No healthcare provider wants a prescribed drug to cause another disease. But, such is the case with drug-induced diseases (DIDs), which refer to unintended effects of a drug that could result in complications or death, with symptoms sufficient to elicit medical attention or hospitalization.
One may question why the FDA wouldn’t always explicitly warn of the potential of a drug-induced disease when a new agent hits the market. In truth, research reviewed by the FDA for drug approval doesn’t always focus on all the adverse effects and complications, including DIDs. Moreover, these trials lack sufficient power, or patient numbers, to determine DIDs. Hence, it can become the physician’s responsibility to monitor for DIDs.
Moreover, physicians should avoid prescribing agents that they suspect could result in DIDs. After all, prevention trumps treatment.
In this article, we’ll take a closer look at four Drug. Induced. Diseases.
1.DID hyponatremia/SIADH
Causes: Thiazide diuretics; antiepileptics (eg, carbamazepine, valproic acid); antidepressants (eg, SSRIs, MAO inhibitors); typical/atypical antipsychotics; chemotherapy agents (eg, vinca alkaloids, platinum compounds)
Drugs are a common cause of hyponatremia and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). SIADH results in the release of ADH from the posterior pituitary in response to high osmotic pressure, increasing blood pressure via arteriole constriction, decreasing water loss in the form of sweat, and heightening water retention by the kidneys which results in decreased urine output.
Among other symptoms, severe hyponatremia can lead to nausea/vomiting, lethargy, seizures, pulmonary edema, and coma.
2. DID pulmonary disease
Causes: Antibiotics (eg, nitrofurantoin, sulfa drugs); cardiac agents (eg, amiodarone); chemo (eg, bleomycin, cyclophosphamide, methotrexate)
Pulmonary DID takes various forms, including allergic reactions, alveolar hemorrhage, interstitial fibrosis, pneumonitis, pleural effusion, and mediastinitis. Symptoms include bloody sputum, fever, cough, shortness of breath, and chest pain. The mechanism of such lung toxicity involves increased production of oxygen-free radicals and oxidants, as well as inhibition of the antioxidant system.
3. DID QT prolongation/Torsades de pointes
Causes: Antimicrobials (eg, fluoroquinolones, azoles); antidepressants (eg, SSRIs, SNRIs); antipsychotics (eg, typical and atypical antipsychotics)
This ventricular arrhythmia can lead to sudden cardiac death, and because scores of medications can cause it, QT prolongation is the most common reason drugs are withdrawn from the market.Symptoms include dizziness, heart palpitations, shortness of breath, chest pains, and cold sweats.
4. DID hypoglycemia
Causes: Insulin, metformin, sulfonylureas, beta-blockers
DID hypoglycemia is common in diabetic patients. In addition to medications, lifestyle choices can also contribute to hypoglycemia including alcohol use, increased physical activity, overdosing on antidiabetic medications, and missing meals.
Signs and symptoms include feeling shaky or anxious, sweating, irritability, confusion, tachycardia, and syncope. Of note, hypoglycemia mediates these signs and symptoms via the release of epinephrine and its sympathetic effects.
