title: When Hydromorphone Is Not Working, Try Loratadine: An Emergency Department Case of Loratadine as Abortive Therapy for Severe Pegfilgrastim-Induced Bone Pain.
abstract: BACKGROUND
  Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF-induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics.
  
  
  METHODS
  This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug-resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case suggests that loratadine may be an easy to implement, safe, and effective therapy in the emergency department management of intractable bone pain caused by G-CSF use. Emergency physicians should be aware that loratadine may successfully relieve otherwise intractable G-CSF-induced bone pain and allow for discharge home.
authors.affiliation: Department of Emergency Medicine, Medical Toxicology, Cooper University Hospital, Camden, New Jersey.
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.affiliation: Department of Emergency Medicine, Medical Toxicology, Cooper University Hospital, Camden, New Jersey; Cooper Medical School of Rowan University, Medical Toxicology, Cooper University Hospital, Camden, New Jersey.
authors.forename: Rachel
authors.initials: R
authors.lastname: Haroz
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D001842:Bone and Bones / Q000503:physiopathology*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D017336:Loratadine / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000188:drug therapy; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D017336:Loratadine; D000069585:Filgrastim; D004091:Hydromorphone
keywords: Neulasta; Neupogen; bone pain; emergency department; filgrastim; loratadine; pain control; pegfilgrastim