Idiosyncratic Adverse Drug Reactions: Current Concepts

Uetrecht, Jack; Naisbitt, Dean J.

doi:10.1124/pr.113.007450

Cited by 269 publications

(270 citation statements)

References 310 publications

(299 reference statements)

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“…The skin, liver and blood cells are the most common targets, though they can affect other organs as well. 5 These have been a major source of concern as they constitute most life threatening adverse effects of AEDs. In this case phenytoin was found to affect skin causing retiform rash, and, agranulocytosis was attributed to levetiracetam.…”

Section: Discussionmentioning

confidence: 99%

Can idiosyncratic drug reactions occur in quick succession? a case of cross sensitivity between levetiracetam and phenytoin

Nayak¹,

Kakode²,

Rataboli³

2017

Int J Basic Clin Pharmacol

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The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cause diagnostic dilemma to the doctor and increased burden of suffering to the patient. We present a single case report of a 23 year old female who developed rash and agranulocytosis in quick succession as ADRs to phenytoin and levetiracetam respectively. These antiepileptic drugs (AEDs) were prescribed as prophylaxis against post traumatic seizures (PTS). Hence a proper rationale for the prophylactic treatment of PTS and pharmacovigilance for early detection of adverse drug reactions is the need of the hour.

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Section: Discussionmentioning

confidence: 99%

Can idiosyncratic drug reactions occur in quick succession? a case of cross sensitivity between levetiracetam and phenytoin

Nayak¹,

Kakode²,

Rataboli³

2017

Int J Basic Clin Pharmacol

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“…Additional neurological consultation was performed. Because of complete clinical manifestations and no changes in CT and MRI, diagnosis of idiosyncratic reaction for contrast was recognized [2]. The presented case is a warning for clinicists that coronarography and other procedures in which contrast is used can be very dangerous for patients' health and even for their life.…”

mentioning

confidence: 90%

Idiosynkratyczna reakcja na kontrast podczas koronarografii pod postacią hipertermii oraz afazji czuciowo-ruchowej

et al. 2017

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The paper presents a case of 67-year-old man in whom coronarography was performed after positive exercise electrocardiography. During the angiography, extremely rare contrast reaction occured. Within the next few hours patient's clinical condition deteriorated significantly, so that he required special and atypical treatment. Finally, the patient recovered completely without any neurological or other deficits.Key words: coronarography, contrast reaction, adverse effects Cardiologica 2017; 12, 1: 78-80 Severe adverse effects after non-ionic contrast administration are very rare. It is estimated that these complications affect only about 0.031% of patients [1]. FoliaA 67-year-old man was admitted to the Department of Interventional Cardiology and Cardiac Arrhythmias due to long-term, recurrence retrosternal chest pain inducible by exercise. His medical history included hypertension, type 2 diabetes mellitus and an ischemic stroke that happened fourteen years ago without any residual effects. At admission the patient was in good general condition, his heart rate was regular at 70 bpm. Lung and heart sounds were clear, abdomen was soft and non-tender, with no organomegaly. He did not present any focal and generalized neurological symptoms. The resting electrocardiogram (ECG) revealed no abnormalities, without signs of acute or past ischemia. Markers of myocardial necrosis were negative.To support the diagnosis of stable coronary artery disease, a non-invasive cardiac test -exercise ECG was conducted ( Figure 1). Because of unclear result (ECG positive, clinical negative), we decided to perform a coronarography with nonionic, low-osmolality contrast -Iomeron 400. The examination showed normal vessels, without any significant stenosis (Figures 2, 3).Fifteen minutes after the examination, sensory and motor aphasia without paresis occured. Then, patient presented strong psychomotor arousal and consciousness disorders. Urgent computed tomography (CT) was performed and did not reveal any bleeding or ischemic area. Within next few hours a rapid increase of patient's body temperature (over 40°C) was observed. Hyperthermia did not decrease after typical antipyretics. The mechanical cooling (wrap with ice bags, stomach and bladder rinsing

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“…3,4,6,7 Idiosyncratic drug reactions In general, idiosyncratic drug reactions are unpredictable adverse effects that cannot be explained based on the pharmacology of a drug. 8,9 Although the exact mechanism is still incompletely understood, these events are often believed to result from reactive metabolites of a drug and not the drug itself. 8,9 They are dose-dependent reactions in individuals who are susceptible; however, there is no specific dose at which they occur in most patients.…”

Section: 6mentioning

confidence: 99%

“…8,9 Although the exact mechanism is still incompletely understood, these events are often believed to result from reactive metabolites of a drug and not the drug itself. 8,9 They are dose-dependent reactions in individuals who are susceptible; however, there is no specific dose at which they occur in most patients. 8 These reactions can affect any organ system, but commonly involve the liver, skin and bone marrow, and can be accompanied by fever.…”

Section: 6mentioning

confidence: 99%