Side effects, drug reactions

For 15 years, this title has been a reference manual for cutaneous eruptions. The 16th edition has been expanded and enhanced to present a comprehensive listing of all adverse drug reactions (ADRs), side effects, drug interactions and other safety information for prescription and over-the-counter medications. The aims of this book are ... 

UNTOWARD EFFECTS Erythromycin rarely causes serious side effects. Allergic reactions include fever, eosinophUia, and rash, either alone or in combination these manifestations resolve after therapy is stopped. Cholestatic hepatitis, the most striking side effect, is caused primarily by erythromycin estolate and rarely by the ethylsuccinate or the stearate and may be a hypersensitivity reaction to the estolate ester. The illness starts after 1-3 weeks of treatment and presents with nausea, vomiting, and abdominal cramps. These symptoms soon are followed by jaundice, fever, leukocytosis, eosinophilia, and elevated plasma transaminases. Liver biopsy reveals cholestasis and periportal inflammation, sometimes with necrosis of neighboring parenchymal cells. Findings usually resolve within a few days after drug cessation and rarely are prolonged. 

Since many of the uses of antihistamines involve conditions such as rashes, which should be treatable by local application, there is some rationale for developing drugs for topical use. The known side effects of antihistamines could in principle be avoided if the drug were functionalized so as to avoid systemic absorption. The known poor absorption of quaternary salts make such derivatives attractive for nonabsorbable antihistamines for topical use. Thus, reaction of the well-known anti his-taminic drug promethazine (104) with methyl chloride leads... 

All drugs, in addition to their therapeutic effects, have the potential to do harm, i.e. to cause adverse/unwanted reactions (side effects). These may or may not be related to the principal pharmacological action of the drug. Examples of the second category are toxic effects of metabolites of a drug or immunological reactions. 

For the topical treatment of some chronic inflammatory skin diseases (like atopic dermatitis) immunosuppressive macrolides (like TRL and pimecrolimus) that permeate the inflamed epidermis are of benefit for patients. Severe side effects comparable to those after systemic application of TRL in transplanted patients (see above) have not been observed so far. For the treatment of psoriasis vulgaris these drugs are less effective. The CD2 antagonist alefacept may be a suitable alternative to allergic reactions. 

MDMA overdose as well as the concomitant consumption of selective serotonin reuptake inhibitors (SSRI) with other dmgs that exert serotoninergic effects (such as inhibitors of monoamine oxidase) can rapidly lead to the serotonin syndrome. Its symptoms, which are reversible upon cessation, of the drug include confusion, muscle rigidity in the lower limbs, and hyperthermia suggesting an acute reaction to serotonin overflow in the CNS. Blocking the function of SERT outside the brain causes side effects (e.g., nausea), which may be due to elevated 5HT however , impairment of transporter function is not equivalent to direct activation of 5HT recqrtors in causing adverse effects such as fibrosis and pulmonary hypertension. 

As with all drugs, the specific side effects of the quinolones must be considered when they are chosen for treatment of bacterial infections [5]. Reactions of the gastrointestinal tract and the central neivous system are the most often observed adverse effects during therapy with quinolones. It should be underlined, however, that compared with many other antimicrobials, diarrhea is less frequently observed during quinolone treatment. Antibiotic-associated colitis has been observed rarely during quinolone therapy. Similarly, hypersensitivity reactions, as observed during therapy with penicillins and other (3-lactams, is less frequently caused by quinolones. Some other risks of quinolone therapy have been defined and must be considered if a drug from this class is chosen for treatment of bacterial infections. 

Tacrine is particularly damaging to the liver and can result in hepatotoxicity. Because tacrine is more likely to cause adverse reactions and drug interactions, it must be administered more frequently (4 times a day) and is rarely used in current therapy. Donepezil has fewer and milder side effects than tacrine It is considered the agent of first choice However, some patients may achieve a better response with one drug than another. Additional adverse reactions are listed in the Summary Drug Table Cholinesterase Inhibitors. 

However, pervasive computing will ultimately do much more it will change the very way in which new drugs are tested. At present, all drugs go through three clinical phases, but the process is both very costly and very inefficient. Clinical trials cannot detect rare side effects and drug interactions, or sometimes even fairly common reactions. In fact, one recent study conducted by Harvard Medical School and Public Citizen, the US consumer advocacy... 

The use of duloxetine in stress urinary incontinence is complicated by (1) the potential for multiple clinically relevant drug-drug interactions with cytochrome P-450 2D6 and 1A2 inhibitors, (2) withdrawal reactions if abruptly discontinued, (3) high rates of nausea and other side effects, (4) the hepa-totoxicity that contraindicates its use in patients with any degree of hepatic impairment, and (5) its mild hypertensive effect. 

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