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Severe Multiple Drug Intolerance Syndrome in Fibromyalgia and Irritable Bowel Syndrome
Alicia A Alvarez1, Jayme M Palka2, David A Khan3
1First Physicians Group, Sarasota Memorial Hospital, Sarasota, Fla.
Background:
Multiple drug intolerance syndrome (MDIS) describes patients with multiple nonimmunologically mediated adverse reactions to medications. Patients with more than 10 medication intolerance labels are considered to have severe MDIS. There is overlap in the characteristics of patients with MDIS and fibromyalgia and irritable bowel syndrome (IBS). Severe MDIS can limit treatment options in this already complex patient group.
Objective:
This study assessed the prevalence of severe MDIS in patients with fibromyalgia and IBS and its associated risk factors.
Methods:
A retrospective chart review identified patients diagnosed with fibromyalgia or IBS who had been seen at a large academic center from August 2019 to July 2020. Exact birthdate- and sex-matched controls who had been seen within the same time frame were selected at random. Listed drug intolerance data and patient characteristics were then analyzed with logistic regression and χ2 testing.
Results:
Patients with fibromyalgia and IBS were 12 and 3 times more likely to have severe MDIS compared with controls, respectively. Severe MDIS was associated with polypharmacy in both groups. Opiates were the most frequently reported drug intolerance across all participants. Although patients with IBS more often reported gastrointestinal symptoms as adverse reactions, individuals with fibromyalgia did not more frequently report pain or behavioral changes as adverse reactions.
Conclusions:
There was an increased rate of severe MDIS in patients diagnosed with fibromyalgia and IBS. Additional studies are needed to better understand the morbidity of MDIS and how it can best be managed in patients with fibromyalgia and IBS.
Insights
Patients with fibromyalgia and irritable bowel syndrome (IBS) have a higher prevalence of severe multiple drug intolerance syndrome (MDIS). This condition is linked to polypharmacy and requires further investigation for effective management strategies.
Area of Science:
- Pharmacology
- Clinical Medicine
- Patient Safety
Background:
- Multiple drug intolerance syndrome (MDIS) involves nonimmunological adverse drug reactions.
- Severe MDIS is defined by over 10 medication intolerance labels.
- MDIS shares characteristics with fibromyalgia and irritable bowel syndrome (IBS), complicating treatment.
Purpose of the Study:
- To determine the prevalence of severe MDIS in fibromyalgia and IBS patients.
- To identify risk factors associated with severe MDIS in these patient groups.
Main Methods:
- Retrospective chart review of fibromyalgia or IBS patients from August 2019 to July 2020.
- Comparison with randomly selected, matched controls.
- Analysis of drug intolerance data and patient characteristics using logistic regression and chi-squared testing.
Main Results:
- Fibromyalgia and IBS patients were 12 and 3 times more likely to have severe MDIS than controls, respectively.
- Severe MDIS correlated with polypharmacy in both patient groups.
- Opiate intolerance was most common; IBS patients reported more GI symptoms, while fibromyalgia patients did not report more pain or behavioral issues.
Conclusions:
- An elevated rate of severe MDIS exists in patients with fibromyalgia and IBS.
- Further research is necessary to understand MDIS morbidity and optimize its management in these populations.
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