Pharmacists Can Identify and Manage Drug-Induced Diseases

Medications can be lifesaving and vital for managing chronic diseases, but it is important to keep in mind that medications can also be associated with drug-induced diseases. These are defined as an unintended drug effect that results in morbidity and mortality.¹ Symptoms result in the patient seeking emergency attention and/or requiring hospitalization.^1,2 Postmarketing surveillance is critical to identifying drug-induced diseases, and pharmacists play a vital role in identifying and managing drug-induced diseases.^3-7

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Fluoroquinolone Antibiotic-Induced Conditions

There are a variety of medications that can result in drug-induced diseases. Fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, are one example.² The FDA added a boxed warning to fluoroquinolones in 2008 about the increased risk of tendinitis and tendon rupture. Additionally, myasthenia gravis symptom exacerbation was added to the boxed warning.²

In 2018, the FDA issued a drug safety communication about strengthening the labeling warnings section of fluoroquinolones regarding the risks of hypoglycemia and mental health adverse effects, including agitation, nervousness, memory impairment, and delirium.² Because fluoroquinolones are associated with many drug-induced diseases, they should be reserved for serious bacterial infections, such as pneumonia. Fluoroquinolones can be considered if first-line agents fail to treat bacterial sinusitis, chronic bronchitis, and uncomplicated bacterial infections.

Pharmacists can play an important role in preventing and identifying fluoroquinolone drug–induced diseases. Recommending alternative antibiotics and reporting adverse effects to the FDA’s MedWatch program are a couple of examples. Reporting adverse drug reactions assists with the postmarketing surveillance process for medications.

Proton Pump Inhibitor–Induced Diseases

In some cases, drug interactions can contribute to drug-induced diseases. For instance, the use of proton pump inhibitors (PPIs) with clopidogrel (Plavix; Sanofi) can lower the risk of gastrointestinal adverse effects.³ However, PPIs may reduce the efficacy of clopidogrel, causing an increased risk of cardiovascular adverse events, such as myocardial infarction and stroke.³ Omeprazole (Prilosec; AstraZeneca) has been found to be the most likely PPI to cause this interaction with clopidogrel.

Additionally, long-term use of PPIs can increase the risk of developing osteoporosis.⁴ Approximately 25% to 70% of PPI prescriptions do not have an appropriate indication.⁵ Additionally, PPIs can cause a variety of other drug-induced diseases, including Clostridioides difficile, dementia, pneumonia, and nutrient deficiencies.⁵ Studies have shown that pneumonia may occur within the first month of starting a PPI,⁵ whereas other research shows that hypomagnesemia can occur within 3 months of starting a PPI; however, in most cases, it tends to happen after 1 year of PPI use.⁵ This prompted the FDA to issue a drug safety communication in 2011 about the link between PPIs and hypomagnesemia.⁶

Pharmacists can educate patients about the link between long-term PPI use with drug-induced diseases during medication therapy management consults. Additionally, pharmacists can assist with deprescribing PPIs that are no longer needed or are being used for inappropriate indications.⁷ This is especially critical in patients who develop or are at risk for adverse events. It is also important to educate patients that OTC PPIs should not be used for more than 14 days at a time every 4 months.⁶

REFERENCES

1. Miller DA, Tisdale JE, Stamatakis MK, Malinowski SS. Drug-induced diseases: prevention, detection and management. Presented at: ASHP Midyear Clinical Meeting & Exhibition; 2016; Las Vegas, NV.

2. FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. News release. FDA. July 10, 2018. Accessed March 26, 2025. https://www.fda.gov/news-events/press-announcements/fda-updates-warnings-fluoroquinolone-antibiotics-risks-mental-health-and-low-blood-sugar-adverse

3. Liu Y, Wang JB, Zeng L, Gossell-Williams M, Moriel P, Yan M. Editorial:advances in drug-induced diseases. Front Pharmacol. 2023;14:1193099.doi:10.3389/fphar.2023.1193099

4. Costa NSD, Lima LS, Galiciolli MEA, et al. Drug-induced osteoporosis and mechanisms of bone tissue regeneration through trace elements. J Trace Elem Med Biol. 2024;84:127446. doi:10.1016/j.jtemb.2024.127446

5. Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2018:10:2042098618809927.doi:10.1177/2042098618809927

6. FDA drug safety communication: low magnesium levels can be associated with long-term use of proton pump inhibitor drugs (PPIs). FDA. March 2, 2011. Updated August 4, 2017. Accessed March 26, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communicationlow-magnesium-levels-can-be-associated-long-term-use-proton-pump

7. Targownik LE, Fisher DA, Saini SD. AGA clinical practice update on de-prescribing of proton pump inhibitors: expert review. Gastroenterology.2022;162(4):1334-1342. doi:10.1053/j.gastro.2021.12.247