By O. L. Wade and Linda Beeley (Auth.)

ISBN-10: 0433345519

ISBN-13: 9780433345510

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Genetic differences affecting tissue sensitivity. Little is known about genetic variation in receptor sensitivity to drugs. Hereditary resistance to warfarin has been described ADVERSE REACTIONS TO DRUGS 36 in two families (O'Reilly and Aggeler, 1970), the members of which required very high doses and high plasma levels of warfarin to achieve an anticoagulant effect; and by analogy with warfarin resistance in rats this is thought to be due to a mutation in the vitamin K-warfarin receptor (Pool, O'Reilly, Schneiderman and Alexander, 1968).

However, it is often forgotten that many drugs produce vasodilation and postural hypotension as a side effect.. These include the sedatives, tranquillisers, anti-depressants, narcotic analgesics, anaesthetics and alcohol—any of which may cause severe hypotension in patients on antihypertensive drugs. Many drugs produce CNS depression—either as part of their therapeutic effect, or as a side effect—and their effects are additive. This may be hazardous when alcohol is taken together with sedatives, antidepressants or antihistamines particularly if the patient drives or works with heavy machinery.

Thus the potentiation of mercaptopurine by allopurinol is important because allopurinal is used to prevent the urate nephropathy which may follow treatment of acute leukaemia. The interaction that occurs between the adrenergic neurone blocking drugs (guanethidine, bethanidine) and the sympathomimetic amines present in nasal decongestants is important because nasal stuffiness is a side effect of treatment with this group of antihypertensive drugs. Interactions involving drugs which can be bought without a prescription are especially important not only because these drugs are widely used but also because a doctor may be unaware that his patient is taking them.

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Adverse Reactions to Drugs by O. L. Wade and Linda Beeley (Auth.)

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