By O. L. Wade and Linda Beeley (Auth.)
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Extra resources for Adverse Reactions to Drugs
Many basic drugs such as procainamide and the tricyclic antidepressants have a volume of distribution many times greater than the plasma volume. Thus, although they are highly protein-bound, displacement is not important clinically. Warfarin, on the other hand is not widely distributed and displacement from binding can be important. (4) Even if an important amount of a drug is displaced the duration of the clinical potentiation will depend on the rate of drug elimination. The potentiation is likely to be important if the usual rate of elimination is slow or if the drug is eliminated by renal tubular secretion which is unaifected by changes in concentration of free drug.
Treatment may be ineffective if a drug is rapidly metabolised and dose related unwanted effects are more likely to occur in people who metabolise a drug slowly (Fig. 5). This will matter most for drugs with a low therapeutic ratio. Thus patients who metabolise coumarin anticoagulants slowly require only a small dose for adequate anticoagulation and may bleed if the usual dose is given. Patients who develop side effects from nortriptyline have a slower rate of metabolism and higher plasma concentrations than those without side effects.
Ampicillin, cloxacillin. For most purposes either erythromycin or possibly cephaloridine will be a suitable alternative in patients who have previously reacted to penicillin. Tetracyclines. Should not be used in pregnancy or in children under 7 because they are deposited in bones and teeth producing discoloration of the teeth. Metronidazole. Patients given metronidazole in the treatment of Vincent's gingivitis should be warned about the possible effects of alcohol.