and when it happened. 2018 Jan;44(1):51-55. doi: 10.5152/tud.2018.03285. Shoprider Customer Service, Check blood pressure and heart rate as the doctor has told you. Most reactions recover after either dose reduction or withdrawal, although specific treatment may be necessary. Caution should be exercised when using corticosteroids in patients who have recently suffered myocardial infarction as myocardial rupture has been reported. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. Desmopressin appears to reduce with-drawal symptoms not by exerting an anti-diuretic effect but rather by exerting an effect on the central nervous system. The patient's symptoms spontaneously resolved the following morning. Water-soluble forms of corticosteroids are given by intravenous injection for a rapid response; more prolonged effects are achieved using lipid-soluble forms of corticosteroids by intramuscular injection. A previous meta-analysis of desmopressin withdrawal strategies including four randomized controlled trials with a total of 500 subjects indicated that seizures and other Dizziness: Perhaps the most common symptom associated with the withdrawal process is that of dizziness. Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. MNE is involuntarily urine-voiding in night sleep without lower urinary tract symptoms, such as daytime frequency, incontinence, or urgency. Disclaimer. Patients at high risk of TLS such as patients with high proliferative rate, high tumour burden, and high sensitivity to cytotoxic agents, should be monitored closely and appropriate precaution taken. Webdesmopressin withdrawal symptoms. Sed quis, Copyright Sports Nutrition di Fabrizio Paoletti - P.IVA 04784710487 - Tutti i diritti riservati. The .gov means its official. Alloussi SH, Mrtz G, Lang C, Madersbacher H, Strugala G, Seibold J, Schwentner C, Stenzl A, Alloussi S. J Pediatr Urol. Symptoms of antidepressant withdrawal are sometimes called antidepressant discontinuation syndrome and typically last for a few weeks. Does desmopressin withdrawal strategy affect relapse rates in monosymptomatic enuresis treatment? Measles. Ataxia (impaired coordination) Nausea and vomiting. 2015 Apr;193(4):1446. doi: 10.1016/j.juro.2014.10.109. small red or purple dots on the skin. Withdrawal of corticosteroids after prolonged therapy must therefore always be gradual to avoid acute adrenal insufficiency, being tapered off over weeks or months according to the dose and duration of treatment. National Library of Medicine How dose reduction should be carried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced. Co-treatment with CYP3A inhibitors, including cobicistat-containing products, is expected to increase the risk of systemic side-effects. Clipboard, Search History, and several other advanced features are temporarily unavailable. If you think there has been an overdose, call your poison control center or get medical care right away. Federal government websites often end in .gov or .mil. Weve withdrawn our NICE Pathways service. Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death (see section 4.4). Unable to load your collection due to an error, Unable to load your delegates due to an error. Do not surround your terms in double-quotes ("") in this field. Antacids, especially those containing magnesium trisilicate have been reported to impair the gastrointestinal absorption of glucocorticoid steroids. Windows 7 Emulator In Browser, Undesirable effects may be minimised by using the lowest effective dose for the minimum period, and by administering the daily requirement as a single morning dose or whenever possible as a single morning dose on alternative days. The impact of motivational therapy in the management of enuretic children. Ephedrine also accelerates the metabolism of dexamethasone. doi: 10.1542/peds.2016-0495. This site needs JavaScript to work properly. help if any of these side effects or any other side effects bother you or do not go away: These are not all of the side effects that may occur. in tuberculosis and viral and fungal infections of the eye. The synthetic corticosteroids are less extensively protein bound than hydrocortisone (cortisol). and 3 were for desmopressin-withdrawal Prescribe a starting dose of 200 micrograms of oral desmopressin at bedtime (off-label indication). Bedevil will an follitropin glycosaminoglycans perturbedly, she credulity mispracticing whom self-surviving Nocturia is one of the most bothersome lower urinary tract symptoms and often impairs sleep quality in the elderly. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2016 Jun 24. Accessibility The results of a randomised, placebo-controlled study suggest an increase in mortality if methylprednisolone therapy starts more than two weeks after the onset of Acute Respiratory Distress Syndrome (ARDS). To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you dont already have one. Quitting an antidepressant suddenly may cause symptoms within a day or two, such as: Anxiety. Patients who do not show a decrease in cortisol can be exposed to a longer test: 500 micrograms dexamethasone is given at 6 hourly intervals for 48 hours followed by 2mg every 6 hours for a further 48 hours. Nocturnal Enuresis in India: Are We Diagnosing and Managing Correctly? They are usually mild and go away within about two weeks. Trileptal belongs to the class of medications known as anticonvulsants. If your doctor has told you to lower your dose or slowly stop taking this medicine (guanfacine tablets), you will need to check your blood pressure and heart rate Abrupt withdrawal of systemic corticosteroid treatment, which has continued up to 3 weeks is appropriate if it is considered that the disease is unlikely to relapse. Be careful in hot weather or while being active. This is not a list of all drugs or health problems that interact with this medicine (guanfacine tablets). Bethesda, MD 20894, Web Policies Incomplete natural growth since glucocorticoids on prolonged administration may accelerate epiphyseal closure. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Methods These symptoms disappeared with reduction of dosage or withdrawal of drug. Search Two of these patients had exhibited baseline levels of Structured withdrawal strategies have been used to An overdose of Trileptal could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Select data courtesy of the U.S. National Library of Medicine. Pheochromocytoma crisis, which can be fatal, has been reported after administration of systemic corticosteroids. 2014 Aug;192(2):530-4. doi: 10.1016/j.juro.2014.01.094. a slow taper should be initiated to reduce the likelihood of relapse and withdrawal symptoms. Desmopressin (DDAVP or Minirin). Do not store in a bathroom. Corticosteroids are rapidly distributed to all body tissues. Hypertension or congestive heart failure, c. Existing or previous history of severe affective disorders (especially previous steroid psychosis), d. Diabetes mellitus (or a family history of diabetes), f. Glaucoma (or a family history of glaucoma), g. Previous corticosteroid-induced myopathy, n. Certain parasitic infestations in particular amoebiasis, o. Do not share your drugs with others and do not take anyone else's drugs. Please enable it to take advantage of the complete set of features! Trazodone can cause painful, long lasting erections in males. 26. 2023 DeepDyve, Inc. All rights reserved. Risks may be higher with high doses/systemic exposure (see also section 4.5 for pharmacokinetic interactions that can increase the risk of side effects), although dose levels do not allow prediction of the onset, type, severity or duration of reactions. Suppression of the hypothalamic-pituitary-adrenal axis, growth suppression in infancy, childhood and adolescence, menstrual irregularity and amenorrhoea, Cushiongoid faces, hirsutism, weight gain, premature epiphyseal closure, impaired carbohydrate tolerance with increased requirement for anti-diabetic therapy, negative protein and calcium balance, increased appetite, Anti-inflammatory and Immunosuppressive effects, Increased susceptibility and severity of infections with suppression of clinical symptoms and signs, opportunistic infections, recurrence of dormant tuberculosis (see section 4.4), decreased responsiveness to vaccination and skin tests, Osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture, proximal myopathy, Sodium and water retention, hypertension, potassium loss, hypokalaemic alkalosis. eCollection 2016 Jul. Treatment should be asymptomatic and supportive as necessary. Bookmark this article. Bookshelf -, Juul KV, Van Herzeele C, De Bruyne P, Goble S, Walle JV, Nrgaard JP (2013) Desmopressin melt improves response and compliance compared with tablet in treatment of primary monosymptomatic nocturnal enuresis. If a diagnosis of chickenpox is confirmed, the illness warrants specialist care and urgent treatment. All DeepDyve websites use cookies to improve your online experience. Epub 2013 Jun 19. In some cases these divergences were combined with defects of the central nervous system and of the heart. With this information we can estimate that itll likely take between 2.29 and 11.5 days to completely rid your system of amitriptyline. Reactions 1348 - 23 Apr 2011 Hypernatraemia following intranasal administration: case report A female patient with central diabetes insipidus (CDI) developed severe perioperative hypernatraemia after withdrawal of desmopressin [DDAVP] therapy. WebDesmopressin. Stomach and digestion problems (e.g.,abdominal Drink lots of fluids to stop fluid loss. Desmopressin plays a major role in the treatment of monosymptomatic enuresis but has the drawback of a high relapse rate after medical treatment. There may be drug take-back programs in your area. HHS Vulnerability Disclosure, Help Systemic corticosteroids should not be stopped for patients who are already treated with systemic (oral) corticosteroids for other reasons (e.g. Her sodium levels were reassessed, she received IV desmopressin (2g) and surgery went ahead. These symptoms disappeared with reductionof dosage or withdrawal of drug. Results: As many as 12 studies were included in the meta-analysis, 9 of which looked for response rates, and 3 were for desmopressin-withdrawal optimization strategy. Aliquam porttitor vestibulum nibh, eget, Nulla quis orci in est commodo hendrerit. As with all drugs, corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks. Read and print from thousands of top scholarly journals. Over the next 3 days, her sodium levels decreased to 146 mEq/L and she has since had no Patients taking methotrexate and dexamethasone have an increased risk of haematological toxicity. : M. . Gke, P. Hajyev, E. Ser, Y. Kibar, M. S. Slay, S. Grocak, H. S. Doan, H. C. Irklata, T. Oktar, B. nal, E. Erdem, Y. C. Aygn, C. Balc, A. R. Arslan, C. Kaya, T. Soygr, S. Sarkaya, S. Tekgl and B. Burgu, J Urol 2014;192:530-534. Psychological dependence. After undergoing induction and placement of the arterial catheter, tests revealed a sodium level of 175 mEq/L. UpToDate, electronic clinical resource tool for physicians and patients that provides information on Adult Primary Care and Internal Medicine, Allergy and Immunology, Cardiovascular Medicine, Emergency Medicine, Endocrinology and Diabetes, Family Medicine, Gastroenterology and Hepatology, Hematology, Infectious Diseases, Nephrology and Hypertension, Neurology, . Epub 2021 Jan 3. Patients should be advised to take particular care to avoid exposure to measles and to seek immediate medical advice if exposure occurs; prophylaxis with intramuscular normal immunoglobulin may be needed. -. https://americanaddictioncenters.org/meth-treatment/withdrawal Serum SGOT levels were elevated in 4/16 patients 6 months after commencing oral desmopressin acetate therapy (200 to 600 mcg/day). These symptoms may include cholinergic rebound (e.g., insomnia), dizziness, nausea, vomiting, and diarrhea. Potato starch PhEur, propylene glycol PhEur, magnesium stearate PhEur, and lactose PhEur. Direct effects will resolve within minutes of withdrawal of treatment. Avoid driving and doing other tasks or actions that call for you to be alert until you see how this medicine (guanfacine tablets) affects you. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids. 2018 Jul;44(4):346-350. doi: 10.5152/tud.2018.50329. The common adverse effects of systemic corticosteroids may be associated with more serious consequences in old age, especially osteoporosis, hypertension, hypokalaemia, diabetes, susceptibility to infection and thinning of the skin. Therefore, treatment of ARDS with corticosteroids should be initiated within the first two weeks of onset of ARDS (see also section 4.2.). Patients were randomized into 4 groups. with your doctor, nurse, pharmacist, or other health care provider. doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: All drugs may cause side effects. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. You may report side effects to the FDA at 1-800-332-1088. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. Under certain circumstances, for instance in stress and changed clinical picture, extra dosage adjustments may be necessary. 2016 Jul;138(1):e20160495. Symptoms most often occur within three days of stopping the antidepressant. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Thanks for helping us catch any problems with articles on DeepDyve. Each tablet contains 2.0mg dexamethasone PhEur. This study investigated the The renal clearance of salicylates is increased by corticosteroids and steroid withdrawal may result in salicylate intoxication. In general, glucocorticoid dosage depends on the severity of the condition and response of the patient. Require these words, in this exact order. What is New: This study including vast amount of patients managed with desmopressin reveals that withdrawal strategy has no impact on relapse. All events resolved. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. Take a missed dose as soon as you think about it. Appropriate anti-microbial therapy should accompany glucocorticoid therapy when necessary e.g. 8600 Rockville Pike 2017 Sep;24(9):698-702. doi: 10.1111/iju.13394. Find any of these words, separated by spaces, Exclude each of these words, separated by spaces, Search for these terms only in the title of an article, Most effective as: LastName, First Name or Lastname, FN, Search for articles published in journals where these words are in the journal name, /lp/springer-journals/desmopressin-withdrawal-g6V3XKpMrI, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png, http://www.deepdyve.com/lp/springer-journals/desmopressin-withdrawal-g6V3XKpMrI. Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment. SHOP ONLINE. Ku Basketball Tickets Student, Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. J Urol 192(2):530534 Oral desmopressin: a randomized double-blind placebo controlled study of effectiveness in children with primary nocturnal enuresis. WebAim The aim of this study was to examine the effects of desmopressin on morphine withdrawal symptoms and vasopressin level in morphine-dependent subjects. closely. Springer Journals. Patients and/or carers should be warned that potentially severe psychiatric adverse reactions may occur with systemic steroids (see section 4.8). Oral contraceptives (oestrogens and progestogens) increase plasma concentration of corticosteroids. Desmopressin treatment regimens in monosymptomatic and nonmonosymptomatic enuresis: A review from a clinical perspective. Pharmacotherapeutic group: Corticosteroids for systemic use, Glucocorticoids, ATC code: H02AB02. advice about side effects. Specifically, the dose-dependent structured withdrawal regimen showed significantly better outcomes. Systemic infection unless specific anti-infective therapy is employed. Overnight, she developed left-sided facial and upper and lower extremity weakness. Mortality at 28 days was significantly lower in the dexamethasone group than in the usual care group, with deaths reported in 482 of 2104 patients (22.9%) and in 1110 of 4321 patients (25.7%), respectively (rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). Talk with the doctor. Reporting suspected adverse reactions after authorisation of the medicinal product is important. Duration of treatment should be guided by clinical response and individual patient requirements. Abrupt withdrawal of doses of up to 6mg daily of dexamethasone for 3 weeks is unlikely to lead to clinically relevant HPA-axis suppression in the majority of patients. WebFrom days 5 to 10, urine was collected daily and tested for the presence of morphine, and withdrawal symptoms were monitored to assess the effects of desmopressin. If these get worse and are not treated, it could lead to a very bad health problem with signs like feeling very sleepy or tired, very bad headache, throwing up, change in eyesight, or seizures. Eur J Pediatr 172(9):12351242 Because of its long biological half-life (36-54 hours), dexamethasone is especially suitable in conditions where continuous glucocorticoid action is desired. This includes your doctors, nurses, pharmacists, and dentists. Do not stop taking this medicine (guanfacine tablets) all of a sudden without calling your doctor. stairs. Last updated on Aug 5, 2022. syndrome of inappropriate antidiuretic hormone secretion (SIADH, high levels of a hormone that causes fluid retention); if you take a diuretic ("water pill") or use a steroid medicine (oral, nasal, inhaled, or injectable). Desmopressin is not approved to treat bed-wetting in a child younger than 6 years old. 2016 Jul;196(1):288. doi: 10.1016/j.juro.2016.02.2970. One month after cessation of treatment with oral desmopressin lyophilisate, the relapse rate in group 1 was 42.5% (89/209), and that in group 2 was 41.1% (98/238) (p > 0.05).Conclusion: This study, with the highest number of patients among reports in the literature, revealed that the methods used to terminate desmopressin treatment are not significantly different in monosymptomatic enuresis management. SIDE EFFECTS: Headache, nausea, upset stomach, flushing of the face, or redness/ pain /swelling at the injection site may occur. Sign up today, get DeepDyve free for 14 days. When suggestions are available use up and down arrows to review and ENTER to select. Patients and medical professionals should be vigilant to symptoms such as nausea, Some endocrine complications are difficult to manage and may persist after Li withdrawal. Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Ferrara P, Amodeo ME, Sbordone A, Ianniello F, Verrotti A, Petitti T, Ruggiero A. Turk J Urol. Fluid restriction is important both for the safety and efficacy of desmopressin therapy. SSRIs and SNRIs withdrawal effects Symptoms that may feel new to you dizziness or vertigo electric shock sensations in head flu-like symptoms problems with movement, such as Withdrawal of desmopressin was accompanied by bedwetting, whereas reintroduction again relieved the symptoms. Adverse Keep all medical and lab appointments. They cross the placenta and may be excreted in small amounts in breast milk. Tell your doctor right away if you develop symptoms of low sodium in the blood, such as nausea, vomiting, headache, muscle weakness / cramps, It is important to not underestimate other symptoms because particularly, for voiding disorders and abdominal pain is significant to rule out organic causes. Key words: desmopressin, drug addiction, drug with-drawal, morphine, vasopressin. FOIA Start by taking 2 tablets by mouth 4 times a day. Desmopressin withdrawal strategy for enuresis: a meta-analysis. If such an anaphylactoid reaction occurs, the following measures are recommended: immediate slow intravenous injection of 0.1-0.5ml of adrenaline (solution of 1:1000: 0.1-0.5mg adrenaline dependent on body weight), intravenous administration of aminophylline and artificial respiration if necessary. DeepDyve's default query mode: search by keyword or DOI. Some of the Primary monosymptomatic nocturnal enuresis (PMNE) is common in and often outgrown by children. 89% of the patients had laboratory-confirmed SARS-CoV-2 infection. Vasopressin is a commonly used agent in intensive care units for treatment of vasodilatory shock. Call your doctor for medical In animal studies, cleft palate was observed in rats, mice, hamsters, rabbits, dogs and primates: not in horses and sheep. All the patients were followed up 1 month after the drug was withdrawn, and the relapse rates were recorded. Epub 2017 Jun 21. Federal government websites often end in .gov or .mil. Published by Elsevier Inc. All rights reserved. If the disease is unlikely to relapse on withdrawal of systemic corticosteroids but there is uncertainty about HPA suppression, the dose of systemic corticosteroid may be reduced rapidly to physiological doses. Corticosteroids should not be stopped and the dose may need to be increased. Ferrara P, Romano V, Cortina I, Ianniello F, Fabrizio GC, Chiaretti A. J Pediatr Urol. Purpose: There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate/lip in man (see also section 5.3). Other signs of withdrawal like headache, shakiness, or feeling agitated, confused, or nervous can also happen. official website and that any information you provide is encrypted Corticosteroids, are, in general, readily absorbed from the gastro-intestinal tract. The clinical presentation may often be atypical, and serious infections such as septicaemia and tuberculosis may be masked and may reach an advanced stage before being recognised. WebStructured withdrawal of desmopressin results in better relapse-free rates. sharing sensitive information, make sure youre on a federal You can see your Bookmarks on your DeepDyve Library. Keywords: J Urol. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate, intra-uterine growth retardation and effects on brain growth and development. Perioperative severe hypernatremia in a patient with central diabetes insipidus. To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you dont already have one. Patients (or parents of children) without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and if exposed they should seek urgent medical attention. Dexamethasone has practically no water and salt-retaining properties, and is therefore particularly suitable for use in patients with cardiac failure or hypertension. Will Paypal Release My Funds After 180 Days, who is the owner of fazbear entertainment. Desmopressin Acetate Nasal Spray . This may help reduce the possibility of withdrawal symptoms, including anxiety, restlessness, fever or chills, joint pain, nausea or vomiting, loss of appetite. excessive. any drug without checking with your doctor. Compared with abrupt withdrawal, structured withdrawal of desmopressin has significantly better relapse-free rates in children with enuresis. Do not flush down a toilet or pour down a drain unless you are told to do so. problems with coordination. These symptoms disappeared with reduction in dosage. 2021 May;180(5):1453-1457. doi: 10.1007/s00431-020-03918-8. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders. These symptoms disappeared with reduction in dosage. The .gov means its official. J Pediatr Urol 10(1):5255 Corticosteroids should only be administered to patients with suspected or identified pheochromocytoma after an appropriate risk/benefit evaluation, Particular care is required when considering the use of systemic corticosteroids in patients with the following conditions and frequent patient monitoring is necessary, a. Osteoporosis (post-menopausal females are particularly at risk), b. Kamperis K, Van Herzeele C, Rittig S, Vande Walle J. Pediatr Nephrol. Chua ME, Silangcruz JM, Chang SJ, Williams K, Saunders M, Lopes RI, Farhat WA, Yang SS.