29:T550,

Objective: To review the efficacy, safety, and tolerability of a sublingual formulation of cyclobenzaprine for the treatment of fibromyalgia. Data Sources: A literature search was conducted through PubMed and DrugBank using the following terms: cyclobenzaprine, fibromyalgia, sublingual, Tonmya^TM, and TNX-102 SL. Study Selection and Data Extraction: Articles describing the pharmacology, pharmacokinetics, efficacy, safety, and/or tolerability of sublingual cyclobenzaprine were included in this review. Data Synthesis: Cyclobenzaprine is a tricyclic antidepressant like agent which exhibits sedative and muscle relaxant effects in the treatment of fibromyalgia. Clinical trials have demonstrated improvements in daily pain scores compared with placebo. Common adverse events associated with this agent include oral hypoesthesia, oral paresthesia, and abnormal taste. Conclusions: Pharmacologic agents receive a weak recommendation for use in the treatment guidelines and include agents such as duloxetine, pregabalin, tramadol, amitriptyline, and a nonsublingual formulation of cyclobenzaprine. Tonmya, the newest agent approved for fibromyalgia, provides clinicians with an additional treatment option in a convenient dosage form for this potentially debilitating condition.

2a:T4f1,

Objective: We report a unique case of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) possibly related to administering daptomycin and ceftaroline for persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We describe treatment strategies and challenges of determining drug causality when multiple antimicrobials are administered. Case: A 78-year-old male developed SJS/TEN during week 6 of daptomycin and ceftaroline therapy. Other antimicrobials administered within the previous 8 weeks included vancomycin, meropenem, piperacillin/tazobactam, levofloxacin, and fluconazole. Causality was assessed using the Algorithm of Drug Causality for Epidermal Necrolysis, which indicated probable association with ceftaroline and possible association with daptomycin. Management included discontinuing both agents, transferring to a burn intensive care unit, wound care, and treatment with intravenous immunoglobulin. Discussion/Conclusion: Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of daptomycin and ceftaroline is rare. Appropriate and timely diagnosis and management by a multidisciplinary team led to favorable clinical outcomes.

2b:T4b2,

Objective: Acute pancreatitis is an inflammatory disorder of the pancreas with diverse etiologies, including rare drug-induced causes such as propofol. Propofol-associated acute pancreatitis has been linked to hypertriglyceridemia; however, causal attribution is particularly challenging in patients with chronic kidney disease, due to metabolic disturbances and overlapping clinical features. Case: We report the case of a 49-year-old female with end-stage chronic kidney disease admitted with septic shock requiring mechanical ventilation and continuous sedation with propofol infused at 70 mg/h. After 8 days of therapy, she developed progressive hypertriglyceridemia followed by clinical and biochemical findings consistent with acute pancreatitis. Common etiologies were excluded, and the temporal relationship supported a probable adverse drug reaction. Discussion/Conclusions: This case highlights the diagnostic and causal complexity of acute pancreatitis in critically ill patients with advanced chronic kidney disease and underscores the importance of vigilant metabolic monitoring and multidisciplinary medication review during propofol therapy.