Uncommon side effects of common drugs in patients with familial dysautonomia

Abstract

Purpose: Patients with the autosomal recessive disorder of familial dysautonomia typically exhibit exacerbated adverse side effects to many common drugs. We aimed to catalog these adverse effectswith a focus on common drugs that are frequently administered to FD patients and compare their incidences to those within the general population.Methods: We used data of 595 FD patients from an international database with information on drugs received and adverse effects. To investigate the molecular causes of reported differences in drug responses in FD patients, we used expression microarrays to compare the mRNA expression profiles in peripheral blood leukocytes of FD patients (n = 12) and healthy individuals (n = 10).Results: Several drug classes, including cholinergics, anti-cholinergics, anti-convulsants, methylxanthines, SSRIs, and antibiotics caused either unreported symptoms or elevated rates of adverse events in FD patients. FD patients experienced different or more frequent adverse side effects than the general population in 31/123 drugs.These side effects included blood cell dyscrasias, amenorrhea, gastrointestinal bleeding, and bronchospasm. New findings include enhanced reaction of FD patients to H2 antagonist agents and to serotonin receptor agonists. We also detected eight genes differentially expressed between FD patients and healthy individuals that may underlie the differential drug responses of FD patients. Conclusion:We provide evidence that suggests the use of several common drugs should be discontinued or reduced in FD patients.There were no prior presentations, sponsors or grants for this research.

Covid-19-Induced Dysautonomia: A Menace of Sympathetic Storm

“…In heart failure there is a noradrenalin spillover and sympathetic activation with parasympathetic inhibition due to alteration the expression of N-type calcium channel with enhancement of cardiac excitability (Lara et al, 2010). The development of DNS may affect the response to the different drugs, in a study involved 595 patients with DNS there is abnormal response and high adverse effects to the anticholinergic, cholinergic and anti-convulsant drugs (Perl et al, 2021).…”