Metabolic idiosyncrasy

Type B not related to dose, not generally predictable, likely to have an immunological basis or related to a metabolic idiosyncrasy. 

EXTENSIONS AND COMMENTARY With the extraordinary experience that had been observed with one person with 5-TOM, this ethyl homologue was not only run up with special caution, but that individual ran his own personal titration. And he proved to be perhaps twice as sensitive to 5-TOET than any of the other subjects. An approach to what might just be some unusual metabolic idiosyncrasy on the part of his liver, is discussed in the recipe for TOMSO. 

It has been suggested that liver injury due to amiodarone is either due to a direct biochemical action or perhaps metabolic idiosyncrasy. Because there have been cases in which oral administration has not led to a recurrence, it has also been suggested that the vehicle in which amiodarone is usually dissolved, polysorbate (Tween) 80, is responsible rather than the amiodarone itself (SEDA-18, 202). 

There seem to be individuals with a metabolic idiosyncrasy who develop serious but probably fully reversible liver damage when exposed to ranitidine. The Netherlands Centre for Monitoring of Adverse Reactions has pubhshed data on six cases, in most of which other causal factors could be excluded (12), and a fatal case of liver injury has been reported from France (SEDA-16, 422). 

Noninunune-mediated reactions, or metabolic idiosyncrasy , where nonim-mune, often poorly characterized, pathways are affected by the drug leading to the reaction. 

Recent investigations have reduced some disease states from an idiosyncrasy of unknown etiology to a well-defined metabolic disorder due to enzymatic deficiencies with appropriate therapeutic conclusions. 

Ideally, the size of doses should be determined for each patient by blood analyses performed at the beginning of treatment. This procedure builds the patient s idiosyncrasies (of distribution or metabolism) into the dose. When it is not possible to do this, it is usual to take published average figures, derived from a group of patients. 

We retain idiosyncrasy for non-immunologic reactions to food which are peculiar to only certain individuals and which can be attributed to the metabolic or pharmacological properties of the inciting substances, e.g., the response to lactose in alactasia. A group of reactions in which the mechanism is unknown must be classified as idiopathic. We describe as... 

Combine the lymphoblasts with the test agent and a suitable metabolizing element, and note the increase in the fraction of surviving cells that are able to form colonies under selective conditions. For readers who would prefer a more complete discussion, we next consider the mechanics of exposure, colony enumeration, selection procedures, and a number of idiosyncrasies of several types of mutants. 

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