CRC LITT DRUG ERPT REF MNL INCL DRUG INTRACT PDF

INTRODUCTION

Any drug can cause any rash.

An adverse drug reaction (ADR) – or an adverse drug event (ADE) – describes any unwanted, unpleasant, noxious, or harmful consequence associated with the use of medications that have been administered in standard doses by the proper route for the purposes of prophylaxis, diagnosis, or treatment. This definition does not include abuse, overdose, withdrawal, or error of administration. It appears that most ADRs are related to the dose. Death is the ultimate adverse drug event.

ADRs, major problems in drug therapy, are a few of the leading causes of morbidity and mortality in health care and they should be considered in the differential diagnosis of a wide variety of medical disorders.

More and more people – primarily the older population – are taking more and more prescription and over-the-counter medications. New drugs are appearing in the medical marketplace on an almost daily basis. More and more drug reactions – in the form of cutaneous eruptions – are developing from all drugs. It has been reported that more than 100,000 hospitalized people in the United States alone died in 1999 as a result of medications.

While most adverse drug reactions are relatively mild, and many disappear when the drug is either stopped or when the dose has changed, other adverse drug reactions are often more serious and longer lasting. Cutaneous drug eruptions can mimic almost any inflammatory dermatosis. While most eruptions are mild and self-limited, severe and life-threatening eruptions do occur, as seen with the Stevens-Johnson syndrome and toxic epidermal necrolysis.

About five percent of hospital admissions in the United States are estimated to be for treatment of adverse drug reactions. Also, each time a person is hospitalized, the risk of having at least one adverse drug reaction is about fifteen percent; and as many as one-third of all emergency department and urgent care center visits are drug related.

ADRs are underreported and thus are an underestimated cause of morbidity and mortality. The incidence and severity of ADRs can be influenced by patient-related specific factors: age, sex, disease, genetic factors, geographic factors, and by drug-related factors: type of drug, route of administration (intramuscular, intravenous and topical administrations are more likely to cause hypersensitivity reactions; oral medications are less likely to result in drug hypersensitivity), duration of therapy, dosage, and bioavailability, as well as by interactions with other drugs. More drugs – and more combinations of drugs – are being used to treat patients than ever before, and it has been estimated that fatal ADRs are the third or fourth leading cause of death in the US.

The terms ‘drug allergy,' ‘drug hypersensitivity,' and ‘drug reaction' are often used interchangeably. Drug allergy is restricted specifically to a reaction mediated by IgE; drug hypersensitivity is an immune-mediated response to a drug agent in a sensitized patient; and drug reactions comprise all adverse events related to drug administration, regardless of etiology.

Adverse drug reactions have been arbitrarily classified into six types:

1. Dose-related (e.g. Digoxin toxicity)

2. Non-dose-related (e.g. Immunological reactions)

3. Dose-related and Time-related (e.g. Corticosteroids)

4. Time-related (e.g. Tardive dyskinesia)

5. Withdrawal (e.g. Opiate or beta-blocker withdrawal)

6. Unexpected failure of therapy (e.g. Inadequate dosage of an oral contraceptive)

Physicians in all specialties are often perplexed by the nature of some of these problems. The few sources that are available to identify the causes of many of these side effects cannot be accessed by proprietary (Trade, Brand) names.

This Manual is a Drug Eruption Reference guide that describes and catalogues the adverse cutaneous side effects of more than 1000 commonly prescribed and over-thecounter generic drugs (more than 50 of which are new to this edition). All drugs have been listed and indexed by both their Generic and Trade (Brand) names for easy accessibility.

As a result of space constraints, several of the Generic drugs from earlier editions have been extirpated either because they have been withdrawn from the marketplace or that they are rarely if ever prescribed now. These, please note, are still available – and always will be – on the website – www.drugeruptiondata.com.

In addition to adverse cutaneous reactions, there are many severe, hazardous interactions that are known to occur between two or more drugs. I have incorporated only the highly, clinically significant drug interactions that can trigger potential harm, and that could be life-threatening. These interactions are predictable and well documented in controlled studies; they should be avoided. This subdivision denoting hazardous interactions has been omitted from those drugs where no such interactions have been reported.

For each drug, I have listed all the known adverse side effects – in the form of drug reactions – that can result from the use of the matching drug.

Appropriate references (author, journal or book, volume, date and page) for each side effect of every drug have been cited. Where there is more than one reference to a specificside effect, I have employed the most illustrative and most recent citation(s) in the literature.

In this new, 2008 state-of-the-art fourteenth edition, I have cited more than 30,000 references and sources from journals articles, books and observations as well as from dermatologists from all over the world via the Internet and from personal communications. This Manual includes all references, 28,367, from 1980 until October, 2007. The complete number, 39,599, of references, as far back as 1922, can be found on the website, (www.drugeruptiondata.com)

The first part of the Manual lists, in alphabetical order, all the listed 1,195 Generic drugs and over 6,000 Trade name drugs with their corresponding names for easy access to the A-Z section – the main body of the Manual.

Next comes a listing of the various Classes of drugs, and those Generic drugs that belong to each class.

The major portion of the Manual – the body of the work – lists the 1,195 Generic drugs, herbals and supplements in alphabetical order and the adverse reactions that can arise from their use along with the appropriate references.

The last parts of the Manual include a description of the 34 most common Reaction Patterns; a listing of those drugs that can occasion more than 100 different reaction patterns, including, among others, Acne, Acute generalized exanthematous pustulosis, Alopecia, Aphthous stomatitis, Bullous eruptions, Bullous pemphigoid, Erythema multiforme, Erythema nodosum, Exanthems, Exfoliative dermatitis, Fixed eruptions, Lichenoid eruptions, Lupus erythematosus, Onycholysis, Pemphigus, Photosensitivity, Pityriasis rosea, Pruritus, Psoriasis, Purpura, Pustular eruptions, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Urticaria, and Vasculitis.