Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

BMJ : British Medical Journal
Munir PirmohamedAlasdair Breckenridge

Abstract

To ascertain the current burden of adverse drug reactions (ADRs) through a prospective analysis of all admissions to hospital. Prospective observational study. Two large general hospitals in Merseyside, England. 18 820 patients aged > 16 years admitted over six months and assessed for cause of admission. Prevalence of admissions due to an ADR, length of stay, avoidability, and outcome. There were 1225 admissions related to an ADR, giving a prevalence of 6.5%, with the ADR directly leading to the admission in 80% of cases. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions to the NHS is 466m pounds sterling (706m Euros, 847m dollars). The overall fatality was 0.15%. Most reactions were either definitely or possibly avoidable. Drugs most commonly implicated in causing these admissions included low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding. The burden of ADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs. Although many of the implicated drugs have proved benefit, measures need to be put into place to redu...Continue Reading

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Dec 10, 2015·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Susannah L CollinsMunir Pirmohamed
Feb 7, 2012·The American Journal of Geriatric Pharmacotherapy·Annemie SomersMirko Petrovic
Jan 10, 2012·Homeopathy : the Journal of the Faculty of Homeopathy·Stella Bawden
Jan 8, 2016·Genome Medicine·Stephane BourgeoisMunir Pirmohamed
Dec 14, 2011·Gaceta sanitaria·Antonio Vallano FerrazJosep M Arnau de Bolós
May 24, 2011·Lancet·David Gurwitz, Jeantine E Lunshof
May 17, 2011·Lancet·Mark Nelson
Mar 1, 2011·Annals of Emergency Medicine·Corinne M HohlBoris Sobolev
Feb 19, 2011·La Revue de médecine interne·M-A Loriot
Dec 15, 2010·Clinics in Dermatology·Sueli Coelho da Silva CarneiroMarcia Ramos-e-Silva
Dec 28, 2010·Trends in Pharmacological Sciences·Sarah C Sim, Magnus Ingelman-Sundberg
Nov 26, 2010·Forensic Science International : Synergy·A SajantilaB Budowle
Sep 18, 2010·Chemico-biological Interactions·B Kevin ParkDominic Williams
Nov 5, 2015·European Heart Journal·EUGenMed Cardiovascular Clinical Study GroupVerena Stangl
Sep 8, 2010·European Journal of Internal Medicine·Andreea FarcasDan Dumitrascu
Apr 7, 2010·The American Journal of Medicine·Alan N Barkun, Grigorios Leontiadis
Apr 20, 2010·Maturitas·Hilary Anne Wynne, Julia Blagburn
Nov 7, 2015·Pharmacogenetics and Genomics·Adolfo FigueirasEMPHOGEN group
Feb 18, 2010·The Journal of Allergy and Clinical Immunology·J Luis CastrejonDean J Naisbitt
Feb 9, 2010·International Journal of Medical Informatics·Pauline E JohanssonGunilla C Nilsson
Feb 11, 2010·Farmacia hospitalaria : órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria·D Sevilla SánchezJ Ribas Sala
Nov 26, 2009·Toxicology and Applied Pharmacology·Richard D BegerLaura K Schnackenberg
Nov 20, 2015·Der Urologe. Ausg. A·G Glaeske
Oct 23, 2009·La Revue de médecine interne·A PiauB Vellas
Mar 5, 2016·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Thomas GoedeckePeter Arlett
Jan 29, 2009·Gastroenterología y hepatología·Gianfranco Nardulli, Angel Lanas
Sep 11, 2009·La Revue de médecine interne·D LevêqueS Vinzio
Jun 30, 2009·Forensic Science International : Synergy·Burkhard MadeaJohanna Preuss
Jun 23, 2009·Revista española de geriatría y gerontología·Eva Delgado SilveiraAlfonso J Cruz-Jentoft
Apr 21, 2009·International Journal of Medical Informatics·Brian MeadeMichael Boland
Aug 5, 2008·Mayo Clinic Proceedings·Michael J BlahaAndrew P Defilippis
Dec 23, 2008·Drug Discovery Today·James L Stevens, Thomas K Baker
Sep 16, 2008·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·A ZancanL Manzo
Jun 17, 2008·Research in Social & Administrative Pharmacy : RSAP·Marika K Pohjanoksa-MäntyläM Airaksinen
Nov 18, 2008·European Journal of Internal Medicine·Alexandra AlexopoulouAthanasios J Archimandritis
Feb 5, 2008·Clinical Neurology and Neurosurgery·Arthur C Croft, Anthony V D'Antoni
Oct 14, 2008·European Journal of Internal Medicine·Priska VonbachJürg H Beer
Oct 2, 2007·Current Problems in Cancer·Russell P Kruzelock, William Short
Aug 7, 2007·Archives of Gerontology and Geriatrics·Winit Winit-WatjanaJiraporn Kespichayawattana
May 8, 2007·Emergency Medicine Clinics of North America·Gerald F O'Malley
Apr 10, 2007·Journal of Autoimmunity·Colin J D RossMichael R Hayden
Nov 23, 2006·The Medical Clinics of North America·Burke A Cunha
Apr 6, 2006·Emergency Medicine Clinics of North America·Michelle P Blanda
Oct 1, 2014·Journal of Evaluation in Clinical Practice·Eline Thornquist, Anna Luise Kirkengen
Dec 10, 2014·Methods of Information in Medicine·G DeclerckM-C Jaulent
Jul 8, 2015·The Journal of Emergency Medicine·Michael Ganetsky
Aug 9, 2015·The Journal of Allergy and Clinical Immunology·Munir PirmohamedB Kevin Park
Jan 29, 2005·British Journal of Clinical Pharmacology·J K Aronson
Aug 20, 2015·International Journal of Clinical Pharmacy·Mohammed AlsbouKhalil Al-Salem
Sep 15, 2004·The Journal of Clinical Hypertension·Doemnic A Sica
Apr 7, 2005·Journal of Clinical Pharmacy and Therapeutics·A Li Wan Po
Feb 1, 2005·Pharmacoepidemiology and Drug Safety·Gianluca TrifiròAchille Patrizio Caputi
May 12, 2009·Cardiovascular Therapeutics·Heather LeaverChim C Lang
Dec 13, 2006·Pharmacoepidemiology and Drug Safety·Matthijs L BeckerBruno H Ch Stricker
Apr 17, 2007·Pharmacoepidemiology and Drug Safety·Jennifer Richardson, Anita Holdcroft
Jun 29, 2006·British Journal of Clinical Pharmacology·R L HowardMunir Pirmohamed
Jan 9, 2009·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·R MirakianBSACI
Aug 3, 2006·Journal of Clinical Pharmacy and Therapeutics·E C DaviesMunir Pirmohamed
Sep 6, 2006·Pharmacoepidemiology and Drug Safety·Anne G GranasAnne M Horn
Dec 23, 2008·Pharmacoepidemiology and Drug Safety·Sara PourseyedMostafa Moin
Feb 28, 2008·Pharmacoepidemiology and Drug Safety·Cornelis S van der HooftMiriam C J M Sturkenboom
Oct 16, 2007·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Lee StruninBrian Jack
Apr 28, 2006·Pharmacotherapy·C A Bond, Cynthia L Raehl
Jan 8, 2008·Alimentary Pharmacology & Therapeutics·P A H M WijnenG H Koek
Mar 27, 2007·Journal of Clinical Pharmacy and Therapeutics·P GallagherDenis O'Mahony
Mar 27, 2007·Journal of Clinical Pharmacy and Therapeutics·K C SokolM M Li
Feb 6, 2007·British Journal of Clinical Pharmacology·A BlenkinsoppPhilip A Routledge
Nov 23, 2006·British Journal of Clinical Pharmacology·J K Aronson
Nov 22, 2007·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·E Rebelo GomesP Demoly
Apr 14, 2006·Basic & Clinical Pharmacology & Toxicology·Thomas M Macdonald, L Wei
Feb 6, 2007·British Journal of Clinical Pharmacology·J K Aronson
Mar 13, 2008·British Journal of Clinical Pharmacology·J M Ritter
Dec 12, 2007·British Journal of Clinical Pharmacology·Karin WesterStaffan Hägg
Jan 13, 2006·British Journal of Pharmacology·Patrick Vallance, Trevor G Smart
Dec 15, 2006·British Journal of Clinical Pharmacology·Agnes I Vitry
Nov 2, 2006·British Journal of Clinical Pharmacology·Johnson GeorgeDerek Stewart
Mar 27, 2007·Pharmacotherapy·C A Bond, Cynthia L Raehl
Oct 26, 2006·British Journal of Clinical Pharmacology·Munir Pirmohamed
Oct 31, 2006·Pharmacoepidemiology and Drug Safety·Johanna UlfvarsonU Bergman
Jul 18, 2006·British Journal of Clinical Pharmacology·J K Aronson
Feb 27, 2008·Pharmacoepidemiology and Drug Safety·Juliet M FosterPhilip Hannaford
Aug 2, 2007·Journal of Thrombosis and Haemostasis : JTH·E K RomboutsF J M Van Der Meer
Dec 21, 2006·Clinical and Experimental Immunology·A MalbránN Galassi
Oct 17, 2006·Basic & Clinical Pharmacology & Toxicology·G Morgan
Aug 3, 2006·The British Journal of Dermatology·S ConstableMunir Pirmohamed
Nov 13, 2007·British Journal of Clinical Pharmacology·David J Back, Sara E Gibbons
Mar 1, 2012·British Journal of Clinical Pharmacology·Philip A Routledge
Mar 1, 2012·British Journal of Clinical Pharmacology·Robin E Ferner
Mar 1, 2012·British Journal of Clinical Pharmacology·I Ralph Edwards
Jul 27, 2010·British Journal of Clinical Pharmacology·E RougheadAndrew L Gilbert
Sep 14, 2010·Journal of Clinical Pharmacy and Therapeutics·A R CoxR E Ferner
Apr 22, 2011·Journal of Nursing Management·Marie E GabeSue Jordan
Sep 18, 2013·British Journal of Clinical Pharmacology·Andrius PatapovasThomas Bürkle
Sep 18, 2013·British Journal of Clinical Pharmacology·Thomas BürkleRenke Maas
May 20, 2011·Journal of Clinical Pharmacy and Therapeutics·S LorimerN J Langford
Oct 24, 2012·Medicinal Research Reviews·Andrew V StachulskiMartin S Lennard
Aug 3, 2011·Pharmacoepidemiology and Drug Safety·Janet KrskaCraig Wilson
Apr 20, 2010·Journal of Clinical Pharmacology·Isa Naina MohamedJames S McLay
Mar 9, 2011·Pharmacoepidemiology and Drug Safety·Dominik RottenkolberNet of Regional Pharmacovigilance Centers
Sep 3, 2011·British Journal of Clinical Pharmacology·Karine LacutCeline Verstuyft
Nov 9, 2012·The International Journal of Pharmacy Practice·Leanne StaffordGregory M Peterson
May 21, 2013·Pharmacotherapy·Chuenjid KongkaewDarren M Ashcroft
Jun 29, 2012·British Journal of Clinical Pharmacology·Philip A Routledge
Dec 21, 2012·Journal of the American Geriatrics Society·Dominique Bonnet-ZamponiOptimization of Medication in AGEd study group
Apr 27, 2013·Journal of Clinical Pharmacy and Therapeutics·Anne J LeendertsePatricia M L A van den Bemt
Dec 15, 2010·British Journal of Clinical Pharmacology·Eline M RodenburgLoes E Visser
Oct 25, 2011·Journal of Clinical Pharmacy and Therapeutics·Jamie J ColemanRobin E Ferner
Feb 19, 2013·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·E RamirezS Quirce
Apr 19, 2012·British Journal of Clinical Pharmacology·Simon R J Maxwell, John Mucklow
Apr 22, 2011·Journal of Nursing Management·Ana Filipa MacedoFrancisco Batel Marques
Jul 14, 2010·Pharmacoepidemiology and Drug Safety·Florence T BourgeoisKenneth D Mandl
Jun 23, 2011·British Journal of Clinical Pharmacology·Steven LaneMunir Pirmohamed
Nov 30, 2011·British Journal of Clinical Pharmacology·Pernille WarrerLise Aagaard
May 25, 2013·Pharmacoepidemiology and Drug Safety·Björn WettermarkHt Sørensen
Aug 11, 2010·Journal of Evaluation in Clinical Practice·Greg J KyleSusan Tett
Mar 17, 2016·The New England Journal of Medicine·Tobias DreischulteBruce Guthrie
Nov 3, 2010·British Journal of Clinical Pharmacology·E A DaviesMunir Pirmohamed
Sep 17, 2013·Pharmacoepidemiology and Drug Safety·L PasinaPiermannuccio Mannucci
Jun 14, 2013·Pharmacoepidemiology and Drug Safety·Ana MiguelAltamiro Costa Pereira
Oct 23, 2009·Fundamental & Clinical Pharmacology·Geneviève DurrieuJean-Louis Montastruc
Nov 16, 2010·Journal of Internal Medicine·Isla S MackenzieL Wei
Mar 16, 2012·British Journal of Clinical Pharmacology·Carolina J P W KeijsersPaul A F Jansen
Jun 19, 2012·British Journal of Clinical Pharmacology·Richard KiaChris E Goldring
Apr 13, 2011·British Journal of Clinical Pharmacology·Jacqueline AdamDaniel Yerly
May 7, 2011·Journal of Clinical Pharmacy and Therapeutics·R B Raffa, J V Pergolizzi
Feb 23, 2011·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·G PorebskiW J Pichler
Apr 21, 2011·Journal of Evaluation in Clinical Practice·Claire ScullinJames C McElnay
Jun 20, 2012·International Journal of Rheumatic Diseases·Pramote TragulpiankitUamporn Sirikhedgon
Apr 22, 2011·Journal of Nursing Management·Sue Jordan
Apr 22, 2011·Journal of Nursing Management·Steve HemingwayKate Dewhirst
Jun 30, 2011·International Journal of Geriatric Psychiatry·Ian D MaidmentCornelius Katona
Feb 22, 2011·British Journal of Clinical Pharmacology·Paul GavazaMary Steinhardt
Jan 12, 2011·British Journal of Clinical Pharmacology·Isa Naina MohamedJames S McLay
Nov 26, 2011·British Journal of Clinical Pharmacology·John MucklowSimon R J Maxwell
Mar 4, 2011·Journal of Clinical Pharmacy and Therapeutics·R M GallagherR L Smyth
Apr 14, 2016·Schizophrenia Research and Treatment·Hyeong-Min Lee, Yuna Kim
May 18, 2013·International Journal of Clinical Practice·P-J LiaoK-H Hsu
Jun 30, 2012·Pharmacoepidemiology and Drug Safety·Melvyn P Smith, Sherael D Webley
Jan 18, 2011·British Journal of Clinical Pharmacology·John D Blakey, Ian P Hall
Feb 16, 2013·International Journal of Clinical Practice·J García-Aparicio, J I Herrero-Herrero
Mar 8, 2014·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Ramon S CancinoSuzanne E Mitchell
Jun 24, 2009·Phytotherapy Research : PTR·Simla BasarJohannes Westendorf
Apr 13, 2013·The International Journal of Pharmacy Practice·Cinzia PezzolesiSoraya Dhillon
Jun 7, 2014·The International Journal of Pharmacy Practice·Kathryn WoodBrian Williams
Sep 17, 2009·Pharmacoepidemiology and Drug Safety·Gianluca TrifiròEU-ADR group
Nov 26, 2009·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·C Pickard, A P Sampson
Jun 24, 2014·The International Journal of Pharmacy Practice·Janice O OlaniyanPaul Robinson
Jul 24, 2014·Basic & Clinical Pharmacology & Toxicology·Stephen M CampbellBjörn Wettermark
Jun 25, 2010·British Journal of Clinical Pharmacology·Caitriona CahirKathleen Bennett
Dec 25, 2009·Pharmacoepidemiology and Drug Safety·Changhai SuYixin Su
Aug 29, 2009·Internal Medicine Journal·I Scott, S Jayathissa
Jan 1, 2014·British Journal of Clinical Pharmacology·Katja M HakkarainenStaffan Hägg
Dec 31, 2009·Journal of Thrombosis and Haemostasis : JTH·M C Struijk-MulderH R Büller
May 29, 2013·British Journal of Clinical Pharmacology·Caitriona CahirTom Fahey
Jul 21, 2010·British Journal of Clinical Pharmacology·Lelia O'ShaughnessyMartin Llewelyn
Jul 21, 2010·British Journal of Clinical Pharmacology·E A DaviesMunir Pirmohamed
Oct 24, 2014·Journal of Internal Medicine·L E WalkerMunir Pirmohamed
Jul 6, 2014·Fundamental & Clinical Pharmacology·Anne Bénard-LaribièreEMIR Study Group on behalf of the French network of pharmacovigilance centres
Mar 10, 2010·Basic & Clinical Pharmacology & Toxicology·Riccardo LacchiniJose E Tanus-Santos
Mar 13, 2014·Pharmacoepidemiology and Drug Safety·Supinya DechanontChuenjid Kongkaew
Nov 29, 2013·British Journal of Clinical Pharmacology·Abdullah Al HamidZoe Aslanpour
May 22, 2010·International nursing review·L M LimK-L Tan
Feb 14, 2014·Journal of the American Geriatrics Society·Benjamin Zaniello, Erica Phillips-Caesar
Sep 8, 2015·Social Science & Medicine·Felicity Thomas, Michael Depledge
Jun 4, 2014·IEEE Transactions on Nanobioscience·Huiru ZhengFrancisco Azuaje
Sep 18, 2013·IEEE Journal of Biomedical and Health Informatics·Jenna M RepsRichard B Hubbard
Jul 7, 2015·British Journal of Clinical Pharmacology·Richard SloaneMunir Pirmohamed
May 3, 2016·Cell Systems·Itay ShakedEytan Ruppin
Sep 2, 2015·The American Journal of Gastroenterology·Shih-Chang HungHung-Chang Hung
Dec 9, 2015·Journal of Research in Pharmacy Practice·Kheirollah GholamiToktam Faghihi
Nov 18, 2008·Chemico-biological Interactions·Dennis A Smith
Aug 14, 2015·Journal of Evaluation in Clinical Practice·Jelle TichelaarMilan C Richir
Sep 11, 2014·British Journal of Clinical Pharmacology·Alasdair Breckenridge
Jan 27, 2015·British Journal of Clinical Pharmacology·E A Davies, M S O'Mahony
Apr 19, 2015·BMJ Supportive & Palliative Care·N A MorganD C Currow
Mar 15, 2006·Lancet·Simon R J Maxwell, David J Webb
Aug 11, 2015·Journal of the American Medical Directors Association·Fabienne J H MagdelijnsPatricia M Stassen
Dec 17, 2014·Journal of Evaluation in Clinical Practice·Feras W D El HajjiJames C McElnay
Oct 18, 2005·Trends in Molecular Medicine·Jeantine E Lunshof, David Gurwitz
Jan 29, 2016·Archives of Disease in Childhood·Ana Belén RivasEmilio Vargas