Swallowing disorders are common in older patients, particularly following a stroke. Moreover, certain medications may exacerbate these disorders. The aim of this study was to assess the prevalence of such medications in patients aged 65 years or over with swallowing disorders hospitalized in a post-stroke unit. An observational study was conducted in a geriatric hospital among patients aged 65 years or over admitted for stroke or transient ischemic attack (TIA). A literature review was first carried out to identify potentially iatrogenic medications. The primary outcome was the prevalence of the use of these medications within 14 days following the assessment of swallowing function. Among the 284 patients included, 113 (39.8%) had swallowing disorders, of whom 110 (97.3%) were taking one or more medications likely to worsen the condition (mean 4.7 ± 2.3 medications). The three most commonly identified medications were amlodipine (9.6%), oxazepam (9.3%), and aspirin (8.7%). The main mechanism involved was dry mouth. These medications are frequently prescribed for the management of risk factors and sequelae following stroke or TIA, highlighting the importance of a multidisciplinary evaluation of their benefit-risk balance.

Drug-mediated phototoxicity and photocarcinogenicity have long remained poorly understood. One of the most significant dilemmas surrounding this issue is the sporadic nature of these reactions. This sporadic occurrence may be explained by modern and newly introduced concepts such as drug-mediated nitrosogenesis of skin cancer, as well as nitroso-photocarcinogenesis of skin cancer. Regardless of their carcinogenic potential, all nitrosamines may exhibit phototoxic properties and may therefore act as photocarcinogenic substances, because of the instability of the nitroso group under UV radiation. Drug-related Nitroso Photocarcinogenesis represents a new and innovative concept that seeks to provide a logical explanation for the phenomenon of nitroso-photocarcinogenicity. Various groups of medications, including antihypertensive agents (beta-blockers, ACE inhibitors, calcium antagonists, centrally acting sympatholytics, and sartans), anticoagulants, antidiabetic drugs, and several other classes, possess secondary amino groups. Under gastric conditions - an acidic environment and in the presence of nitrite-rich food - these amino groups may lead to the formation of nitrosamines, which are well known carcinogens and established photocarcinogens. The subsequent resorption of these drug-mediated nitroso compounds may result in their subsequent deposition in the skin. The decomposition of nitrosamines under the influence of ultraviolet radiation may lead to the release of nitric oxide and/or procarcinogenic mediators capable of damaging DNA of keratinocytes and melanocytes. Thus, in practice, malignant cellular branches may be initiated even when the relevant groups of medications are not externally contaminated with nitrosamines. In this sense, generic drugs from heterogenous classes may effectively act as donors of photocarcinogenic compounds to the human skin. In this context, and in support of the aforementioned modern concept of skin cancer, we present another case of keratinocyte cancer (basal cell carcinoma) that developed relatively shortly after combined intake of four drugs (apixaban, flecainide, amlodipine, and perindopril), each containing a secondary amino group in its structure - serving as a potential precursor for the generation of photocarcinogens in the stomach. The skin cancer has been removed surgically without "!" The defect has been treated via nasal tip rotation flap as dermatosurgical approach. The role of endogenous, gastric related Nitrosogenesis during intake of potentially completely uncontaminated drugs (containing secondary amino groups in their chemical structure), in relation to nitroso-photocacinogenesis and the subsequent development of skin cancer, is discussed.

Activated charcoal is widely used in the medical management of acute intoxications, yet its gross appearance at autopsy is poorly described and may represent a diagnostic pitfall. We report a case highlighting this issue. An elderly man with a history of cardiovascular disease, diabetes mellitus, and prostate cancer was found unresponsive in his closed residential garage after making suicidal statements. Open bottles of amlodipine and glimepiride were found on his person. He was hospitalized, where routine toxicology screening was negative, and he died in the intensive care unit less than 24 h after admission. At autopsy, the stomach contained an abundant amount of dense, black, odorless, thick material adherent to the gastric mucosa which wiped off after gentle cleaning. After removal, the underlying mucosa was intact, without hemorrhage or ulceration. Review of medical records indicated that activated charcoal had been administered during hospitalization due to concern for intentional medication ingestion. Subsequent expanded toxicology testing demonstrated a markedly elevated amlodipine concentration, consistent with acute toxicity. The cause of death was certified as amlodipine toxicity, and the manner of death as suicide. This case illustrates the characteristic gross appearance of activated charcoal in the stomach and discusses its potential to mimic other causes of black gastric contents, including gastrointestinal hemorrhage, caustic ingestion, Wischnewsky spots, hydrocarbons, black esophagus, and iron deposition. Awareness of this finding and careful correlation of gross autopsy findings with medical history and toxicologic results are essential to avoid misinterpretation and diagnostic error in forensic practice.

Introduction Calcium channel blockers (CCBs), particularly amlodipine, are among the most widely prescribed antihypertensive agents globally. However, no comprehensive disproportionality analysis has quantified this association. This pharmacovigilance study utilized the FDA Adverse Event Reporting System (FAERS) to evaluate the reporting association between CCBs and pseudolymphoma. Methods The FAERS database was parsed through its 14,104,743 adverse event reports. Five CCBs were evaluated: three dihydropyridines (amlodipine, nifedipine, felodipine) and two non-dihydropyridines (diltiazem, verapamil). Disproportionality was quantified using reporting odds ratios. The MedDRA preferred term "pseudolymphoma" was employed for case identification. Results Among 319 pseudolymphoma reports, 44 were associated with dihydropyridines and 1 with non-dihydropyridines. Amlodipine demonstrated the strongest signal (ROR 38.08, 95% CI 27.60-52.54; n=42), followed by nifedipine (ROR 18.61, 95% CI 4.64-74.74; n=2). Diltiazem showed a non-significant signal (ROR 5.47, 95% CI 0.77-38.93; n=1). Felodipine and verapamil yielded no reports. Dihydropyridines exhibited 7- to 70-fold greater reporting odds ratios compared with non-dihydropyridines. Conclusions This analysis establishes a robust, though not causal, class-specific safety signal linking dihydropyridine CCBs, particularly amlodipine, to pseudolymphoma risk. The substantial disproportionality suggests a pharmacologically mediated mechanism requiring heightened clinical surveillance, prompt recognition, and timely drug discontinuation to prevent potential malignant transformation.

Objectives: As widely used first-line antihypertensive drugs, dihydropyridine calcium channel blockers (DHP-CCBs) have relatively few studies comparing their adverse reactions based on real-world data. This study aims to identify and compare the potential adverse drug reaction (ADR) signals of four DHP-CCBs (amlodipine, felodipine, nicardipine, and nifedipine) through the US Food and Drug Administration Adverse Event Reporting System (FAERS), providing a reference for further drug safety assessment and clinical medication risk awareness. Methods: Adverse event reports from medical professionals (Q3 2014-Q4 2024) were analyzed using signal detection methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and the Medicines and Healthcare Products Regulatory Agency (MHRA) methods. Risk signals for the four DHP-CCBs were compared with both the full database and the DHP-CCBs background. For high-risk signals in amlodipine, multivariate logistic regression was used for validation. The analysis reveals distinct ADR profiles for the four DHP-CCBs. Results: Amlodipine is strongly linked to suicide-related risks, confirmed by logistic regression. Nicardipine and nifedipine show significant risks for pregnancy-related events, such as premature delivery and exposure during pregnancy. Nicardipine is also associated with hyponatremia, hyperkalemia, and lactic acidosis. These adverse events are not yet included in the FDA labeling for any of the DHP-CCBs. Although palpitations and angioedema are listed for felodipine, their signal strength is much higher compared to the other DHP-CCBs. Conclusions: The ADR risk profiles of the four DHP-CCBs differ significantly. This study identified several high-risk adverse events not included in current labels. Clinical use should consider each drug's risk profile and patient-specific factors, with particular attention to serious risk signals. For pregnant and postpartum women, the benefits and risks of using nicardipine and nifedipine should be carefully evaluated.