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DETECTION AND
MONITORING OF ADRS
Dr. Ramesh Bhandari
Asst. Professor,
Department of Pharmacy Practice
KLE College of Pharmacy, Belagavi
Dr.
Ramesh
Bhandari
Drug Development
REVISIT
Dr.
Ramesh
Bhandari
DRUG DEVELOPMENT
Drug
Discovery
Pre-Clinical
Development
Clinical
Development
Regulatory
approval
Post
Marketing
Surveillance
Drug
Candidate
Developed
Compound
Regulatory
Submissio
n
Drug
Approved
for
marketing
Dr.
Ramesh
Bhandari
Detection and monitoring of ADRs
• Acute toxicity
• Specific animal tests
• Clinical trials
Pre-
marketing
Studies
• Spontaneous reporting
system
• Epidemiological methods
Post-
Marketing
Surveillance
Dr.
Ramesh
Bhandari
Acute Toxicity
 Study organs affected
 Study dose dependency of toxicity
Dr.
Ramesh
Bhandari
Specific animal tests
 Carcinogenicity
 Teratogenicity
 Mutagenicity
“However, animal can only serve as
approximate models for humans”
Dr.
Ramesh
Bhandari
Clinical Trials
 Approx. 4000-5000 individuals exposed
 In 3 phases
 Identify adverse reactions of a frequency
greater than 0.5 – 1.0%
“Children, elderly, multiple disease patients
and pregnant women are normally
excluded”
Dr.
Ramesh
Bhandari
Post Marketing Surveillance
 Benefit for the identification of all drug
related risks
 Include active and passive
pharmacovigilance methodologies
Spontaneous Reporting System
Pharmaco-epidemiological
methods
Dr.
Ramesh
Bhandari Spontaneous Reporting
System
 Most sensitive, powerful and cost effective system
for identification of ADR
 Every health care practitioner should report any
suspicion of a drug unexpectedly causing a risk to
patient situation.
 Outcome – signals generation of unknown
problems.
“Not possible to quantify the risk”
Dr.
Ramesh
Bhandari
Pharmacoepidemiological Methods
 Verify the hypothesis of a causal link between drug
exposure and an ADR.
 Also possible to quantify the risk
 Various pharmacoepidemiological methods
includes
 Case reports
 Cohort studies
 Case-Control studies
Dr.
Ramesh
Bhandari
Cohort Studies
Population
Drug
Exposed
ADR
No ADR
Drug
Unexposed
ADR
No ADR
Time
Dr.
Ramesh
Bhandari
Case-Control Studies
Population
Cases
(ADR)
Drug
Exposed
Drug
Unexposed
Control
(No ADR)
Drug
Exposed
Drug
Unexposed
Time
Dr.
Ramesh
Bhandari
In Hospital Setup
 Healthcare professionals can detect ADRs during ward
rounds with the medical team or during review of the patients
treatment chart.
 To assist detection of ADRs, healthcare professionals should closely
monitor patients who are at high risk. These include:
◦ Patients with renal or hepatic impairment
◦ Patients taking drugs which have a potential to cause ADRs example:
Narrow therapeutic agents
◦ Patients who had previous allergic reactions
◦ Patients taking multiple drug therapy (poly pharmacy)
◦ Pregnant and breast feeding women.
Dr.
Ramesh
Bhandari
In Hospital Setup
 First step in detection of ADR is data collection.
 Data to be collected includes patient’s demographic information,
presenting complaints, past medical and medication history, drug
therapy details including OTC, current and medication on
admission, laboratory investigation details,
 Details of suspected ADR such as time of onset of reaction,
nature and severity, details of the suspected drug including dose,
frequency, time of administration, duration of treatment, plasma
concentration of the drug,
 Previous reports on reactions, data on any other causes including
risk factors and predisposing factors.
Dr.
Ramesh
Bhandari
In Hospital Setup
 Suspected ADRs has to be then assessed for causality
and/Or Severity.
Dr.
Ramesh
Bhandari
REFERENCE
1) G. Parthasarathi, Karin Nyfort Hansen, Milap C
Nahata. A textbook of clinical pharmacy practice
Essential concepts and skills. 2nd edition,
Universities Press.
Dr.
Ramesh
Bhandari

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Detection and monitoring of ADRs