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Adverse Drug Reactions - Part II

Course Number: 537

Preventing ADRs

Preventing ADRs is a critical part of clinical practice. Oral healthcare providers must have an awareness of and access to information related to ADRs. To minimize such events, they must develop a rational approach to the use of pharmacotherapeutic agents in the management of oral/odontogenic problems; especially, since in the treatment of most such conditions non-pharmacological intervention such as primary dental care is a more effective and safer alternative than pharmacotherapy.30

Inappropriate overprescribing is a major concern in healthcare and practitioners must caution against prescribing out of convenience or to meet patient demand.1,31-34 Overprescribing not only contributes to ADR risk, but also antimicrobial resistance and opioid habituation.

The benefits should always outweigh the risks when a drug is prescribed. If clinicians were to observe this basic principle routinely, then the number of unnecessary or inappropriate prescriptions would be reduced. Drug therapy should be individualized by taking into consideration both drug- and patient-related variables.35-37 Patient-related factors that contribute to ADR risk include progressing age, multiple co-morbidities, living alone, and poor coping skills of ambulatory patients.

When a medication is prescribed, the patient and/or guardian/caretaker must have a clear understanding of its purpose and dosing. Simple and clear oral instructions on how and when to take a drug should be given and reinforced by clear labeling and written instructions. Special labels are available for blind or poorly sighted patients.

Follow-up should be accomplished to assess the patient’s compliance and response to drug therapy. The patient should be encouraged to report any potential ADR so that appropriate action can be taken, e.g., dosage adjustments or discontinuance of medication. Complex regimens and frequent dosing lend themselves to noncompliance. A byproduct of poor compliance is hoarding of drugs, which can further contribute to noncompliance and ADRs as patients may confuse new bottles with old ones or use hoarded drugs for the wrong purpose.