The importance of adverse drug reactions is often underestimated. They are common, can be life threatening, and unnecessarily expensive. Because of the wide range of drugs available, the manifestations of toxicity can be variable and affect any organ system. In fact, adverse drug reactions have taken over from syphilis and tuberculosis as the great mimics of other diseases. It is also likely that the pattern of toxicity is going to change with the introduction of new biotechnology products. It is therefore important for the prescribing clinician to be aware of the toxic profile of drugs they prescribe and to be ever vigilant for the occurrence of unexpected adverse reactions.

Both type A and type B adverse reactions are complex, and their prevention for future populations will depend on an understanding of their pathogenesis, and exactly how a foreign chemical, i.e. a drug, interacts with macromolecules within the body. Pharmacogenomic strategies have been proposed for the prevention of these reactions in the future by prediction of susceptible individuals (Roses, 2000). However, despite the hype surrounding the area, this is likely to be a long-term goal and will crucially depend on (a) the availability of accurately phenotyped patients, which for the rare reactions will necessitate multi-centre international collaborations, (b) the demonstration that genotyping is clinically- and cost-effective, (c) an understanding of the mechanisms of the adverse reactions so that more targeted SNP profiling can be undertaken, and (d) most crucially, education of the end-users, i.e. clinicians, so that they understand the rationale for performing the tests, and how to interpret the results.

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