Adverse drug reaction
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An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted, negative consequences associated with the use of given medications. An ADR is a particular type of adverse effect. 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.
Informing a patient that ARDs may be a sign that a drug is working may increase acceptance of a medication.
ADRs may be classified by cause and severity.
- Type A: pharmacologically predictableddfd
- Type B: bizarre and unpredictable (or idiosyncratic)
- Type C: arising from chronic use
- Type D: delayed reaction
- Type E: end of dose reaction
- Type F: failure of therapy
- 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
- - or -
- Requires Intervention to Prevent Permanent Impairment or Damage
Overall Drug Risk
While no official scale exists yet to communicate overall drug risk, the iGuard Drug Risk Rating System is a five color rating scale similar to the Homeland Security Advisory System:
- Red (High Risk)
- Orange (Elevated Risk)
- Yellow (Guarded Risk)
- Blue (General Risk)
- Green (Low Risk)
Adverse effects may be local, i.e. limited to a certain location, or systemic, where a medication has caused adverse effects throughout the systemic circulation.
As research better explains the biochemistry of drug use, less ADRs are Type B and more are Type A. Common mechanisms are:
- Abnormal pharmacokinetics due to
- genetic factors
- comorbid disease states
- Synergistic effects between either
- a drug and a disease
- two drugs
Comorbid disease states
Phase I reactions
Phase II reactions
Interactions with other drugs
The risk of drug interactions 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 prinicple plasma proteins for drug binding are:
- α1-acid glycoprotein
Some drug interactions with warfarin are due to changes in protein binding.
Patients have abnormal metabolism by cytochrome P450 due to either inheriting abnormal alleles or due to drug interactions. Tables are available to check for drug interactions due to P450 interactions..
An example of synergism is two drugs that both prolong the QT interval.
- Note that an ADR should not be labeled as 'certain' unless the ADR abates with dechallenge and recurs with rechallenge are true.
A more complicated scale is the Naranjo algorithm.
Publications reporting adverse drug reactions
Systematic reviews do not well search for or report adverse drug reactions. This difficulty may in part be due to problematic reporting of adverse drug reactions in trials incuding outcome reporting bias.
Searching for publications
Various search strategies have been developed to locate publications that report adverse drug reactions.
Many countries have official bodies that monitor drug safety and reactions. On an international level, the WHO 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.
- EudraVigilance (European Union)
- Paradoxical reaction
- The Medical Letter on Drugs and Therapeutics
- Yellow Card Scheme (UK)
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