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Adverse Drug Reactions and the changing Face of Therapeutics

(Cover Story)

Adverse drug reactions and, or side effects come in various shades and colours, and have overtime become issue for concern except that much attention has not been paid to this recurring phenomenon, or so it seems. Most at times the effects of adverse drug reaction is just mild and so it is easily overlooked, but at some other times they can be dangerously alarming such as even leading to death! And so health watchers are wont to ask: with all of these, is therapeutics entering a new phase?  In this write-up, Editor, MORGAN NWANGUMA ponders these issues, and brings to light what we ought to guard against, and what we all can do.

In a developed society such as Australia, facts have it that an estimated 140,000 patients are admitted to hospital every year because of problems associated with the use of medicines, including side effects. We do not even have a record of what goes on here in Nigeria.

In our clime however, the case of Dr. Adeyosola Adebayo (a medical doctor) whom in 2012 lost his life to the dreaded Stevens-Johnson Syndrome, a case of adverse drug reaction, continues to haunt our collective memory. This horror of a disease was later in 2016 to resurface as it claimed yet another life, and the younger brother to the late Dr. Adebayo decided to do a ‘run for life’ against the disease. Elsewhere, in Canada more than seven years ago a rising pop artiste, Ms. Sandy Duperval came down with a case of toxic epidermal necrolysis which left her fighting for her life. Experts said she was reacting to some antibiotics given to her by her doctors.

In recent times the issue of adverse drug reaction has become a huge subject of concern and debate. Drug side effects and adverse reactions of drugs can be as a result of so many factors. But beware; this debate is not exclusive to pharmaceutical drugs. Experts have argued over the years that the talk about herbal remedies not exhibiting side effects is just a myth.

Yes, even herbal medicaments sometimes do have their side effects, and studies have also revealed that complementary medicines can actually interact with pharmaceutical medicines to result in (adverse) side effects. But very importantly is the fact that most ethical orthodox drugs are regarded by pharmaceutical experts as ‘poisons’. This implies that absolute caution must be exercised when handling them.

But besides and beyond all of these, the drugs in question are usually either traditional small-molecule drugs, by and large derived from chemical synthesis, or biopharmaceuticals, which include recombinant proteins, vaccines, blood products used therapeutically (such as IVIG), gene therapy, monoclonal antibodies and cell therapy (for instance, stem-cell therapies). And so, secondary and usually adverse effects are ‘normal’ fallouts of drug administration or therapy.

Drug side (adverse) effect

Experts say that a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended. Most of the time this term is primarily used to refer to adverse effects; it can also apply to beneficial, but unintended, consequences of the use of a drug.

Occasionally, drugs are given, or procedures performed purposely for their side effects; in that case the side effect is no longer considered as a side effect, but an intended effect. Take for example, X-rays were traditionally used as an imaging technique, and even still today; the discovery of their oncolytic capability led to their use in radiotherapy (ablation of malignant tumours).

Drug side effects however, fall into several categories. Allergic reactions can as well occur with any drug – ranging from itching and skin rashes, to a severe anaphylactic reaction.

For some drugs, it is just natural for them to bring about side effects because of their chemical structure. A classic example is the very familiar allergy drug –diphenhydramine, which also goes by the brand name Benadryl. Despite the fact that it takes care of allergy symptoms, it also goes ahead to inhibit the activity of the body chemical called acetylcholine, resulting into sleepiness and a lot more other side effects, such as dry mouth.

What kinds of drugs have side effects?

Both pharmaceutical drugs, and even at times, complementary formulations especially when combined with orthodox drugs tend to clash and give rise to unwanted reactions or side effects. There are some kinds of drugs that are noted for their side effects. And so, from drugs as simple as the common analgesics such as paracetamol and aspirin, to the most sophisticated prescription drugs that are available, they all come with side effects. According to experts many of these are inconsequential, some are just an inconvenience, and a few are serious, while others are just difficult to explain.

It is likely that the most common set of side effects for medicines taken internally has to do with the gastrointestinal system. Almost any drug can cause nausea or an upset stomach, though not many people get to experience this. But for drugs applied externally, skin irritation is usually common, and there are reasons for all these.

Factors that escalate drug side effects

Quite a number of factors lead to drug side effects, while others will actually escalate these side effects.

For specific reasons doctors would warn patients to steer clear of alcohol while on medication. When you combine alcohol with some drugs it can lead to unwanted and sometimes hazardous side effects. If you make this mistake with drugs such as antihistamines or antidepressant medicines, you are very likely to experience unwanted reactions like sleepiness. When this happens be sure not to drive or operate machinery, etc.

Generally, all manner of medicament can bring about unwanted side effects. For instance, antibiotics such as those in the sulfonamide and penicillin families cause allergic reactions in around five percent of users. Skin rashes easily manifest on using these drugs. But, whether a reaction is as a result of the drug being used or the ailment that you are attempting to get rid of still remains a topical issue among medical scientists. And as earlier stated, complications could also arise no matter how mild, from interactions of any other formulations, inclusive of complementary or alternative preparations you may be consuming.

From specific studies however, it would appear that the ordering of genes could be responsible for the various forms of drug adverse reactions, scientists have observed. Thus in a peer review published in the medical journal, Future Medicine titled ‘Adverse drug reactions and pharmacogenomics: recent advances’, the researchers state that “pharmacogenomics, the study of how variation in the human genome affects response to drugs, attracts attention from clinicians and the pharmaceutical industry alike. The aim is to distinguish, using appropriate genetic tests, individuals who may be harmed by certain drugs from those who may benefit from them.”

Sometimes too, the assertion is that “there are strong associations with single genetic factors, whether these represent the exceptions rather than the rule is unclear” the authors say. Still, there are great possibilities that adverse drug reactions may very well have to do with both genetic and environmental factors as they relate with the individual.

Some types of Drug Side effects

The fact is that when properly dosed some drugs would normally but seldom show noticeable side effects. A typical example is Warfarin (Coumadin, Jantoven), used for the prevention of blood clots; it is usually well tolerated, but serious internal bleeding do sometimes occur, experts say.

For certain drugs side effects will only manifest when they are mixed with some particular substances. This is what is usually referred to as drug interactions, such as drinking alcohol while taking narcotic painkillers. This has been found to cause alarming increase in accidental overdose deaths. Also, drinking grapefruit ‘juice’ can affect the blood levels of several drugs, including some medications used for controlling blood pressure and cholesterol.

Experts say for further information on unwanted drug effects for over-the-counter (OTC) medicines, patients should always refer to the drug literature that come along with them, or the printed inserts that accompany prescription drugs whenever you purchase them. Also, ensure to consult your pharmacist or doctor if you have any questions regarding a drug’s side effects.

Meanwhile, like earlier stated, some herbal or complementary remedies that are packaged in the form of tablets, caplets and capsules can as well come with their own type of side effects.

Echinacea, a coarse perennial herb has a number of different types of reactions which have been reported, including asthma attacks, loss of pregnancy, skin irritation, swelling, etc. Feverfew, a European perennial, is not suitable for pregnant women as it can lead to uterine contractions, and maybe abortions. Some other herbal formulations such as made from Asteraceae plants including the above mentioned in addition to dandelion and chamomile, may sometimes lead to unwanted side effects like allergic dermatitis and hay fever, experts warn.

 What you can do

It behoves every drug user to be extra vigilant and report any side effects immediately to their doctor or pharmacist. They may need to adjust the dose or type of medication you are on. But if you notice you are sensitive to a particular drug, and you do not get a replacement, your doctor may wish to put you through a desensitisation therapy.

Other precautionary measures should include that you ensure to adhere strictly to the prescription, and do not take anybody else’s medications. Make it a habit to consult with your pharmacist when you purchase over-the-counter drugs, and let your doctor be aware of all the drugs you have been taking including complementary medicine or supplements.

Adverse Drug Reactions and the changing Face of TherapeuticsYou must as well know that positive lifestyle changes including but not limited to diet and exercise, can help your situation in no small measures. It will invariably reduce or put a stop to your (over) dependence on drugs usage.

On the part of physicians, expert opinions hold that reporting all cases of adverse drug reactions should be mandatory; this will go a long way in strengthening post market surveillance of drugs in the Nigerian market for instance, as well as build an organised drug safety database.

According to a professor of general internal medicine at the Johns Hopkins University School of Medicine, USA, Dr. Sonal Singh – “There should be something…, where every new prescription you have, you get intensive monitoring.” He explains that, “Every new prescription should have doctors reporting if there was an adverse event or not.”


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