From the Guidelines
The most common adverse effects of medications used in general internal medicine wards include gastrointestinal disturbances, such as nausea, vomiting, diarrhea, and hepatotoxicity, as reported in a 2020 study on COVID-19 treatments 1.
Common Adverse Effects
- Gastrointestinal disturbances: nausea, vomiting, diarrhea, and abdominal discomfort
- Hepatotoxicity: elevated liver enzymes and liver injury
- These adverse effects are commonly associated with antiviral medications, such as remdesivir, lopinavir/ritonavir, and favipiravir, which are used to treat COVID-19 1.
Medication-Specific Adverse Effects
- Remdesivir: diarrhea (9%), elevated hepatic enzymes (23%) 1
- Lopinavir/ritonavir: nausea (9.5%), vomiting (6.3%), diarrhea (4.2%), and abdominal discomfort (4.2%) 1
- Favipiravir: digestive tract reactions, including nausea, and hepatotoxicity (7.76%) 1 ### Importance of Monitoring Monitoring for these adverse effects is crucial, especially in elderly patients who are more susceptible due to altered drug metabolism and polypharmacy, as highlighted in a 2022 review on polypharmacy in older people with cardiovascular disease 2.
Additional Considerations
- Other medications, such as biguanides, sulfonylureas, and thiazolidinediones, used to treat type 2 diabetes, can also cause gastrointestinal disturbances, hypoglycemia, and hepatotoxicity, as reported in a 2019 scientific statement from the American Heart Association and the Heart Failure Society of America 3.
- The use of these medications requires careful consideration of the potential risks and benefits, as well as regular monitoring for adverse effects.
From the FDA Drug Label
The following factors, alone or in combination, may be responsible for INCREASED PT/INR response: ENDOGENOUS FACTORS: blood dyscrasias — diarrhea hyperthyroidism see CONTRAINDICATIONS elevated temperature poor nutritional state cancer hepatic disorders steatorrhea collagen vascular disease infectious hepatitis vitamin K deficiency congestive heart failure jaundice EXOGENOUS FACTORS: Potential drug interactions with warfarin sodium tablets are listed below by drug class and by specific drugs. Classes of Drug also: other medications affecting blood elements which may modify hemostasis dietary deficiencies prolonged hot weather unreliable PT/INR determinations
- Increased and decreased PT/INR responses have been reported (oral) (17-Alkyl Penicillins, intravenous, Gout Treatment Agents Testosterone Derivatives) (fluoroquinolones) (topical) ogen dextran (intravaginal, oral, systemic) activator (t-PA) dextrothyroxine moricizine hydrochloride* tolbutamide diazoxide nalidixic acid tramadol diclofenac naproxen trimethoprim/sulfamethoxazole dicumarol neomycin urokinase diflunisal norfloxacin valdecoxib disulfiram ofloxacin valproate doxycycline olsalazine vitamin E erythromycin omeprazole zafirlukast esomeprazole oxandrolone zileuton ethacrynic acid oxaprozin ezetimibe oxymetholone fenofibrate pantoprazole
The most common adverse effects of medications used in general internal medicine wards that are related to warfarin sodium tablets are bleeding events, which can be increased by various factors, including:
- Medications such as fluoroquinolones, diclofenac, and tramadol
- Botanicals such as garlic, Ginkgo biloba, and cranberry products
- Endogenous factors such as blood dyscrasias, diarrhea, and hyperthyroidism 4
From the Research
Adverse Effects of Medications
The most common adverse effects of medications used in general internal medicine wards are:
- Gastrointestinal system reactions, such as abdominal pain, nausea, and constipation 5
- Central nervous system reactions, such as delirium, seizures, and strokes 6
- Cardiovascular system reactions, such as those associated with the use of certain antiemetics and gastrointestinal medications 6
- Hematological system reactions, such as those affecting the blood and blood-forming organs 7
- Skin reactions, such as rashes and other dermatological conditions 7
Medication Classes Associated with Adverse Effects
Several classes of medications are associated with adverse effects, including:
- Proton pump inhibitors, which are commonly used to treat gastrointestinal disorders 5
- Benzodiazepines, which are commonly used to treat anxiety and insomnia 5
- Selective serotonin-reuptake or norepinephrine-reuptake inhibitors, which are commonly used to treat depression and other mental health conditions 5
- Non-steroidal anti-inflammatory drugs, which are commonly used to treat pain and inflammation 5
- Opioids, which are commonly used to treat pain 5
Risk Factors for Adverse Drug Reactions
Several risk factors are associated with an increased risk of adverse drug reactions, including:
- Duration of hospital admission, with longer admissions associated with a higher risk of adverse drug reactions 7
- Changes in renal status during hospitalization, such as a decline in kidney function 7
- Drug interactions, which can increase the risk of adverse drug reactions 7
- Polypharmacy, or the use of multiple medications, which can increase the risk of adverse drug reactions 8