Intended for healthcare professionals

Student Education

The medic's guide to prescribing:Minimising adverse drug reactions

BMJ 2007; 334 doi: https://doi.org/10.1136/sbmj.0706222 (Published 01 June 2007) Cite this as: BMJ 2007;334:0706222
  1. Rachel Green, fifth year medical student1,
  2. Simon Maxwell, senior lecturer1
  1. 1University of Edinburgh College of Medicine, Edinburgh EH16 4TJ

How do you go about minimising the harmful effects of prescription drugs? Rachel Green and Simon Maxwell discuss

An elderly lady is admitted to the accident and emergency department after a collapse. A middle aged man presents with shock after a haematemesis and nearly loses his life. A housewife becomes pregnant despite apparently reliable use of the oral contraceptive pill. Are you puzzled by this? You may be. Slightly suspicious that these were not simply spontaneous misfortunes? You have reason to be. Are you thinking that a drug might be the cause? You should be. Would that be unusual? Not really. Adverse drug reactions (ADRs) are, in fact, very common.

A recent prospective analysis of 18820 patients admitted to two UK hospitals over a six month period showed that 6.5% of admissions were related to an ADR either directly (80%) or in part (20%)1. Many of these were considered possibly (63%) or definitely (9%) avoidable had more care been taken, and 2.3% were fatal. A further study showed that more than 10% of patients who are admitted to hospital experience an ADR resulting from their hospital care2. During your career as a junior doctor it's likely that you will care for many patients who have had an ADR; your prescribing will also result in some. The purpose of this article is to highlight the diagnosis, common causes, and reporting of ADRs, and will also provide some pointers as to how you can help to avoid them.

What exactly is an adverse drug reaction?

The World Health Organization's definition of an ADR is “a response to a drug that is noxious and unintended and occurs at doses used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function.”3 This 30 year old definition is highly debated but …

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