Adverse drug reaction
Encyclopedia
An adverse drug reaction (abbreviated ADR) is an expression that describes harm associated with the use of given medication
s at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug
or result from the combination of two or more drugs. The meaning of this expression differs from the meaning of "side effect
", as this last expression might also imply that the effects can be beneficial. The study of ADRs is the concern of the field known as pharmacovigilance
.
Types A and B were proposed in the 1970s, and the other types were proposed subsequently when the first two proved insufficient to classify ADRs.
defines a serious adverse event as one when the patient outcome is one of the following:
Severity is a point on an arbitrary scale of intensity of the adverse event in question. The terms "severe" and "serious" when applied to adverse events are technically very different. They are easily confused but can not be used interchangeably, require care in usage.
A headache is severe, if it causes intense pain. There are scales like "visual analog scale" that help us assess the severity. On the other hand, a headache is not usually serious (but may be in case of subarachnoid haemorrhage, subdural bleed, even a migrane may temporally fit criteria), unless it also satisfies the criteria for seriousness listed above.
Drug Risk Rating System is a five color rating scale similar to the Homeland Security Advisory System
:
s may be local, i.e. limited to a certain location, or systemic, where a medication has caused adverse effects throughout the systemic circulation
.
For instance, some ocular antihypertensives cause systemic effects, although they are administered locally as eye drop
s, since a fraction escapes to the systemic circulation.
or hepatic
insufficiency, may alter drug metabolism. Resources are available that report changes in a drug's metabolism due to disease states.
is the study of the inherited basis for abnormal drug reactions.
Inheriting abnormal allele
s of cytochrome
P450 can alter drug metabolism. Tables are available to check for drug interactions due to P450 interactions.
Inheriting abnormal butyrylcholinesterase (pseudocholinesterase) may affect metabolism of drugs such as succinylcholine
Inheriting abnormal N-acetyltransferase
which conjugated some drugs to facilitate excretion may affect the metabolism of drugs such as isoniazid
, hydralazine
, and procainamide
.
Inheriting abnormal thiopurine S-methyltransferase
may affect the metabolism of the thiopurine
drugs mercaptopurine
and azathioprine
.
s is increased with polypharmacy
.
These interactions are usually transient and mild until a new steady state is achieved. These are mainly for drugs without much first-pass liver metabolism. The principal plasma proteins for drug binding are:
Some drug interactions with warfarin
are due to changes in protein binding.
Patients have abnormal metabolism by cytochrome
P450 due to either inheriting abnormal allele
s or due to drug interactions. Tables are available to check for drug interactions due to P450 interactions.
.
, the Venulet algorithm and the WHO causality term assessment criteria. Each have pros and cons associated with their use and most require some level of expert judgement to apply.
An ADR should not be labeled as 'certain' unless the ADR abates with a challenge-dechallenge-rechallenge
protocol (stopping and starting the agent in question). The chronology of the onset of the suspected ADR is important, as another substance or factor may be implicated as a cause; co-prescribed medications and underlying psychiatric conditions may be factors in the ADR.
A simple scale is available at http://annals.org/cgi/content/full/140/10/795.
Assigning causality to a specific agent often proves difficult, unless the event is found during a clinical study or large databases are used. Both methods have difficulties and can be fraught with error. Even in clinical studies some ADRs may be missed. Psychiatric ADRs are often missed as they are grouped together in the questionnaires used to assess the population http://www.ncbi.nlm.nih.gov/pubmed/20852483.
runs the Uppsala Monitoring Centre
, and the European Union
runs the European Medicines Agency
(EMEA). In the United States
, the Food and Drug Administration
(FDA) is responsible for monitoring post-marketing studies.
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
or result from the combination of two or more drugs. The meaning of this expression differs from the meaning of "side effect
Side effect
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences of the use of a drug.Occasionally, drugs are...
", as this last expression might also imply that the effects can be beneficial. The study of ADRs is the concern of the field known as pharmacovigilance
Pharmacovigilance
Pharmacovigilance is the pharmacological science relating to the detection, assessment, understanding and prevention of adverse effects, particularly long term and short term side effects of medicines...
.
Cause
- Type A: Augmented pharmacologic effects - dose dependent and predictable
- Intolerance
- Side Effects
- Type B: Bizarre effects (or idiosyncraticIdiosyncratic drug reactionIdiosyncratic drug reactions, also known as type B reactions, are drug reactions that occur rarely and unpredictably amongst the population. This is not to be mistaken with idiopathic, which implies that the cause is not known...
) - dose independent and unpredictable - Type C: Chronic effects
- Type D: Delayed effects
- Type E: End-of-treatment effects
- Type F: Failure of therapy
- typeG: Genetic reactions
Types A and B were proposed in the 1970s, and the other types were proposed subsequently when the first two proved insufficient to classify ADRs.
Seriousness and Severity
The American Food and Drug AdministrationFood and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
defines a serious adverse event as one when the patient outcome is one of the following:
- Death
- Life-threatening
- Hospitalization (initial or prolonged)
- Disability - significant, persistent, or permanent change, impairment, damage or disruption in the patient's body function/structure, physical activities or quality of life.
- Congenital anomaly
- Requires intervention to prevent permanent impairment or damage
Severity is a point on an arbitrary scale of intensity of the adverse event in question. The terms "severe" and "serious" when applied to adverse events are technically very different. They are easily confused but can not be used interchangeably, require care in usage.
A headache is severe, if it causes intense pain. There are scales like "visual analog scale" that help us assess the severity. On the other hand, a headache is not usually serious (but may be in case of subarachnoid haemorrhage, subdural bleed, even a migrane may temporally fit criteria), unless it also satisfies the criteria for seriousness listed above.
Overall Drug Risk
While no official scale exists yet to communicate overall drug risk, the iGuardIGuard
The holding company for MediGuard.org is iGuard Inc.. The aim of the company is to monitor the safety of prescription medicines, over-the-counter medicines and healthcare supplements. As of February 2011, there are over 2,480,000 registered users in the company's web-site...
Drug Risk Rating System is a five color rating scale similar to the Homeland Security Advisory System
Homeland Security Advisory System
In the United States, the Homeland Security Advisory System was a color-coded terrorism threat advisory scale. The different levels trigger specific actions by federal agencies and state and local governments, and they affect the level of security at some airports and other public facilities. It...
:
- Red (high risk)
- Orange (elevated risk)
- Yellow (guarded risk)
- Blue (general risk)
- Green (low risk)
Location
Adverse effectAdverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s may be local, i.e. limited to a certain location, or systemic, where a medication has caused adverse effects throughout the systemic circulation
Systemic circulation
Systemic circulation is the part of the cardiovascular system which carries oxygenated blood away from the heart to the body, and returns deoxygenated blood back to the heart. This physiologic theory of circulation was first described by William Harvey...
.
For instance, some ocular antihypertensives cause systemic effects, although they are administered locally as eye drop
Eye drop
Eye drops are saline-containing drops used as a route to administer medication in the eye. Depending on the condition being treated, they may contain steroids, antihistamines, sympathomimetics, beta receptor blockers, parasympathomimetics, parasympatholytics, prostaglandins, non-steroidal...
s, since a fraction escapes to the systemic circulation.
Mechanisms
As research better explains the biochemistry of drug use, fewer ADRs are Type B and more are Type A. Common mechanisms are:- Abnormal pharmacokinetics due to
- geneticGeneticsGenetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
factors - comorbidComorbidityIn medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...
disease states
- genetic
- Synergistic effects between either
- a drug and a disease
- two drugs
Comorbid disease states
Various diseases, especially those that cause renalRenal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
or hepatic
Liver failure
Acute liver failure is the appearance of severe complications rapidly after the first signs of liver disease , and indicates that the liver has sustained severe damage . The complications are hepatic encephalopathy and impaired protein synthesis...
insufficiency, may alter drug metabolism. Resources are available that report changes in a drug's metabolism due to disease states.
Genetic factors
Abnormal drug metabolism may be due to inherited factors of either Phase I oxidation or Phase II conjugation. PharmacogenomicsPharmacogenomics
Pharmacogenomics is the branch of pharmacology which deals with the influence of genetic variation on drug response in patients by correlating gene expression or single-nucleotide polymorphisms with a drug's efficacy or toxicity...
is the study of the inherited basis for abnormal drug reactions.
Phase I reactions
Inheriting abnormal allele
Allele
An allele is one of two or more forms of a gene or a genetic locus . "Allel" is an abbreviation of allelomorph. Sometimes, different alleles can result in different observable phenotypic traits, such as different pigmentation...
s of cytochrome
Cytochrome
Cytochromes are, in general, membrane-bound hemoproteins that contain heme groups and carry out electron transport.They are found either as monomeric proteins or as subunits of bigger enzymatic complexes that catalyze redox reactions....
P450 can alter drug metabolism. Tables are available to check for drug interactions due to P450 interactions.
Inheriting abnormal butyrylcholinesterase (pseudocholinesterase) may affect metabolism of drugs such as succinylcholine
Phase II reactions
Inheriting abnormal N-acetyltransferase
Acetyltransferase
Acetyltransferase is a type of transferase enzyme that transfers an acetyl group.Examples include:* Histone acetyltransferases including CBP histone acetyltransferase* Choline acetyltransferase* Chloramphenicol acetyltransferase...
which conjugated some drugs to facilitate excretion may affect the metabolism of drugs such as isoniazid
Isoniazid
Isoniazid , also known as isonicotinylhydrazine , is an organic compound that is the first-line antituberculosis medication in prevention and treatment. It was first discovered in 1912, and later in 1951 it was found to be effective against tuberculosis by inhibiting its mycolic acid...
, hydralazine
Hydralazine
Hydralazine is a direct-acting smooth muscle relaxant used to treat hypertension by acting as a vasodilator primarily in arteries and arterioles...
, and procainamide
Procainamide
Procainamide INN is a pharmaceutical antiarrhythmic agent used for the medical treatment of cardiac arrhythmias, classified by the Vaughan Williams classification system as class Ia.-History:...
.
Inheriting abnormal thiopurine S-methyltransferase
Thiopurine methyltransferase
Thiopurine methyltransferase or thiopurine S-methyltransferase is an enzyme that methylates thiopurine compounds. The methyl donor is S-adenosyl-L-methionine, which is converted to S-adenosyl-L-homocysteine....
may affect the metabolism of the thiopurine
Thiopurine
The thiopurine drugs are purine antimetabolites widely used in the treatment of acute lymphoblastic leukemia, autoimmune disorders , and organ transplant recipients.Metabolism is catalyzed by S-methyltransferase....
drugs mercaptopurine
Mercaptopurine
Mercaptopurine is an immunosuppressive drug.It is a thiopurine.-Uses:...
and azathioprine
Azathioprine
Azathioprine is a purine analogue immunosuppressive drug. It is used to prevent organ rejection following organ transplantation and to treat a vast array of autoimmune diseases, including rheumatoid arthritis, pemphigus, inflammatory bowel disease , multiple sclerosis, autoimmune hepatitis, atopic...
.
Interactions with other drugs
The risk of drug interactionDrug interaction
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...
s is increased with polypharmacy
Polypharmacy
Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....
.
Protein binding
These interactions are usually transient and mild until a new steady state is achieved. These are mainly for drugs without much first-pass liver metabolism. The principal plasma proteins for drug binding are:
- albuminAlbuminAlbumin refers generally to any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat denaturation. They are commonly found in blood plasma, and are unique to other blood proteins in that they are not glycosylated...
- α1-acid glycoprotein
- lipoproteins
Some drug interactions with warfarin
Warfarin
Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
are due to changes in protein binding.
Cytochrome P450
Patients have abnormal metabolism by cytochrome
Cytochrome
Cytochromes are, in general, membrane-bound hemoproteins that contain heme groups and carry out electron transport.They are found either as monomeric proteins or as subunits of bigger enzymatic complexes that catalyze redox reactions....
P450 due to either inheriting abnormal allele
Allele
An allele is one of two or more forms of a gene or a genetic locus . "Allel" is an abbreviation of allelomorph. Sometimes, different alleles can result in different observable phenotypic traits, such as different pigmentation...
s or due to drug interactions. Tables are available to check for drug interactions due to P450 interactions.
Synergistic effects
An example of synergism is two drugs that both prolong the QT intervalQT interval
In cardiology, the QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart's electrical cycle. In general, the QT interval represents electrical depolarization and repolarization of the left and right ventricles...
.
Assessing causality
Causality assessment is used to determine the likelihood that a drug caused a suspected ADR. There are a number of different methods used to judge causation, including the Naranjo algorithmNaranjo algorithm
The Naranjo algorithm, Naranjo Scale, or Naranjo Nomogram is a questionnaire designed by Naranjo et al. for determining the likelihood of whether an ADR is actually due to the drug rather than the result of other factors. Probability is assigned via a score termed definite, probable, possible or...
, the Venulet algorithm and the WHO causality term assessment criteria. Each have pros and cons associated with their use and most require some level of expert judgement to apply.
An ADR should not be labeled as 'certain' unless the ADR abates with a challenge-dechallenge-rechallenge
Challenge-dechallenge-rechallenge
Challenge-dechallenge-rechallenge is a medical testing protocol in which a medicine or drug is administered, withdrawn, then re-administered, while being monitored for adverse effects at each stage...
protocol (stopping and starting the agent in question). The chronology of the onset of the suspected ADR is important, as another substance or factor may be implicated as a cause; co-prescribed medications and underlying psychiatric conditions may be factors in the ADR.
A simple scale is available at http://annals.org/cgi/content/full/140/10/795.
Assigning causality to a specific agent often proves difficult, unless the event is found during a clinical study or large databases are used. Both methods have difficulties and can be fraught with error. Even in clinical studies some ADRs may be missed. Psychiatric ADRs are often missed as they are grouped together in the questionnaires used to assess the population http://www.ncbi.nlm.nih.gov/pubmed/20852483.
Monitoring bodies
Many countries have official bodies that monitor drug safety and reactions. On an international level, the WHOWho
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
runs the Uppsala Monitoring Centre
Uppsala Monitoring Centre
The Uppsala Monitoring Centre , located in Uppsala, Sweden, is the field name for the World Health Organization Collaborating Centre for International Drug Monitoring...
, and the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
runs the European Medicines Agency
European Medicines Agency
The European Medicines Agency is a European agency for the evaluation of medicinal products. From 1995 to 2004, the European Medicines Agency was known as European Agency for the Evaluation of Medicinal Products.Roughly parallel to the U.S...
(EMEA). In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, the Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) is responsible for monitoring post-marketing studies.
Examples of adverse effects associated with specific medications
| Condition | Substance |
|---|---|
| misoprostol Misoprostol Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D... (Cytotec), a labor-inducing drug (this is a case where the adverse effect has been used legally and illegally for performing abortions) |
|
| many sedatives and analgesics such as diazepam Diazepam Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,... , morphine Morphine Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more... , etc. |
|
| Thalidomide Thalidomide Thalidomide was introduced as a sedative drug in the late 1950s that was typically used to cure morning sickness. In 1961, it was withdrawn due to teratogenicity and neuropathy. There is now a growing clinical interest in thalidomide, and it is introduced as an immunomodulatory agent used... and Accutane |
|
| aspirin Aspirin Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer... therapy |
|
| COX-2 inhibitors (i.e. Vioxx) | |
| gentamicin Gentamicin Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. However, gentamicin is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila... (an antibiotic Antibiotic An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of... ) |
|
| propofol Propofol Propofol is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. Propofol is also commonly used in veterinary medicine... (Diprivan) |
|
| heart bypass surgery | |
| interferon Interferon Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to... |
|
| atypical antipsychotic Atypical antipsychotic The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia... medications (neuroleptic psychiatric drugs) |
|
| orlistat Orlistat Orlistat , also known as tetrahydrolipstatin, is a drug designed to treat obesity. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake... (Xenical) |
|
| many drugs, such as antidepressant Antidepressant An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;... s |
|
| vaccination Vaccination Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens... (in the past, imperfectly manufactured vaccines, such as BCG Bacillus Calmette-Guérin Bacillus Calmette-Guérin is a vaccine against tuberculosis that is prepared from a strain of the attenuated live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans by being specially subcultured in an artificial medium for 13 years, and also prepared from... and poliomyelitis Poliomyelitis Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route... , have caused the very disease they intended to fight). |
|
| corticosteroid Corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte... -based eye drops Eye Drops Eye Drops was a television program on TechTV that showcased short computer animation movies and clips made using off the shelf 3D animation software. The show claimed to showcase all different types of animation, but only a very small number of shorts featured non-CG animation... |
|
| chemotherapy Chemotherapy Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen.... against cancer Cancer Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the... , leukemia Leukemia Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases... , etc. |
|
| spinal anesthesia | |
| ephedrine Ephedrine Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia.... users, which prompted FDA to remove the status of dietary supplement Dietary supplement A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet... of ephedra Ephedra Ephedra refers to the plant Ephedra sinica. E. sinica, known in Chinese as ma huang , has been used in traditional Chinese medicine for 5,000 years for the treatment of asthma and hay fever, as well as for the common cold... extracts |
|
| stimulants, Ritalin, Adderall Adderall Adderall is a brand name of amphetamine salts–based medication used for attention-deficit hyperactivity disorder and narcolepsy. It is a brand-name psychostimulant medication composed of racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide, and... , etc. |
|
| stavudine Stavudine Stavudine is a nucleoside analog reverse transcriptase inhibitor active against HIV.-History:... (Zerit, for anti-HIV HIV Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive... therapy) or metformin Metformin Metformin is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes, in particular, in overweight and obese people and those with normal kidney function. Its use in gestational diabetes has been limited by safety concerns... (for diabetes) |
|
| paracetamol Paracetamol Paracetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies... |
|
| estrogen-containing hormonal contraception Hormonal contraception Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive... such as the combined oral contraceptive pill |
|
| fluoroquinolone medications | |
| statin Statin Statins are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Increased cholesterol levels have been associated with cardiovascular diseases, and statins are therefore used in the... s (anti-cholesterol Cholesterol Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes... drugs) |
|
| withdrawal from benzodiazepine Benzodiazepine A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring... |
|
| antihistamine Antihistamine An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions... use. Some antihistamines are used in sleep aids explicitly because they cause drowsiness. |
|
| sildenafil Sildenafil Sildenafil citrate, sold as Viagra, Revatio and under various other trade names, is a drug used to treat erectile dysfunction and pulmonary arterial hypertension . It was originally developed by British scientists and then brought to market by the US-based pharmaceutical company Pfizer... (Viagra) when used with nitroglycerine |
|
| fluoxetine Fluoxetine Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company... and other SSRI antidepressants |
|
| MPTP MPTP MPTP is a neurotoxin precursor to MPP+, which causes permanent symptoms of Parkinson's disease by destroying dopaminergic neurons in the substantia nigra of the brain... a meperidine related drug considered highly neurotoxic |
|
| long-term use of metoclopramide Metoclopramide Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly... and many antipsychotic Antipsychotic An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s... medications |
|
| fluoroquinolone drugs even occurring as late as 6 months after treatment had been terminated. |
See also
- Classification of Pharmaco-Therapeutic ReferralsClassification of Pharmaco-Therapeutic ReferralsThe Classification of Pharmaco-Therapeutic Referrals is a taxonomy focused to define and group together situations requiring a referral from pharmacists to physicians regarding the pharmacotherapy used by the patients. It has been published in 2008...
- Drug therapy problemsDrug therapy problemsDrug Therapy Problems is a categorization of drug problems, in the field of Pharmaceutical care. However it can also be used as a definition of the specific manners in which drug therapy can cause problems...
- EudraVigilanceEudraVigilanceEudraVigilance is the European data processing network and management system for reporting and evaluation of suspected adverse reactions during the development of new drugs and for following the marketing authorisation of medicinal products in the European Economic Area .The European...
(European UnionEuropean UnionThe European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
) - History of pharmacyHistory of pharmacyThe history of pharmacy as an independent science is relatively young. The origins of historiography pharmaceutical back to the first third of the nineteenth century which is when the first historiographies that while not touching all aspects of pharmaceutical history is the starting point for the...
- IatrogenesisIatrogenesisIatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...
- Paradoxical reactionParadoxical reactionA paradoxical reaction or paradoxical effect is when medical treatment, usually a drug, has the opposite effect to that which would normally be expected.An example of a paradoxical reaction is when a pain relief medication causes an increase in pain...
- PolypharmacyPolypharmacyPolypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....
- ToxicologyToxicologyToxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...
- The Medical Letter on Drugs and TherapeuticsThe Medical Letter on Drugs and TherapeuticsThe Medical Letter on Drugs and Therapeutics is a scientific journal providing evaluations of drugs...
- Yellow Card SchemeYellow Card SchemeThe Yellow Card Scheme is the UK system for collecting information on suspected Adverse Drug Reactions to medicines. The Scheme was founded in 1964 after the thalidomide disaster, and was developed by Dr Bill Inman....
(UK)