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ABSTRACT: Drug-induced bleeding presents in many ways, including excessive bruising, nosebleeds, heavy menses, gastrointestinal bleeding, and rectal bleeding. Drug-induced bleeding is potentiated by numerous drugs, natural medicines, and drug-drug interactions. Pharmacists should be aware of patient-specific risk factors and should actively monitor for medications that contribute to bleeding. By minimizing the risk of drug-induced bleeding in patients, pharmacists have the opportunity to reduce long-term adverse effects. In addition, pharmacists can educate patients on ways to reduce the risk of drug-induced bleeding and help them recognize the symptoms of drug-induced bleeding. Drug-induced bleeding is commonly thought of as gastrointestinal GI bleeding resulting from the use of nonsteroidal anti-inflammatory drugs NSAIDs. Nosebleeds and abnormal bruising, in addition to GI bleeding, may be linked to the use of oral anticoagulants. Hemorrhoidal bleeding may be associated with drugs that cause constipation. In addition, other predictors that may contribute to or cause an increase in bleeding include advancing age, the use of multiple drugs, drug-drug interactions, and coexisting diseases or conditions. This article will focus on drug-induced bleeding that is caused primarily by agents other than NSAIDs. Selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors are reported to inhibit the reuptake of serotonin into platelets, resulting in an increased risk of bleeding. Fluoxetine and fluvoxamine pose additional risks since they inhibit warfarin metabolism by CYP enzymes. Anticoagulants are used for the prevention and treatment of deep venous thrombosis, pulmonary embolism, and thromboembolism and for the prevention of stroke in atrial fibrillation. NOAs are direct inhibitors of factor Xa rivaroxaban, apixaban, edoxaban and thrombin factor IIa, dabigatran. Bleeding associated with their use is treated with the administration of RBCs and plasma, activated prothrombin complex concentrate, or recombinant factor VIIa, hemodialysis, or idarucizumab for dabigatran. This symptom may be perplexing to patients who cannot differentiate between dyspepsia and abdominal pain associated with bleeding. Untreated constipation can lead to complications, including hemorrhoids, anal fissures with rectal bleeding, and rectal prolapse. Certain natural medicines and supplements have been reported to cause bleeding either on their own or when used in combination with other drugs. TABLE 3 lists common natural medicines that affect platelet aggregation and could elicit bleeding. Medication reconciliation and patient education prevent moderate or significant drug-drug interactions. It is recommended to check the international normalized ratio INR 5 days after initiation of an antimicrobial or antibiotic in patients taking warfarin. Risk factors for increased bleeding include use of a drug or natural medicine that has the potential for bleeding TABLES ; concomitant use of drugs causing drug-drug interactions TABLE 4 ; advancing age; prior history of GI bleeding; decreased renal function; uncontrolled hypertension; regular or excessive use of alcohol; and the presence of Helicobacter pylori. Prescribing information and FDA Medication Guides instruct patients to immediately contact their healthcare provider if symptoms of bleeding are present. Signs and symptoms of minor bleeding include gum bleeding, occasional nosebleeds, easy bruising, or bleeding that takes longer than normal to stop. Education on reducing the risk of bleeding includes the recommendation to avoid all drugs that interact with anticoagulants and other drugs known to potentiate bleeding TABLES 1 and 2. If analgesia is needed, acetaminophen at a maximum dosage of 2 g per day may be used. Patients should be counseled not to double up on doses in the event of missing a dose and not to skip doses in an effort to save money. Patients should be encouraged to document their compliance with an electronic device or on a calendar. A current medication card should be maintained at all times so that all healthcare providers are aware of all medications. In some cases, a sudden or severe episode of headache, dizziness, faintness, or weakness will occur before the medical emergency. Other emergency symptoms that are linked to bleeding or stroke include unusual pain or swelling and abnormalities in vision, speech, or gait. Dietary guidelines to maintain a consistent diet are important for patients taking warfarin. Sudden changes in diet to include high or extra intake of green, leafy vegetables or other foods high in vitamin K will cause the blood to clot, resulting in a lower INR and an increased risk of bleeding. Finally, patients who are taking drugs that could potentiate bleeding because of constipation should be advised to increase fruit and vegetable intake, increase fluid intake, make sure that at least one-half of all grains they consume are whole grains, and consume 25 g to 38 g of fiber daily. In addition to patient education on the signs of bleeding and how to minimize bleeding risk, pharmacists play an important role in helping reduce the risk of drug-induced bleeding by monitoring patient medication profiles for potential drug-drug interactions and by conducting patient interviews to identify other items that may increase risk, such as advanced age, alcohol consumption, use of natural medicines, past medical history, and family history. Bleeding as a result of medication therapy is a severe complication that has a negative impact on patient safety. In many cases, bleeding is not easily identified as a drug-induced problem. Pharmacists can play a pivotal role in minimizing the development of drug-induced bleeding by being aware of the contributing risk factors and medications. Coumadin warfarin product information. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Bleeding incidence with concomitant use of antidepressants and warfarin. Ther Drug Monit. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study. Gastrointestinal bleeding with the new oral anticoagulants—defining the issues and the management strategies. Thromb Haemost. Novel oral anticoagulants in gastroenterology practice. Gastrointest Endosc. Bleeding risk with dabigatran in the frail elderly. N Engl J Med. Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study. Pradaxa dabigatran product information. Accessed June 27, Natural Medicines Comprehensive Database. Accessed June 14, Warfarin with fluoroquinolones, sulfonamides, or azole antifungals: interactions and the risk of hospitalization for gastrointestinal bleeding. Clin Pharmacol Ther. Clopidogrel and proton pump inhibitors—where do we stand in ? World J Gastroenterol. Plavix clopidogrel product information. Celexa citalopram product information. Heparin sodium injection product monograph. Ketorolac tromethamine product information. Feldene piroxicam product information. Xarelto rivaroxaban product information. Effexor XR venlafaxine product information. In: Cohen H, ed. Casebook in Clinical Pharmacokinetics and Drug Dosing. Peptic ulcer disease. Pharmacotherapy: A Pathophysiologic Approach. American Heart Association. Effect of acetaminophen on international normalized ratio in patients receiving warfarin therapy. Featured Issue Featured Supplements. US Pharm. Patient Education Prescribing information and FDA Medication Guides instruct patients to immediately contact their healthcare provider if symptoms of bleeding are present. Conclusion Bleeding as a result of medication therapy is a severe complication that has a negative impact on patient safety. To comment on this article, contact rdavidson uspharmacist. Related CE. View More CE. Related Content. All rights reserved. Reproduction in whole or in part without permission is prohibited.

Ecstasy (MDMA)

Buying MDMA pills Bled

MDMA is an illegal drug with stimulant effects. It can also cause hallucinations. The drug gained popularity in the s with young adults at large music festivals and all-night dance parties or raves. A person experiences feelings of euphoria, increased energy, intimacy and emotional warmth, sensitivity to touch, and a distortion of time and of the senses. People frequently take Ecstasy with other illegal drugs, and pills that people sell as MDMA on the street can contain additives. These factors can contribute to serious and sometimes fatal health effects. MDMA can also be addictive, and research suggests that long-term thinking problems may develop in some people who use it. MDMA 3,4-methylenedioxy-methamphetamine is an artificial drug that people legally used in the s for psychotherapy treatment despite a lack of data to support its effectiveness. This category refers to a drug with high abuse potential and of no recognized medicinal use. People mainly take MDMA by swallowing a capsule or tablet. They can also snort or smoke it as a powder. A person taking the drug will feel the effect within 1 hour, and it can last up to 6 hours. Users commonly take a second dose as the first wears off. These include increased heart rate and blood pressure , decreased appetite, and increased energy. MDMA works by increasing the production of serotonin , dopamine, and norepinephrine. Serotonin also triggers the release of other hormones that can cause feelings of attraction and intimacy. As a result, people may become more affectionate than usual and feel a connection with strangers. The effects last for an average of 3 hours , but people who take a moderate amount may experience withdrawal side effects for a week after. These include :. Not all the effects are predictable because pure Ecstasy can contain other unwanted drugs or chemicals. As the drug is illegal, there is no government regulation over its production. These harmful substances can be particularly dangerous when a person mixes them with MDMA. When people buy MDMA from dealers on the street, they do not know what they are taking. Ingesting other substances, such as cannabis or cocaine, along with MDMA greatly increases the danger of adverse reactions. Deaths have had links to some fatal batches of MDMA. People use MDMA because it enhances feelings of alertness, euphoria, and physical and mental powers. However, there are also some common adverse effects, some severe risks, and possible long-term damage. These stimulant effects, in combination with prolonged physical activity, a hot environment, and other drugs, can result in unpredictable and serious physical complications. Deaths from MDMA use mostly result from hyperthermia. This refers to a sudden increase in body temperature, cardiovascular collapse, or significant dehydration. These can lead to liver, kidney, or heart failure and even death. These signs indicate an emergency. A person needs to seek immediate medical attention if they experience the above MDMA use. The brain can take days or weeks to replenish the serotonin. Side effects of moderate use can persist for a week after using it. Some users continue to use the drug despite experiencing negative consequences. This suggests MDMA has the potential for addiction , although researchers have not yet confirmed this. Due to the altered sense of reality due to MDMA use, people who have taken it can make dangerous decisions without concern that these could lead to negative consequences. The often-added impurities, in combination with the physical rigor of an all-night dance party experience, make taking any form of MDMA significantly dangerous. Learn about its uses and…. Researchers are looking into whether MDMA, also known as ecstasy, can help treat depression by increasing serotonin levels. Learn more here. What are the dangers of mixing MDMA and alcohol? Read on to find out the risks of mixing both, precautions to take, and treatment options. The length of time that molly, or MDMA, stays in the system depends on many factors, including the amount taken. Medical News Today. News Latest News. Podcasts All 3 ways to slow down type 2 diabetes-related brain aging Toxic metals in tampons: Should you be worried? Can tattoos cause blood or skin cancer? What makes a diet truly heart-healthy? Is intermittent fasting actually bad for your heart? Newsletters Sign Up. Follow Us. Fast facts on MDMA. Some people perceive MDMA as a safe party drug, but its effects can be lethal. Tablets that people sell as pure Ecstasy can contain highly toxic additives. A person can feel the adverse after-effects of Ecstasy for a week or more. What is MDMA? MDMA has many of the same physical effects as other stimulants such as cocaine and amphetamines. Adverse effects and risks. Long-term effects. Animal studies show that MDMA in moderate to high doses can damage nerve cells in the brain. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Share this article. Latest news Study detects early Alzheimer's 'stealth' phase before symptoms set in. Can standing too much be harmful to heart health? Semaglutide boosts heart health, weight loss but may lead to gut problems. Tenecteplase more likely to lead to 'excellent' stroke recovery, study finds. Mitochondria may trigger Crohn's disease by disrupting the gut microbiome. Related Coverage. What is MDMA therapy used for? Can MDMA treat depression? Medically reviewed by Timothy J. Legg, PhD, PsyD. What happens when you mix MDMA and alcohol? Medically reviewed by Sirisha Yellayi, DO. How long does molly stay in your system?

Buying MDMA pills Bled