Adverse drug reactions related to the use of non-steroidal anti-inflammatory drugs: results of spontaneous reporting from central India.

To assess the adverse drug reactions to non-steroidal anti-inflammatory drugs through spontaneous reporting system in IGGMC&H, Nagpur and to analyse them using WHO assessment scales, an observational, prospective study was conducted in patients attending outpatient department, inpatient department and casualty of IGGMC and H Nagpur from 1st June 2005 to 31st May 2009. Data were collected by spontaneous adverse drug reactions reporting system. Among 2639 total adverse drug reactions reported, 336 (12.7%) were due to non-steroidal anti-inflammatory drugs. The non-steroidal anti-inflammatory drugs most frequently implicated with adverse drug reactions were ibuprofen (51.19%) followed by diclofenac (27.08%), paracetamol (6.55%), nimesulide (6.25%), aspirin (5.95%). The most commonly affected organ systems were skin and appendages and gastro-intestinal system. Maculopapular rashes were the most frequent skin Involvement. Non-steroidal anti-inflammatory drugs are the most frequently used drugs. As they are commonly associated with adverse drug reactions, their limited and careful use is needed. Considering their prominent role in therapeutics, close clinical observations are very important in minimising adverse drug reactions and demands need for vigilant surveillance of adverse drug reactions in patients, receiving established as well as newer non-steroidal anti-inflammatory drugs.

Relapse of tardive dyskinesia due to reduction in clozapine dose.

Clozapine is a second-generation (atypical) antipsychotic agent, which has been proven efficient against the positive and negative symptoms of schizophrenia, with a low propensity to induce tardive dyskinesia (TD). Compared with typical antipsychotics, it has a greater affinity for dopamine D4 than D2 receptors and additional action on serotonin 5-HT(2A) receptors. Due to its weak D(2) blocking action, it produces few extra pyramidal side effects and TD is rare. TD is one of the muscular side effects of antipsychotic drugs, especially the older generation like haloperidol. TD does not occur until after many months or years of taking antipsychotic drugs. TD is primarily characterized by abnormal involuntary movements of the tongue, lips or jaw, as well as facial grimacing or extremities that develop in association with the use of antipsychotic medications. TD can be embarrassing to the affected patient in public. The movements disappear during sleep and women are at greater risk than men for developing TD.