Adverse Reactions (An Introduction)

• When starting your child on a new medication, parents and caregivers should know potential adverse reactions associated with the medication.

• Before learning about adverse reactions, it's important to understand the different types of adverse reactions.

What is an Adverse Reaction?

• An adverse drug reaction is a response to a medication which is unintended and potentially harmful.

• Adverse reactions can be broken down into 2 categories: “Predictable” or “Unpredictable”.

Predictable	Unpredictable
Side effects Interactions Toxicity	Allergic Idiosyncratic

Predictable

• Expected due to what we know about the drug.

• Usually the most common and least harmful.

• Will usually stop when the medication is discontinued.

Side Effects

• Antibiotics: Diarrhea, nausea, vomiting

• Antihistamines: Drowsiness, dry mouth

• Cough and cold medications: Drowsiness, dizziness, and upset stomach

• Pain relievers: Stomach upset, nausea, and vomiting

• Asthma medications: Tremors, nervousness, and headache

• ADHD medications: Lack of appetite.

(please note that is not an exhaustive list - just a list of examples)

Drug-Drug Interactions

• Taking albuterol (asthma medication) and a beta blocker (propranolol, metoprolol, carvedilol) together can decrease the effectiveness of albuterol.

• Taking ibuprofen or aspirin and other anticoagulants (warfarin, enoxaparin, heparin) together can increase the risk of bleeding

• Taking certain antibiotics while on contraceptives can decrease the effectiveness of contraceptives.

(please note that is not an exhaustive list - just a list of examples)

Drug-Disease Interactions

• Children with asthma taking beta blockers (metoprolol, propranolol, etc) can have a higher risk of asthma attacks.

• Children with high blood pressure can see their blood pressure become higher taking stimulants (Adderall, Ritalin, Concerta).

• Children with diabetes that are taking corticosteroids (prednisone) can see an increase in blood sugar (glucose) levels.

(please note that is not an exhaustive list - just a list of examples)

Drug-Food Interactions

• Eating dairy products with iron (ferrous sulfate) can decrease its effectiveness.

• Eating leafy green vegetables can decrease the effect of warfarin (anticoagulant) and cause clots.

• Eating dairy products with antibiotics like doxycycline can reduce its effectiveness.

• Grapefruit juice can interact with a number of medications and increase their concentration in the blood to dangerous levels.

(please note that is not an exhaustive list - just a list of examples)

Toxicity

Any medication taken in excessively high quantities is dangerous and will cause harm. Always seek medical attention if you believe your child has taken any medication in excessive quantities intentionally or unintentionally.

• Acetaminophen (Tylenol) can cause serious liver damage.

• Ibuprofen can cause serious kidney injury.

• Antidepressants can cause unusual heart rhythms and seizures.

• Stimulants (Adderall, Ritalin, Concerta) can cause seizures.

(please note that is not an exhaustive list - just a list of examples)

Unpredictable

• Not expected from what we know about the drug.

• Rare and potentially more harmful.

Allergic

• Rash/hives due to a penicillin (antibiotic) allergy

• Angioedema (sudden swelling) due to a blood pressure medication such as lisinopril or enalapril.

(please note that is not an exhaustive list - just a list of examples)

Idiosyncratic

• ​Steven-Johnson Syndrome (severe skin reaction) from medications such as carbamazepine (anti-seizure medication).

• Agranulocytosis (body creating a lower number of immune cells) from medications such as clozapine (antipsychotic medication)

(please note that is not an exhaustive list - just a list of examples)

Why does it matter?

Risk vs. Benefit

If you know that your child is experiencing a common (non-severe) side effect (ex: tremors & increased heart rate from albuterol), usually the benefits of the medication will outweigh the unwanted effects.

If your child is experiencing effects that are not expected and/or severe, it is time to get in contact with your child’s medical provider or seek additional medical attention. In this case, you should have a discussion with your child’s medical provider about how the benefit might not outweigh the risks.

Bottom Line

• Adverse reactions can be split into two general categories: predictable and unpredictable.

• Each category is defined by how common the reaction is and severity.

• Knowing the differences between each can help determine when you should seek further medical attention.

Disclaimer

The information in this database regarding prescription drugs is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interaction or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate, or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment