An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers

F1000Res. 2018 May 30:7:677. doi: 10.12688/f1000research.14970.2. eCollection 2018.

Abstract

Background: Adverse drug reactions (ADRs) are a major cause of hospital admissions, prolonged hospital stays, morbidity, and drug-related mortality. In this study, we sought to identify the most frequently reported medications and associated side effects in adolescent-aged patients in an effort to prioritize clinical pharmacology consultation efforts for hospitals seeking to improve patient safety. Methods: Quarterly reported data were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 and ending in the third quarter of 2017. We then used the GeneCards database to map the pharmacogenomic biomarkers associated with the most reported FAERS drugs. Data homogenization and statistics analysis were all conducted in R for statistical programming. Results: We identified risperidone (10.64%) as the compound with the most reported ADRs from all reported cases. Males represented 90.1% of reported risperidone cases with gynecomastia being the most reported ADR. Ibuprofen OR=188 (95% CI, 105.00 - 335.00) and quetiapine fumarate OR=116 (95% CI, 48.40 - 278.00) were associated with the highest odds of completed suicide in teenagers. Ondansetron hydrochloride OR=7.12 (95% CI, 1.59 - 31.9) resulted in the highest odds of pneumothorax. Lastly, olanzapine (8.96%) represented the compound with the most reported drug-drug interactions cases, while valproic acid OR=221 (95% CI, 93.900 - 522.00) was associated with the highest odds of drug-drug interactions. Conclusion: Despite any data limitations, physicians prescribing risperidone in males should be aware of the high rates of adverse drug events and an alternative psychotropic should be considered in male patients. Further, patients with a history of pneumothorax or genetically predisposed to pneumothorax should be considered for an alternative antiemetic to ondansetron hydrochloride, due to increased odds associated with the drug and adverse event.

Keywords: adverse drug reactions; consult; mental health; pharmacogenomics; precision medicine; psychiatry; teenagers.

MeSH terms

  • Adolescent
  • Adverse Drug Reaction Reporting Systems*
  • Biomarkers
  • Child
  • Databases, Factual
  • Drug-Related Side Effects and Adverse Reactions* / complications
  • Female
  • Gynecomastia / etiology
  • Humans
  • Male
  • Pharmacology, Clinical / methods*
  • Pneumothorax / etiology
  • Retrospective Studies
  • Risperidone / adverse effects
  • Treatment Outcome
  • United States
  • United States Food and Drug Administration

Substances

  • Biomarkers
  • Risperidone

Grants and funding

The author(s) declared that no grants were involved in supporting this work.