BMJ  2004;329:459 (21 August), doi:10.1136/bmj.329.7463.459

Letter

Adverse drug reactions as cause of admission to hospital

Alcohol and other non-prescribed drugs may have impact on adverse drug reactions

The first 150 words of the full text of this article appear below.

EDITOR—Adverse drug reactions are an important topic for all clinicians. Pirmohamed et al report an observational study of adverse drug reactions in two large hospitals.¹ However, important clarifications are required about the method and reporting of this study. Three issues affect interpretation in ways that are important to practising clinicians, who need to be alerted to problems when prescribing.

The authors make no mention of alcohol consumption in the patients surveyed. Was alcohol consumption measured? Alcohol is an important drug that may potentiate an adverse reaction or even be an alternative cause of disease which might have been attributed to adverse drug reactions, such as gastrointestinal bleeds. This also applies to nicotine and perhaps even caffeine.

The authors do not comment on how they treated non-prescribed drugs, such as St John's wort. A systematic review in the same issue by Mills et al highlights the potential . . . [Full text of this article]

erlw@lineone.net

Royal London Hospital, London E1 4NF

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