Drug Reactions and Side Effects

Overview

  • Drug reactions organized by system
    • cardiovascular
    • GI
    • hematologic 
    • musculoskeletal
    • neurologic
    • renal
    • reproductive/endocrine
    • respiratory
    • multiorgan
  • Type A reactions
    • predictable
    • common
    • mild and self resolving
    • dose-dependent
  • Type B reactions 
    • unpredictable
    • rare
    • severe
    • idiosyncratic
    • not dose-dependent

Medication Reactions

ReactionCausal Agent
Cardiovascular
Atropine-like side effectsTCAs
Coronary vasospasmCocaineSumatriptan
Cutaneous flushingVancomycinAdenosineNiacin (reduced by co-administration of aspirin)Calcium channel blockers
Dilated cardiomyopathyDoxorubicin (Adriamycin) DaunorubicinTrastuzumab Cocaine
Torsades de pointesClass IA antiarrhythmic (disopyramide, quinidine, procainamide)Class III  antiarrhythmics (amiodarone, sotalol)LithiumChloroquineErythromycin, clarithromycinHaloperidol, thioridazine, ziprasidone
GI
Acute cholestatic hepatitisMacrolidesTroglitazone
Focal to massive hepatic necrosisHalothaneValproic acidAcetaminophenAmanita phalloides
Carbon tetrachloride
HepatitisINHPhenytoinMethyldopa
Pseudomembranous colitisClindamycinAmpicillin
  Hematologic
 Agranulocytosis  ClozapineCarbamazepine ColchicinePropylthiouracilMethimazoleDapsoneCephalosporins
Aplastic anemiaChloramphenicolBenzeneNSAIDsPropylthiouracilMethimazoleCarbamazepinePhenytoin
Direct Coombs-positive hemolytic anemiaMethyldopaPenicillin
Gray baby syndromeChloramphenicol
Hemolysis in G6PD-deficient patientsIsoniazid (INH)DapsoneSulfonamidesPrimaquineChloroquineAspirinIbuprofenNitrofurantoinMethylene blue
Megaloblastic anemiaPhenytoinMethotrexateSulfonamides6-mercaptopurineCytosine arabinoside
Thrombotic complicationsContraceptives
Musculoskeletal
Gingival hyperplasiaPhenytoinCyclosporinNifedipine
GoutFurosemideThiazidesCyclosporinLevodopaNiacin
OsteoporosisCorticosteroids HeparinProton pump inhibitorsLithium
PhotosensitivitySulfonamidesAmiodaroneTetracyclineFluoroquinolones
Rash (Stevens-Johnson syndrome)EthosuximideLamotrigineCarbamazepinePhenobarbitalPhenytoinSulfonamidesFluorquinolonesFurosemidePenicillinAllopurinol
RhabdomyolysisStatins
SLE-like syndromeHydralazineINHProcainamidePhenytoinCarbamazepine
Tendonitis, tendon rupture, and cartilage damage in childrenFluoroquinolones 
Neurologic
Cinchonism QuinidineQuinine
Diabetes insipidusLithiumDemeclocycline
Parkinson-like syndromeHaloperidolChlorpromazineReserpineMetoclopramideMPTP (causes permanent Parkinson’s)ClozapineProchlorperazineCinnarizine
SeizuresBupropionVenlafazineTramadolDiphenhydramineImipenem/cilastatinIsoniazid
Tardive dyskinesiaAntipsychotics (chlorpromazine)
Renal/GU
Fanconi’s syndromeExpired tetracyclineTenofovir
Interstitial nephritisMethicillinNSAIDsAcetominophenFurosemideAllopurinol
Hemorrhagic cystitisCyclophosphamide Ifosfamide (prevented by mesna administration)
Reproductive/Endocrine
Adrenocortical insufficiencyWithdrawal of glucocorticoid therapy
GynecomastiaSpironolactoneDigitalisCimetidineClomipheneBusulfan, nitrourea, vincristine (direct testicular injury)Chronic alcohol useEstrogensKetoconazoleFinasteride
Hot FlashesTamoxifenClomiphene
HypothyroidismLithiumAmiodaroneNeck radiation therapy
Respiratory
CoughACE inhibitors
Pulmonary fibrosisBleomycinAmiodaroneBusulfanMethotrexateCyclophosphamideHydralazineTocainide
  Multiorgan
Disulfiram-like reaction SulfonylureaMetronidazole
Nephrotoxicity/neurotoxicityPolymyxins
Nephrotoxicity/ototoxicityAminoglycosides (neomycin)VancomycinLoop diuretics (ethacrynate, furosemide, bumetanide)CisplatinMercuric chloride

Drug Reactions and Side Effects

Drug reactions and side effects refer to the undesired or unintended effects that can occur when taking medications. While drugs are designed to treat specific conditions or symptoms, they can also interact with the body in ways that lead to unwanted reactions. It’s important to note that not everyone experiences side effects, and the severity and occurrence of side effects can vary from person to person.

Here’s an overview of drug reactions and side effects:

  1. Common side effects: Many medications have common side effects that are known and listed in the drug’s prescribing information. These side effects are usually mild and temporary, and they often resolve on their own without requiring medical intervention. Examples of common side effects include nausea, drowsiness, headache, dizziness, upset stomach, and dry mouth.
  2. Allergic reactions: Some individuals may have an allergic reaction to a medication. Allergic reactions can range from mild to severe and may include symptoms such as rash, itching, swelling, hives, difficulty breathing, and anaphylaxis (a severe, life-threatening allergic reaction). Allergic reactions require immediate medical attention.
  3. Adverse drug reactions: Adverse drug reactions (ADRs) are unwanted and harmful effects caused by medications. ADRs can vary in severity and can affect different organ systems. These reactions can be predictable, dose-dependent, and related to the drug’s known pharmacological properties or can occur idiosyncratically and unpredictably.
  4. Drug interactions: Drug interactions occur when a medication interacts with another drug, food, or substance, affecting its effectiveness or resulting in side effects. Some medications can interact with each other, intensifying or reducing their effects. It’s important to inform healthcare providers about all the medications, supplements, and substances you are taking to minimize the risk of interactions.
  5. Serious side effects: Although rare, some drugs can cause serious side effects that require immediate medical attention. These can include severe allergic reactions, organ damage, blood disorders, heart problems, and neurological effects. Such side effects are usually listed in the drug’s prescribing information, and patients should be aware of them.
  6. Individual variation: Each person may respond differently to medications due to various factors, such as genetics, age, sex, underlying health conditions, and overall drug tolerance. Some individuals may be more susceptible to side effects or may experience unique reactions to certain drugs.

It is crucial to read the medication’s package insert or consult with a healthcare professional to understand the potential side effects and risks associated with a specific drug. If you experience any concerning side effects or adverse reactions while taking medication, it is important to contact your healthcare provider promptly for guidance and appropriate management.

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