title: Fatal cases of gabexate mesilate-induced anaphylaxis.
abstract: Gabexate mesilate, ethyl-4-(6-guanidinohexanoyloxy) benzoate monomethanesulfonate (C16H23N3 O4CH4O3S: M.W. 417.48), is a synthetic protease inhibitor and was introduced for clinical use in 1978. It rarely induces anaphylaxis, and patients with gabexate mesilate-induced shock had been reported to survive with appropriate treatments including respiratory support. However, there were increasing reports on fatal cases in recent years: 6 cases have been reported to develop fatal anaphylaxis following dripping infusions of gabexate mesilate. All the fatal cases rapidly developed anaphylaxis (within 5 minutes), whereas 7 out of 11 in recovered cases developed it 5 or more minutes after the injection. Venous access should be kept for at least 30 minutes to prepare for and to treat this fatal reaction in patients receiving gabexate mesilate repeatedly.
authors.affiliation: Department of Internal Medicine I, Nihon University School of Medicine, Tokyo, Japan. m-2000@mbk.sphere.ne.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Matsukawa
authors.forename: S
authors.initials: S
authors.lastname: Nishinarita
authors.forename: S
authors.initials: S
authors.lastname: Sawada
authors.forename: T
authors.initials: T
authors.lastname: Horie
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D017809:Fatal Outcome; D005260:Female; D016670:Gabexate / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000517:prevention & control; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects*
chemical_list: D015842:Serine Proteinase Inhibitors; D016670:Gabexate