Adverse drug reactions as cause of admission to hospital

Editor—The study by Pirmohamed et al gives some insights into the problems associated with adverse drug reactions.¹ Although the statistic mainly projected is that of 6.5% (1/16) admissions due to adverse reactions, a more useful figure may be that of 107 patients who had adverse reactions that were “definitely avoidable.” If we have a discussion about how these adverse reactions happened and how they could have been avoided it may help in reducing such events in future. Also useful will be a similar discussion on the reasons for the “possibly avoidable” adverse reactions.

Regarding aspirin, I don't think the study gives a correct picture. Even in the general population aspirin is a widely used drug. The study was done in a high risk population of patients admitted to hospital. In such a group we definitely expect a high intake of aspirin. Aspirin may be contributing to gastrointestinal bleeding. But a better way to assess the risk may be a study comparing similar groups of patients taking aspirin and not taking it. Therefore the value in this study does not do justice to aspirin.

It is interesting to note that five of the patients who died had renal failure as a result of medication, mainly angiotensin converting enzyme inhibitors. I would like to know whether they had some underlying renal problem and also about their duration of drug intake. It would be useful to know if the patients' renal function was tested regularly after the drug was started and whether that was of any help.