Adverse drug reactions--tales of a forensic pathologist

Drugs can produce adverse reactions in susceptible patients. This can range from minor discomfort to major morbidity or even death. The pharmacological properties of certain drugs have a high potential in producing these adverse reactions, especially if large doses are given or given simultaneously with interacting drugs or given in the presence of renal or liver dysfunction of the patient. Clinicians should be aware of the potential toxicity of the drugs they prescribe and their interacting drugs. In Singapore, deaths due to adverse drug reaction are regarded as unnatural deaths and they should be reported to the Coroner. These cases are usually subjected to a post-mortem examination. Clinicians are not allowed to sign up cases of death due to adverse drug reactions and those who do so will be subjected to queries from the Registrar of Death and the Coroner. Every year doctors have been called up to explain their misdeeds and warned. Fortunately there are not many such cases. Some cases of deaths due to adverse reactions to tetracyclines, sulphur, phenylbutazone, penicillin, paracetamol, etc will be discussed.