drug-related side effects and adverse reactions

This JAMA Insights discusses continuous glucose monitoring use among individuals with type 2 diabetes, including types of devices, evidence of effectiveness, and adverse effects and contraindications.

Author/s:

Richard M Bergenstal, Thomas W Martens, Roy W Beck

New Frontier, New Challenges—Recognizing and Managing Adverse Effects of Antiamyloid Therapies

Hope Smashey — Tue, 01 Jul 2025 19:24:38 +0000

Date Added:

July 1, 2025

Journal/Publication:

JAMA Intern Medicine

Publication Date:

June 23, 2025

URL:

New Frontier, New Challenges—Recognizing and Managing Adverse Effects of Antiamyloid Therapies

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2242

Keywords

antiamyloid therapies

PMID (1):

40549376

MeSH

Iatrogenic Disease

antiamyloid therapies

Information for primary care clinicians about the possible adverse effects of anti-amyloid therapies. James W. Mold, MD, MPH

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This clinical insight discusses the diagnosis and management of adverse effects of antiamyloid therapies and what medications require consideration or avoidance.

Author/s:

Megan A Rech, Neelum T Aggarwal, Ula Hwang

Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain - Quarterly Progress Report: December 2020

Bethie Seay — Tue, 06 Jul 2021 05:00:00 +0000

Date Added:

July 6, 2021

Type:

Meta-analyses, Reviews, and Guidelines

MeSH

A systematic review of current evidence on cannabis and other plant-based treatments for chronic pain. The results are summarized in Table 2, page 8.

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This is the first progress report for an ongoing living systematic review on plant-based
treatments for chronic pain. The systematic review will synthesize evidence on the benefits and
harms of plant-based compounds (PBCs) such as cannabinoids and kratom used to treat chronic
pain, addressing concerns about severe adverse effects, abuse, misuse, dependence, and
addiction.
The purpose of this progress report is to describe the body of literature identified thus far.
This report will be periodically updated with new studies as they are published and identified,
culminating in a systematic review that provides a synthesis of the accumulated evidence.

Author/s:

McDonagh, M. S., Wagner, J., Ahmed, A. Y., Morasco, B., Kansagara, D., Chou, R.

Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: A systematic review and meta-analysis

Devin Evans — Wed, 07 Apr 2021 05:00:00 +0000

Date Added:

April 7, 2021

Journal/Publication:

PLos Med

Publication Date:

March 29, 2021

Issue:

Volume:

URL:

Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: A systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1371/journal.pmed.1003524

Keywords

PMID (1):

33780450

MeSH

cannabinoids

aged

insulin receptor-related receptor

Drug Combinations

cannabidiol

A systematic review of studies of the use of natural and synthetic cannabinoids in people over 50. James W. Mold, MD, MPH

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Background: Cannabinoid-based medicines (CBMs) are being used widely in the elderly. However, their safety and tolerability in older adults remains unclear. We aimed to conduct a systematic review and meta-analysis of safety and tolerability of CBMs in adults of age ≥50 years.

Methods and findings: A systematic search was performed using MEDLINE, PubMed, EMBASE, CINAHL PsychInfo, Cochrane Library, and ClinicalTrials.gov (1 January 1990 to 3 October 2020). Randomised clinical trials (RCTs) of CBMs in those with mean age of ≥50 years for all indications, evaluating the safety/tolerability of CBMs where adverse events have been quantified, were included. Study quality was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two reviewers conducted all review stages independently. Where possible, data were pooled using random-effects meta-analysis. Effect sizes were calculated as incident rate ratio (IRR) for outcome data such as adverse events (AEs), serious AEs (SAEs), and death and risk ratio (RR) for withdrawal from study and reported separately for studies using tetrahydrocannabinol (THC), THC:cannabidiol (CBD) combination, and CBD. A total of 46 RCTs were identified as suitable for inclusion of which 31 (67%) were conducted in the United Kingdom and Europe. There were 6,216 patients (mean age 58.6 ± 7.5 years; 51% male) included in the analysis, with 3,469 receiving CBMs. Compared with controls, delta-9-tetrahydrocannabinol (THC)-containing CBMs significantly increased the incidence of all-cause and treatment-related AEs: THC alone (IRR: 1.42 [95% CI, 1.12 to 1.78]) and (IRR: 1.60 [95% CI, 1.26 to 2.04]); THC:CBD combination (IRR: 1.58 [95% CI,1.26 to 1.98]) and (IRR: 1.70 [95% CI,1.24 to 2.33]), respectively. IRRs of SAEs and deaths were not significantly greater under CBMs containing THC with or without CBD. THC:CBD combination (RR: 1.40 [95% CI, 1.08 to 1.80]) but not THC alone (RR: 1.18 [95% CI, 0.89 to 1.57]) significantly increased risk of AE-related withdrawals. CBD alone did not increase the incidence of all-cause AEs (IRR: 1.02 [95% CI, 0.90 to 1.16]) or other outcomes as per qualitative synthesis. AE-related withdrawals were significantly associated with THC dose in THC only [QM (df = 1) = 4.696, p = 0.03] and THC:CBD combination treatment ([QM (df = 1) = 4.554, p = 0.033]. THC-containing CBMs significantly increased incidence of dry mouth, dizziness/light-headedness, and somnolence/drowsiness. Study limitations include inability to fully exclude data from those <50 years of age in our primary analyses as well as limitations related to weaknesses in the included trials particularly incomplete reporting of outcomes and heterogeneity in included studies.

Conclusions: This pooled analysis, using data from RCTs with mean participant age ≥50 years, suggests that although THC-containing CBMs are associated with side effects, CBMs in general are safe and acceptable in older adults. However, THC:CBD combinations may be less acceptable in the dose ranges used and their tolerability may be different in adults over 65 or 75 years of age.

Author/s:

Velayudhan, Latha, McGoohan, Katie, Bhattacharyya, Sagnik

Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers

Brian Desmarais — Mon, 11 Nov 2019 15:09:25 +0000

Date Added:

November 11, 2019

Journal/Publication:

The American Journal of Medicine

Publication Date:

October 12, 2019

URL:

Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2019.10.023

Keywords

MeSH

While the full article is not available for free, I though the abstract might be of interest and value. James W. Mold, MD, MPH

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Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine as well as prevention of recurrent attacks there are prescription drugs of proven benefit. For those without health insurance or high co-pays, however, they may be neither available nor affordable and, for all patients, they may be either poorly tolerated or contraindicated.

The totality of evidence, which includes data from randomized trials, suggests that high-dose aspirin, in doses from 900 to 1300 milligrams, taken at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, the totality of evidence, including some, but not all, randomized trials, suggests the possibility that daily aspirin in doses from 81 to 325 milligrams, may be an effective and safe treatment option for the prevention of recurrent migraine headaches.

The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers treating acute as well as recurrent migraine headaches.

Author/s:

Biglione, B., Gitin, A., Gorelick, P., Hennekens, C.

Medication Overload: America’s Other Drug Problem. How the drive to prescribe is harming older adults.

Brian Desmarais — Mon, 01 Jul 2019 14:26:58 +0000

Date Added:

January 21, 2021

Publisher:

Lown Institute

Publication Date:

July 1, 2019

URL:

Medication Overload: America’s Other Drug Problem How the drive to prescribe is harming older adults

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

Antineoplastic Combined Chemotherapy Protocols

Daunorubicin

Etoposide

substance-related disorders

Polypharmacy is a major problem in the U.S. This report summarizes its magnitude, causes, and consequences. Other evidence suggests that when the number of meds increases beyond 4-5, any possible benefits are outweighed by the risks of adverse effects and drug-drug interactions. Medication lists should include OTCs and should be updated at every visit. Patients should be strongly encouraged to bring their medication bottles with them to every visit. James W. Mold, MD, MPH

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In the last year, older adults in the U.S. sought medical care nearly 5 million times due to serious side effects from one or more medications. More than a quarter million of these visits resulted in hospitalizations, at a cost of $3.8 billion (see Appendix A in the full report). These numbers point to a rapidly growing epidemic of medication overload among older Americans. Over the last decade, adults age 65 and older have been hospitalized for serious drug side effects, called adverse drug events (ADEs), about 2 million times. To put this in context, there were 3.2 million opioid-related hospitalizations across the entire population during the same period.1 The trend of increasing ADEs is not propelled by drug abuse, but by the rising number of medications prescribed to older adults (called “polypharmacy” in the scientific literature). More than 40 percent of older adults take five or more prescription medications a day, a threefold increase over the past two decades.2,3 The greater the number of medications—most of which are prescribed for legitimate reasons—the greater the risk for serious adverse reactions in older patients. Medication overload is causing widespread yet unseen harm to our parents and our grandparents. It is every bit as serious as the opioid crisis, yet its scope remains invisible to many patients and health care professionals. While some clinicians are trying to reduce the burden of medications on their individual patients, no professional group, public organization, or government agency to date has formally assumed responsibility for addressing this national problem. If current trends continue, we estimate that medication overload will be responsible for at least 4.6 million hospitalizations between 2020 and 2030. It will cost taxpayers, patients and families an estimated $62 billion. Over the next decade, medication overload is expected to cause the premature death of 150,000 older Americans. In this report, the Lown Institute calls for the development of a national strategy to address medication overload and help older people avoid its devastating effects on the quality and length of their lives. A subsequent National Action Plan for Addressing Medication Overload will lay out a national strategy to address the epidemic of prescribing and ensure the safety of millions of older adults who are now at risk of preventable harm and premature death.

Author/s:

Executive Summary of the Lown Institute

Antipsychotics for Children with Hyperactivity or Disruptive Disorders

Tracy Ashby — Wed, 23 Jan 2019 06:00:00 +0000

Date Added:

January 23, 2019

Journal/Publication:

PCORI

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

March 1, 2018

URL:

Antipsychotics for Children with Hyperactivity or Disruptive Disorders

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

attention deficit disorder with hyperactivity

problem behavior

child

The adverse effects of antipsychotics in children with behavioral disorders including ADHD often outweigh the modest benefits.

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New evidence can help clinicians, caretakers, and others weigh the benefits and harms of antipsychotic treatment for children and adolescents.

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

AHRQ Comparative Effectiveness Reviews

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

February 16, 2016

URL:

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

alcohol use disorder

pharmacotherapy

patient care

PMID (1):

26937549

MeSH

alcoholism

caregivers

decision making

This is a summary of the current evidence on medication-assisted treatment of alcohol use disorder.

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This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and adverse effects of medications in adults with alcohol use disorder (AUD). The systematic review included 167 articles reporting on 135 eligible studies published from January 1, 1970, to October 11, 2013. This summary is provided to inform discussions with patients and/or caregivers of treatment options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Author/s:

John M. Eisenberg Center for Clinical Decisions and Communications Science