Adverse drug reaction#Location

• Type A: augmented pharmacological effects, which are dose-dependent and predictable{{cite journal |vauthors=Coleman JJ, Pontefract SK |date=October 2016 |title=Adverse drug reactions |journal=Clinical Medicine |volume=16 |issue=5 |pages=481–485 |doi=10.7861/clinmedicine.16-5-481 |pmc=6297296 |pmid=27697815 |doi-access=free}}

:Type A reactions, which constitute approximately 80% of adverse drug reactions, are usually a consequence of the drug's primary pharmacological effect (e.g., bleeding when using the anticoagulant warfarin) or a low therapeutic index of the drug (e.g., nausea from digoxin), and they are therefore predictable. They are dose-related and usually mild, although they may be serious or even fatal (e.g. intracranial bleeding from warfarin). Such reactions are usually due to inappropriate dosage, especially when drug elimination is impaired. The term side effects may be applied to minor type A reactions.{{cite book| vauthors = Ritter JM |title=A Textbook of Clinical Pharmacology and Therapeutics|publisher=CRC Press|year=2008|location=Great Britain|isbn=978-0-340-90046-8|page=62}}

• Type B: Type B reactions are not dose-dependent and are not predictable, and so may be called idiosyncratic. These reactions can be due to particular elements within the person or the environment.{{cite journal | vauthors = Iasella CJ, Johnson HJ, Dunn MA | title = Adverse Drug Reactions: Type A (Intrinsic) or Type B (Idiosyncratic) | journal = Clinics in Liver Disease | volume = 21 | issue = 1 | pages = 73–87 | date = February 2017 | pmid = 27842776 | doi = 10.1016/j.cld.2016.08.005 }}

Types A and B were proposed in the 1970s,{{cite book | vauthors = Rawlins MD, Thompson JW | chapter = Pathogenesis of adverse drug reactions. | veditors = Davies DM | title = Textbook of adverse drug reactions. | location = Oxford | publisher = Oxford University Press | date = 1977 | page = 10 }} and the other types were proposed subsequently when the first two proved insufficient to classify ADRs.{{cite book | vauthors = Aronson JK | chapter = Drug therapy | veditors = Haslett C, Chilvers ER, Boon NA, Colledge NR, Hunter JA | title = Davidson's principles and practice of medicine | edition = 19th | location = Edinburgh | publisher = Elsevier Science | date = 2002 | pages = 147–163 }}

Other types of adverse drug reactions are Type C, Type D, Type E, and Type F.{{cite journal | vauthors = Aronson JK, Ferner RE | title = Joining the DoTS: new approach to classifying adverse drug reactions | journal = BMJ | volume = 327 | issue = 7425 | pages = 1222–1225 | date = November 2003 | pmid = 14630763 | pmc = 274067 | doi = 10.1136/bmj.327.7425.1222 }} Type C was categorized for chronic adverse drug reactions, Type D for delayed adverse drug reactions, Type E for withdrawal adverse drug reactions, and Type F for failure of therapy as an adverse drug reaction. Adverse drug reactions can also be categorized using time-relatedness, dose-relatedness, and susceptibility, which collectively are called the DoTS classification.

The U.S Food and Drug Administration defines a serious adverse event as one when the patient outcome is one of the following:{{Cite web |date=1 February 2016 |title=What is a Serious Adverse Event? |url=https://www.fda.gov/safety/reporting-serious-problems-fda/what-serious-adverse-event |access-date=17 April 2023 |website=U.S. Food & Drug Administration}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}

• Death
• Life-threatening
• Hospitalization (initial or prolonged)
• Disability — significant, persistent, or permanent change, impairment, damage or disruption in the patient's body function/structure, physical activities or quality of life.
• Congenital abnormality
• Requires intervention to prevent permanent impairment or damage

Severity is a measure of the intensity of the adverse event in question. The terms "severe" and "serious", when applied to adverse events, are technically very different.{{Cite web |date=1 June 1995 |title=ICH E2A Clinical safety data management: definitions and standards for expedited reporting — Scientific guideline |url=https://www.ema.europa.eu/en/documents/scientific-guideline/international-conference-harmonisation-technical-requirements-registration-pharmaceuticals-human-use_en-15.pdf |access-date=2023-04-30 |website=European Medicines Agency |language=en}} They are easily confused but can not be used interchangeably, requiring care in usage. Seriousness usually indicates patient outcome (such as negative outcomes including disability, long-term effects, and death).

In adverse drug reactions, the seriousness of the reaction is important for reporting.

Some ocular antihypertensives cause systemic effects,{{cite book | vauthors = Rang HP |title=Pharmacology |publisher=Churchill Livingstone |location=Edinburgh |year=2003 |isbn=978-0-443-07145-4 }} Page 146 although they are administered locally as eye drops, since a fraction escapes to the systemic circulation.

Image:Drug-induced hepatitis low mag.jpg (drug-induced hepatitis) with granulomata. Other causes were excluded with extensive investigations. Liver biopsy. H&E stain.]]

Various diseases, especially those that cause renal or hepatic insufficiency, may alter drug metabolism. Resources are available that report changes in a drug's metabolism due to disease states.{{cite web |url=http://www.clinicaldruguse.com/ |archive-url=https://archive.today/20071101053341/http://www.clinicaldruguse.com/ |url-status=dead |archive-date=2007-11-01 |title=Clinical Drug Use |access-date=2007-09-18 }}

The Medication Appropriateness Tool for Comorbid Health Conditions in Dementia{{Cite web|url=http://www.match-d.com.au/|title=MATCH-D Medication Appropriateness Tool for Comorbid Health conditions during Dementia|website=www.match-d.com.au|access-date=2019-06-01}} (MATCH-D) criteria warns that people with dementia are more likely to experience adverse effects, and that they are less likely to be able to reliably report symptoms.{{cite journal | vauthors = Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C | title = Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel | journal = Internal Medicine Journal | volume = 46 | issue = 10 | pages = 1189–1197 | date = October 2016 | pmid = 27527376 | pmc = 5129475 | doi = 10.1111/imj.13215 }}

Pharmacogenomics includes how genes can predict potential adverse drug reactions.{{Cite book | vauthors = Roden DM, Van Driest SL, Brunton LL, Knollmann BC |title=Goodman & Gilman's the pharmacological basis of therapeutics |date=2023 |publisher=McGraw Hill |isbn=978-1-264-25807-9 |edition=14th |location=New York |chapter=Pharmacogenetics and Pharmacogenomics |oclc=1323328254}} However, pharmacogenomics is not limited to adverse events (of any type), but also looks at how genes may impact other responses to medications, such as low/no effect or expected/normal responses (especially based on drug metabolism).

Abnormal drug metabolism may be due to inherited factors of either Phase I oxidation or Phase II conjugation.{{cite journal | vauthors = Phillips KA, Veenstra DL, Oren E, Lee JK, Sadee W | title = Potential role of pharmacogenomics in reducing adverse drug reactions: a systematic review | journal = JAMA | volume = 286 | issue = 18 | pages = 2270–9 | date = November 2001 | pmid = 11710893 | doi = 10.1001/jama.286.18.2270 }}{{cite journal | vauthors = Goldstein DB | title = Pharmacogenetics in the laboratory and the clinic | journal = The New England Journal of Medicine | volume = 348 | issue = 6 | pages = 553–6 | date = February 2003 | pmid = 12571264 | doi = 10.1056/NEJMe020173 }}

Phase I reactions include metabolism by cytochrome P450.{{cite journal | vauthors = Hakkola J, Hukkanen J, Turpeinen M, Pelkonen O | title = Inhibition and induction of CYP enzymes in humans: an update | journal = Archives of Toxicology | volume = 94 | issue = 11 | pages = 3671–3722 | date = November 2020 | pmid = 33111191 | pmc = 7603454 | doi = 10.1007/s00204-020-02936-7 | bibcode = 2020ArTox..94.3671H }} Patients have abnormal metabolism by cytochrome P450 due to either inheriting abnormal alleles or due to drug interactions. Tables are available to check for drug interactions due to P450 interactions.{{cite web | vauthors = Flockhart DA, Thacker D, McDonald C, Desta Z | title = The Flockhart Cytochrome P450 Drug-Drug Interaction Table. | work = Division of Clinical Pharmacology | publisher = Indiana University School of Medicine | date = 2021 |url=https://drug-interactions.medicine.iu.edu/ | archive-url=https://web.archive.org/web/20230327185040/https://drug-interactions.medicine.iu.edu/Home.aspx | archive-date = 27 March 2023 | access-date = 1 May 2023 }}{{cite journal | vauthors = Weinshilboum R | title = Inheritance and drug response | journal = The New England Journal of Medicine | volume = 348 | issue = 6 | pages = 529–537 | date = February 2003 | pmid = 12571261 | doi = 10.1056/NEJMra020021 | doi-access = free }}

Inheriting abnormal butyrylcholinesterase (pseudocholinesterase) may affect metabolism of drugs such as succinylcholine.{{cite journal | vauthors = Evans WE, McLeod HL | title = Pharmacogenomics--drug disposition, drug targets, and side effects | journal = The New England Journal of Medicine | volume = 348 | issue = 6 | pages = 538–49 | date = February 2003 | pmid = 12571262 | doi = 10.1056/NEJMra020526 }}

Inheriting abnormal N-acetyltransferase which conjugated some drugs to facilitate excretion may affect the metabolism of drugs such as isoniazid, hydralazine, and procainamide.

Inheriting abnormal thiopurine S-methyltransferase may affect the metabolism of the thiopurine drugs mercaptopurine and azathioprine.

Protein binding interactions are usually transient and mild until a new steady state is achieved.{{cite journal | vauthors = DeVane CL | title = Clinical significance of drug binding, protein binding, and binding displacement drug interactions | journal = Psychopharmacology Bulletin | volume = 36 | issue = 3 | pages = 5–21 | year = 2002 | pmid = 12473961 }}{{cite journal | vauthors = Benet LZ, Hoener BA | title = Changes in plasma protein binding have little clinical relevance | journal = Clinical Pharmacology and Therapeutics | volume = 71 | issue = 3 | pages = 115–21 | date = March 2002 | pmid = 11907485 | doi = 10.1067/mcp.2002.121829 | s2cid = 6948454 }}[http://gateway.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=11907485.ui OVID full text] [http://gateway.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=image&IMAGE=00003098-200203000-00001%7cTT2&D=ovft summary table at OVID] These are mainly for drugs without much first-pass liver metabolism. The principal plasma proteins for drug binding are:{{cite journal | vauthors = Sands CD, Chan ES, Welty TE | title = Revisiting the significance of warfarin protein-binding displacement interactions | journal = The Annals of Pharmacotherapy | volume = 36 | issue = 10 | pages = 1642–4 | date = October 2002 | pmid = 12369572 | doi = 10.1345/aph.1A208 | s2cid = 20855578 |url=http://www.theannals.com/cgi/reprint/36/10/1642 | access-date = 18 September 2007 | url-status = dead | df = dmy-all | archive-url=https://web.archive.org/web/20080907073600/http://www.theannals.com/cgi/reprint/36/10/1642 | archive-date = 7 September 2008 | url-access = subscription }}

1. albumin
2. α1-acid glycoprotein
3. lipoproteins

Some drug interactions with warfarin are due to changes in protein binding.

The risk of drug interactions is increased with polypharmacy, especially in older adults.{{cite journal |vauthors=Kim J, Parish AL |date=September 2017 |title=Polypharmacy and Medication Management in Older Adults |journal=The Nursing Clinics of North America |volume=52 |issue=3 |pages=457–468 |doi=10.1016/j.cnur.2017.04.007 |pmid=28779826}}

Two or more drugs that contribute to the same mechanism in the body can have additive toxic or adverse effects. One example of this is multiple medications administered concurrently that prolong the QT interval, such as antiarrhythmics like sotalol and some macrolide antibiotics, such as systemic azithromycin.{{Cite web |date=29 April 2023 |title=Drug-Induced Prolongation of the QT Interval and Torsades de Pointes |url=http://online.lexi.com.uml.idm.oclc.org/lco/action/doc/retrieve/docid/patch_f/5712802?cesid=aOpi05xda65&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dqt%2Bprolongation%2Bdrugs%26t%3Dname%26acs%3Dtrue%26acq%3Dqt%2Bpro |access-date=2 May 2023 |website=Lexicomp}}

Another example of additive effects for adverse drug reactions is in serotonin toxicity (serotonin syndrome).{{Cite book | vauthors = Curry SC, O'Connor AD, Graeme KA, Kang AM |chapter=Chapter 13: Neurotransmitters and Neuromodulators | veditors = Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS | title = Goldfrank's toxicologic emergencies|publisher=McGraw Hill |year=2019 |isbn=978-1-259-85961-8 |edition=11th |language=en }} If medications that cause increased serotonin levels are combined, they can cause serotonin toxicity (though therapeutic doses of one agent that increases serotonin levels can cause serotonin toxicity in certain cases and individuals). Some of the medications that can contribute to serotonin toxicity include MAO inhibitors, SSRIs, and tricyclic antidepressants.

Some medications can either inhibit or induce key drug metabolizing enzymes or drug transporters, which when combined with other medications that utilize the same proteins can lead to either toxic or sub-therapeutic adverse effects. One example of this is a patient taking a cytochrome P450 3A4 (CYP3A4) inhibitor such as the antibiotic clarithromycin, as well as another medication metabolized by CYP3A4 such as the anticoagulant apixaban, which results in elevated blood concentrations of apixaban and greater risk of serious bleeds.{{cite journal | vauthors = Mar PL, Gopinathannair R, Gengler BE, Chung MK, Perez A, Dukes J, Ezekowitz MD, Lakkireddy D, Lip GY, Miletello M, Noseworthy PA, Reiffel J, Tisdale JE, Olshansky B | title = Drug Interactions Affecting Oral Anticoagulant Use | journal = Circulation: Arrhythmia and Electrophysiology | volume = 15 | issue = 6 | pages = e007956 | date = June 2022 | pmid = 35622425 | pmc = 9308105 | doi = 10.1161/CIRCEP.121.007956 }} Additionally, Clarithromycin is a permeability glycoprotein (P-gp) efflux pump inhibitor, which when given with apixaban (a substrate for P-gp) will lead to increased absorption of apixaban, resulting in the same adverse effects as with CYP3A4 inhibition.

Causality assessment is used to determine the likelihood that a drug caused a suspected ADR. There are a number of different methods used to judge causation, including the Naranjo algorithm, the Venulet algorithm and the WHO causality term assessment criteria. Each have pros and cons associated with their use and most require some level of expert judgement to apply.{{cite journal | vauthors = Davies EC, Rowe PH, James S, Nickless G, Ganguli A, Danjuma M, Owens L, Odgers E, Green CF, Mottram DR, Pirmohamed M |title=An Investigation of Disagreement in Causality Assessment of Adverse Drug Reactions |url=http://adisonline.com/pharmaceuticalmedicine/Fulltext/2011/25010/An_Investigation_of_Disagreement_in_Causality.3.aspx |journal=Pharm Med |volume=25 |issue=1 |pages=17–24 |year=2011 |doi=10.1007/bf03256843 |s2cid=37301370 |access-date=2 June 2011 |archive-url=https://archive.today/20120701152106/http://adisonline.com/pharmaceuticalmedicine/Fulltext/2011/25010/An_Investigation_of_Disagreement_in_Causality.3.aspx |archive-date=1 July 2012 |url-status=dead |df=dmy-all |url-access=subscription }}

An ADR should not be labeled as 'certain' unless the ADR abates with a challenge-dechallenge-rechallenge protocol (stopping and starting the agent in question). The chronology of the onset of the suspected ADR is important, as another substance or factor may be implicated as a cause; co-prescribed medications and underlying psychiatric conditions may be factors in the ADR.

Assigning causality to a specific agent often proves difficult, unless the event is found during a clinical study or large databases are used. Both methods have difficulties and can be fraught with error. Even in clinical studies, some ADRs may be missed as large numbers of test individuals are required to find a specific adverse drug reaction, especially for rare ADRs. Psychiatric ADRs are often missed as they are grouped together in the questionnaires used to assess the population.{{cite journal | vauthors = Holvey C, Connolly A, Taylor D | title = Psychiatric side effects of non-psychiatric drugs | journal = British Journal of Hospital Medicine | volume = 71 | issue = 8 | pages = 432–6 | date = August 2010 | pmid = 20852483 | doi = 10.12968/hmed.2010.71.8.77664 }}{{cite journal | vauthors = Otsubo T | title = [Psychiatric complications of medicines] | journal = Ryoikibetsu Shokogun Shirizu | issue = 40 | pages = 369–73 | year = 2003 | pmid = 14626141 }}

Many countries have official bodies that monitor drug safety and reactions. On an international level, the WHO runs the Uppsala Monitoring Centre.{{Cite web | author = Uppsala Monitoring Centre |title=The WHO Programme for International Drug Monitoring |url=https://who-umc.org/about-the-who-programme-for-international-drug-monitoring/ |access-date=2023-04-17 |website=who-umc.org |language=en}} The European Union runs the European Medicines Agency (EMA).{{Cite web |date=2018-09-17 |title=Pharmacovigilance: post-authorisation |url=https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance-post-authorisation |access-date=2023-04-17 |website=European Medicines Agency |language=en}} In the United States, the Food and Drug Administration (FDA) is responsible for monitoring post-marketing studies.{{Cite web |date=4 June 2018 |title=Questions and Answers on FDA's Adverse Event Reporting System (FAERS) |url=https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers |archive-url=https://web.archive.org/web/20190923223057/https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers |url-status=dead |archive-date=23 September 2019 |access-date=16 April 2023 |website=U.S. Food & Drug Administration}} The FDA has a reporting system called the FDA Adverse Event Reporting System, where individuals can report adverse drug events. Healthcare professionals, consumers, and the pharmaceutical industry can all submit information to this system. For health products marketed in Canada, a branch of Health Canada called The Canada Vigilance Program is responsible for surveillance.{{Cite web |date=2008-01-24 |title=Canada Vigilance Program |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/canada-vigilance-program.html |access-date=2023-04-16 |website=Government of Canada |language=English}} Both healthcare professionals and consumers can report to this program. In Australia, the Therapeutic Goods Administration (TGA) conducts postmarket monitoring of therapeutic products.{{Cite web |date=20 June 2019 |title=How we regulate medicines |url=https://www.tga.gov.au/resources/resource/guidance/how-we-regulate-medicines |access-date=2 May 2023 |website=Australian Government Department of Health and Aged Care Therapeutic Goods Administration}} In the UK, a monitoring system called the Yellow Card Scheme was established in 1964.{{Cite web |title=Yellow Card Scheme looks to the future at 50th anniversary forum |url=https://www.gov.uk/government/news/yellow-card-scheme-looks-to-the-future-at-50th-anniversary-forum |access-date=2023-04-30 |website=GOV.UK |language=en}} The Yellow Card Scheme was set up to surveil medications and other health products.{{Cite web |title=Information {{!}} Making medicines and medical devices safer |url=https://yellowcard.mhra.gov.uk/information |access-date=2023-04-30 |website=yellowcard.mhra.gov.uk}}

A study by the Agency for Healthcare Research and Quality (AHRQ) found that in 2011, sedatives and hypnotics were a leading source for adverse drug events seen in the hospital setting. Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug.{{cite book | last1=Weiss | first1=Audrey J. | last2=Elixhauser | first2=Anne | last3=Bae | first3=Jaeyong | last4=Encinosa | first4=William | title=Healthcare Cost and Utilization Project (HCUP) Statistical Briefs | chapter=Origin of Adverse Drug Events in U.S. Hospitals, 2011 | publisher=Agency for Healthcare Research and Quality (US) | publication-place=Rockville (MD) | date=2006 | pmid=24228291 | page=}} A second study by AHRQ found that in 2011, the most common specifically identified causes of adverse drug events that originated during hospital stays in the U.S. were steroids, antibiotics, opiates/narcotics, and anticoagulants. Patients treated in urban teaching hospitals had higher rates of ADEs involving antibiotics and opiates/narcotics compared to those treated in urban nonteaching hospitals. Those treated in private, nonprofit hospitals had higher rates of most ADE causes compared to patients treated in public or private, for-profit hospitals.{{cite book | last1=Weiss | first1=Audrey J. | last2=Elixhauser | first2=Anne | title=Healthcare Cost and Utilization Project (HCUP) Statistical Briefs | chapter=Characteristics of Adverse Drug Events Originating During the Hospital Stay, 2011 | publisher=Agency for Healthcare Research and Quality (US) | publication-place=Rockville (MD) | date=2006 | pmid=24354026 | page=}}

Medication related harm (MRH) is common after hospital discharge in older adults, but methodological inconsistencies between studies and a paucity of data on risk factors limits clear understanding of the epidemiology. There was a wide range in incidence, from 0.4% to 51.2% of participants, and 35% to 59% of harm was preventable. Medication related harm incidence within 30 days after discharge ranged from 167 to 500 events per 1,000 individuals discharged (17–51% of individuals).{{cite journal | vauthors = Parekh N, Ali K, Page A, Roper T, Rajkumar C | title = Incidence of Medication-Related Harm in Older Adults After Hospital Discharge: A Systematic Review | journal = Journal of the American Geriatrics Society | volume = 66 | issue = 9 | pages = 1812–1822 | date = September 2018 | pmid = 29972591 | doi = 10.1111/jgs.15419 | s2cid = 49678401 |url=http://sro.sussex.ac.uk/id/eprint/74837/1/Final%20proof%20%27first%20look%27%20030818%20%282%29.pdf }}

In the U.S., females had a higher rate of ADEs involving opiates and narcotics than males in 2011, while male patients had a higher rate of anticoagulant ADEs. Nearly 8 in 1,000 adults aged 65 years or older experienced one of the four most common ADEs (steroids, antibiotics, opiates/narcotics, and anticoagulants) during hospitalization. A study showed that 48% of patients had an adverse drug reaction to at least one drug, and pharmacist involvement helps to pick up adverse drug reactions.{{cite journal | vauthors = Yeung EY | title = Adverse drug reactions: a potential role for pharmacists | journal = The British Journal of General Practice | volume = 65 | issue = 639 | pages = 511.1–511 | date = October 2015 | pmid = 26412813 | pmc = 4582849 | doi = 10.3399/bjgp15X686821 }}

In 2012, McKinsey & Company concluded that the cost of the 50-100 million preventable error-related adverse drug events would be between US$18–115 billion.{{cite web | vauthors = Ebel T, George K, Larsen E, Neal E, Shah K, Shi D |title=Strength in unity:The promise of global standards in healthcare |url=https://www.gs1.org/docs/healthcare/McKinsey_Healthcare_Report_Strength_in_Unity.pdf |website=gs1.org |publisher=McKinsey & Company |access-date=28 October 2022 |archive-url=https://web.archive.org/web/20220619085719/https://www.gs1.org/docs/healthcare/McKinsey_Healthcare_Report_Strength_in_Unity.pdf |archive-date=19 June 2022 |date=October 2012 |url-status=live}}

An article published in The Journal of the American Medical Association (JAMA) in 2016 reported adverse drug event statistics from emergency departments around the United States in 2013-2014.{{cite journal | vauthors = Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS | title = US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014 | journal = JAMA | volume = 316 | issue = 20 | pages = 2115–2125 | date = November 2016 | pmid = 27893129 | pmc = 6490178 | doi = 10.1001/jama.2016.16201 }} From this article, an estimated prevalence of adverse drug events that were presented to the emergency department (ED) was 4 events out of every 1000 people. This article reported that 57.1% of these adverse drug events presented to the ED were in females. As well, out of all of the adverse drug events presented to the emergency department documented in this article, 17.6% were from anticoagulants, 16.1% were from antibiotics, and 13.3% from diabetic agents.

{{col div|colwidth=30em}}

• Alleged problems in the drug approval process
• Classification of Pharmaco-Therapeutic Referrals
• Drug therapy problems
• EudraVigilance (European Union)
• History of pharmacy
• Iatrogenesis
• Lethal dose
• List of withdrawn drugs
• Paradoxical reaction
• Polypharmacy
• Toxicity
• Toxicology
• The Medical Letter on Drugs and Therapeutics
• Yellow Card Scheme (UK)

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{{Reflist}}

• [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312730/ Incidence of adverse drug reactions in human immune deficiency virus-positive patients using highly active antiretroviral therapy] {{PMC|3312730}}

{{Medical resources

| DiseasesDB = 295

| ICD10 = {{ICD10|T88.7}}, {{ICD10|Y40-Y59}}, {{ICD10|U12.9}}

| ICD9 = {{ICD9|995.2}}, {{ICD9|E850}}-{{ICD9|E858}}

| ICDO =

| OMIM =

| MedlinePlus =

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| MeshID = D004362

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{{Clear}}

{{Medical harm}}

{{Consequences of external causes}}

{{External causes of morbidity and mortality}}

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{{DEFAULTSORT:Adverse Drug Reaction}}

Category:Pharmacy

Category:Clinical pharmacology

Category:Drug safety