title: Potential risks and prevention, Part 3: Drug-induced threats to life.
abstract: Potential risk factors for and the preventability of drug-induced threats to life were studied. Case reports of adverse drug events (ADEs) published in Clin-Alert during 1977-97 were the source of information on drug-induced life threats. Patient, drug, and event variables were identified, and the causality, predictability, and preventability of each case were assessed. Data were entered into a relational database for analysis. The data indicated 846 drug-induced life threats. Seventy-four percent of the cases were assessed as definite or probable. Patients received usual or below-usual dosages in 89% of the cases. Patients tended to be middle-aged and only moderately ill. The drug categories most frequently associated with life threats were antimicrobials and central-nervous-system agents. Plasma drug level monitoring should have been performed in 127 cases but occurred only in 31 cases (24%). Event types were distributed as adverse drug reactions (50%), allergic reactions (35%), drug interactions (11%), and medication errors (4%). A commercial reference classified almost half of the drug interactions associated with a life threat as posing minimal or no potential risk to the patient. Half of the life-threatening events were judged to have been preventable; about half of these could have been prevented by a pharmacist. Litigation was reported for only 1% of the cases of drug-induced threats to life; judgments and settlements averaged $1.2 million. A review of published case reports of ADEs for 1977-97 yielded information on possible risk factors for drug-induced life threats and on which events may have been preventable.
authors.affiliation: Total Therapeutic Management, Kennesaw, GA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Marcellino
authors.forename: W N
authors.initials: WN
authors.lastname: Kelly
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D000707:Anaphylaxis / Q000139:chemically induced / Q000517:prevention & control; D015984:Causality; D004347:Drug Interactions; D016903:Drug Monitoring; D062787:Drug Overdose / Q000517:prevention & control; D004358:Drug Therapy / Q000145:classification; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D016365:Liability, Legal; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000145:classification*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D004364:Pharmaceutical Preparations