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home:mp [08.21.2017] – [Olmesartan (Benicar)] sallieqhome:mp [10.16.2017] – [In case of emergency] sallieq
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   * Patients on the MP should not take nimesulide (Aulin / Mesulid / Nimed).  It could cause bleeding. One death has been reported during its use.    * Patients on the MP should not take nimesulide (Aulin / Mesulid / Nimed).  It could cause bleeding. One death has been reported during its use. 
   * Rivaroxaban (Xarelto) increases the risk of bleeding and can cause serious or fatal bleeding. A specific antidote for rivaroxaban is not available.    * Rivaroxaban (Xarelto) increases the risk of bleeding and can cause serious or fatal bleeding. A specific antidote for rivaroxaban is not available. 
 +  * Do not give Telmisartan, it has an over strong action in suppressing the patient's ability to fight infection.
   * Azithromycin is no longer regarded as safe, even in the small quantities formerly recommended for optional use while on MP   * Azithromycin is no longer regarded as safe, even in the small quantities formerly recommended for optional use while on MP
   * **For sicker patients, immunopathology can be physically and mentally challenging** –  Support from a knowledgeable doctor and family/friends becomes of paramount importance. Unless the patient has a good insight into IP and other inconveniences of the treatment, the patient should not start treatment.    * **For sicker patients, immunopathology can be physically and mentally challenging** –  Support from a knowledgeable doctor and family/friends becomes of paramount importance. Unless the patient has a good insight into IP and other inconveniences of the treatment, the patient should not start treatment. 
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 ARF has prepared a [[home:physicians:emergency|Notice for emergency medical personnel]] treating a Marshall Protocol patient. Important points from that document include the following: ARF has prepared a [[home:physicians:emergency|Notice for emergency medical personnel]] treating a Marshall Protocol patient. Important points from that document include the following:
   * **Do not withdraw olmesartan** – In a critical care situation, it is essential to continue oral olmesartan, even in the presence of hypotension, as abrupt withdrawal can be life-threatening. Along with routine lifesaving procedures, it is essential to continue oral olmesartan 40mg dosing every four hours, with 20mg SL p.r.n., until symptoms subside - even if an NG tube is necessary. If B/P is extremely low (mean arterial pressure <55), continue olmesartan as above and increase fluid volume with 0.9 NS or packed red cells.   * **Do not withdraw olmesartan** – In a critical care situation, it is essential to continue oral olmesartan, even in the presence of hypotension, as abrupt withdrawal can be life-threatening. Along with routine lifesaving procedures, it is essential to continue oral olmesartan 40mg dosing every four hours, with 20mg SL p.r.n., until symptoms subside - even if an NG tube is necessary. If B/P is extremely low (mean arterial pressure <55), continue olmesartan as above and increase fluid volume with 0.9 NS or packed red cells.
-  * **antibiotics** – We strongly recommend patients not be treated with MP antibiotics for an acute infection. Unless patients have reached a late stage of the treatment these antibiotics may greatly increase immunopathology as they leave a patient's system. Fluoroquinolone antibiotics may be tolerated although instances of tendon damage have been reported; the patient should be advised of the FDA black-box warnings.  Cephalosporins, Claforin, and the macrolide Biaxin are usually tolerated.+  * **antibiotics** – We strongly recommend patients not be treated with MP antibiotics for an acute infection. Unless patients have reached a late stage of the treatment these antibiotics may greatly increase immunopathology as they leave a patient's system. Cephalosporins, Claforin, and the macrolide Biaxin are usually tolerated. Fluoroquinolone antibiotics may be tolerated although instances of tendon damage have been reported; the patient should be advised of the FDA black-box warnings. 
   * **corticosteroids** – Do not give corticosteroids in any form or by any route (injected, inhaled, oral or IV) as they will lead to metabolic instability.   * **corticosteroids** – Do not give corticosteroids in any form or by any route (injected, inhaled, oral or IV) as they will lead to metabolic instability.
   * Do not give **nimesulide** (Aulin / Mesulid / Nimed).  It could cause bleeding.     * Do not give **nimesulide** (Aulin / Mesulid / Nimed).  It could cause bleeding.  
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 ==== Stopping olmesartan ==== ==== Stopping olmesartan ====
  
-Olmesartan will need to be [[home:mp:break:olmesartan#stopping_olmesartan|weaned gradually]]. Note that the immune response may remain activated for a period of time even after discontinuing olmesartan. Patients who stop olmesartan are terminating their recovery.+Olmesartan will need to be [[home:mp:break:olmesartan#stopping_olmesartan|weaned very gradually]]. Note that the immune response may remain activated for a period of time even after discontinuing olmesartan. Patients who stop olmesartan are terminating their recovery.
  
  
home/mp.txt · Last modified: 09.14.2022 by 127.0.0.1
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