Drug-induced illness causes

One useful approach to tackle this problem of drug-induced illness caused by bad prescribing is known as academic detailing , in which a trained health professional meets with the physician in his or her office and functions as a source of neutral, academically oriented, evidence-based knowledge (see www.RxFacts.org). 

There are many other examples of such a systems approach to reducing drug-induced illness caused by this kind of error. 

I want to reemphasize that drug-induced disturbances in mood or in behavior should be viewed as genuine neurological disorders rather than as vague mental illnesses. The capacity of speculative biochemical imbalances or genetic factors to cause or contribute to mania or depression remains unproven. Nor do we know the specific biochemical or neurological mechanisms whereby psychoactive substances cause mental disturbances. But the capacity for psychoactive substances to disrupt brain function and hence mental function is beyond dispute. Furthermore, a great deal of empirical data confirm their capacity to cause disinhibition, mania, depression, and other mental phenomena associated with violence toward oneself and others, as well as other destructive behaviors. 

In a study using the UK General Practice Research Database to determine rates of drug-induced, rare, serious adverse effects on the liver, kidneys, skin, or blood, occurring within 45 days of completing a prescription or refill in 54 803 users of either fluconazole or itraconazole, three had illnesses for which a fluconazole-induced cause could not be ruled out one with thrombocytopenia, one with neutropenia, and one with an abnormal liver function test just after receiving fluconazole (31). The rates were 2.8/100 000 prescriptions (95% Cl = 0.8, 10) for serious, adverse blood events and 1.4/100 000 prescriptions (95% Cl = 0.25, 8.2) for serious, adverse liver events. These results suggest that fluconazole does not commonly have serious adverse effects on the liver, kidneys, skin, or blood. 

Erectile dysfunction has been reported in 3% to 5% of patients. It may be secondary to ejaculation disorders, or may be due to drug-induced inhibition of nitric oxide synthase (which is needed for producing nitric oxide, a vasodUatory substance) in cavemosal tissue. The role of 5a-reductase inhibitors in causing erectile dysfunction is not clear, as elderly men with BPH commonly develop erectile dysfunction as they age, or have concurrent medical illnesses or concomitant drug therapies that may predispose to the development of sexual dysfunction. ... 

Other adverse effects are caused by immunological reactions, of which the drug-induced lupus syndrome is the most common. Hydralazine also can result in an illness that resembles serum sickness, hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis the mechanism of these autoimmune reactions is unknown. The drug-induced lupus syndrome usually occurs after at least 6 months of continuous treatment with hydralazine, and its incidence is related to dose, sex,... 

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