Patients
receive, on average, 10 different drugs during each hospitalization. The sicker
the patient, the more drugs are given, and there is a corresponding increase in
the likelihood of adverse drug reactions. When <6 different drugs are
given to hospitalized patients the probability of an adverse reaction is ±5%, but if >15 drugs are given,
the probability is _40%.
Retrospective analyses of ambulatory patients have revealed adverse drug
effects in 20%. Serious adverse reactions are also well recognized with
“herbal” remedies and OTC compounds: examples include kava-associated
hepatotoxicity, L-tryptophan-associated eosinophilia-myalgia, and
phenylpropanolamineassociated stroke, each of which has caused fatalities.
A
2000 Institute of Medicine report indicated that 7000 Americans die annually
because of medication errors, that 2 to 3% of hospital admissions are for
illnesses attributed to drugs, that the in-hospital cost was >$2 billion, and that
this represents a tiny fraction of the overall problem of medication errors and
its costs. A small group of widely used drugs accounts for a disproportionate
number of reactions. Aspirin and other NSAIDs, analgesics, digoxin,
anticoagulants, diuretics, antimicrobials, glucocorticoids, antineoplastics,
and hypoglycemic agents account for 90% of reactions, although the drugs
involved differ between ambulatory and hospitalized patients.
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