When should patients with lethal ventricular arrhythmias resume driving? an analysis of state regulations and physician practices

Article Abstract:

Certain abnormal heart rhythms known as ventricular arrhythmias can be fatal. Some people may experience an episode of such an arrythmia while being monitored in a medical setting and be resuscitated successfully. They are said to be survivors of sudden cardiac death. These patients are studied extensively with sophisticated monitoring before an appropriate course of treatment is established. The treatment might consist of anti-arrhythmic drugs or the use of an automatic implantable cardioverter-defibrillator, a device inserted into the patient that can deliver an electric shock to the heart when an abnormal rhythm begins. Some patients require both. When people who suffer these lethal arrhythmias can resume normal activities of life, including driving, is not clear. While 42 states have regulations about resumption of driving after experiencing epileptic seizures, few have regulations regarding loss of consciousness from other reasons, such as heart rhythm abnormalities. A random survey of cardiologists, one from each state, was performed, to determine their knowledge of state laws as well as their opinions on when a patient may resume driving after suffering a ventricular arrhythmia. These cardiologists were evenly divided between those who did and those who did not insert the implantable defibrillators. Of the 50 doctors surveyed, only 13 knew the law in their state. Eleven of these were in the group of specialists who place the implantable defibrillators, and only two were general cardiologists. Of the remaining 37, 12 misunderstood their state's law and 25 had no knowledge of it. Of the 6 states with laws about driving after a diagnosis of ventricular arrhythmia, 4 require that a person not drive for 12 months, one for 6 weeks, and one for 18 months. Those people who were treated with drugs were generally advised by their cardiologists that no driving restrictions were necessary, while those with defibrillators were occasionally told never to drive again. The economic and social implications of driving restrictions are great; since an increasing number of the half a million people each year who experience sudden cardiac death are surviving, the costs could become enormous. Some formal study of the issue should be undertaken to ensure safety, uniformity of advice, and perhaps of laws. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Laws, regulations and rules, Surveys, Cardiologists, Automobile driving, Motor vehicle driving, Arrhythmia, Automobile drivers' licenses, Drivers' licenses

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Effects of alcohol and fluvastatin on lipid metabolism and hepatic function

Article Abstract:

Moderate alcohol consumption does not appear to influence the cholesterol-lowering properties of fluvastatin, but may affect drug metabolism. In alternating six-week cycles, researchers treated 20 patients with high blood cholesterol with 40 milligrams of fluvastatin per day or the same dose of fluvastatin combined with 20 grams of ethanol per day. Investigators took blood samples before and after drug therapy to study how fluvastatin and alcohol affected cholesterol levels and drug metabolism. Blood levels of total cholesterol, low density lipoprotein cholesterol, and apolipoprotein B decreased to similar degrees under both treatment regimens. The average amount of time that elapsed after fluvastatin was administered until blood levels of the drug peaked was greater in during treatment with fluvastatin and alcohol compared to fluvastatin alone.

Evaluation, Physiological aspects, Drug therapy, Hypercholesterolemia, Drug-alcohol interactions, Hydroxymethylglutaryl coenzyme A reductases

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Effects of Fexofenadine, Diphenhydramine, and Alcohol on Driving Performance

Article Abstract:

Diphenhydramine may affect drivers as seriously as alcohol does. This antihistamine is used in many allergy and hay-fever medications. In a study of 40 people with seasonal hay-fever, one 50-milligram dose of diphenhydramine had a more serious impact on driving than a blood alcohol concentration of 0.1%. Many of the drivers did not even feel drowsy but still performed poorly in the Iowa Driving Simulator. Fexofenadine had no serious impact on driving ability.

Antihistamines

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