PT  - JOURNAL ARTICLE
AU  - Robert A. Roth
AU  - James P. Luyendyk
AU  - Jane F. Maddox
AU  - Patricia E. Ganey
TI  - Inflammation and Drug Idiosyncrasy—Is There a Connection?
AID  - 10.1124/jpet.102.041624
DP  - 2003 Oct 01
TA  - Journal of Pharmacology and Experimental Therapeutics
PG  - 1--8
VI  - 307
IP  - 1
4099  - http://jpet.aspetjournals.org/content/307/1/1.short
4100  - http://jpet.aspetjournals.org/content/307/1/1.full
SO  - J Pharmacol Exp Ther2003 Oct 01; 307
AB  - “Drug idiosyncrasy” refers to untoward reactions to drugs that occur in a small fraction of patients and have no obvious relationship to dose or duration of therapy. The liver is a frequent target for toxicity. Much of the conventional thinking about mechanisms of drug idiosyncrasy has centered on hypotheses that the reactions have a metabolic basis involving drug metabolism polymorphisms or that they arise from a specific immune response to the drug or its metabolite(s). For very few drugs does convincing evidence exist for either of these mechanisms, however. The erratic temporal and dose relationships that characterize idiosyncratic drug responses suggest the possibility that some event during the course of therapy renders tissues peculiarly susceptible to toxic effects of the drug. For example, episodes of inflammation are commonplace in people, and results of numerous studies in animals indicate that a modest inflammatory response can enhance tissue sensitivity to a variety of toxic chemicals. These observations have led to the hypothesis that an episode of inflammation during drug therapy could decrease the threshold for drug toxicity and thereby render an individual susceptible to a toxic reaction that would not otherwise occur (i.e., an “idiosyncratic” response). This hypothesis can explain the features of drug idiosyncrasy using fundamental pharmacologic principles, and results of recent animal studies are supportive of this. Knowledge gaps that need to be filled before the hypothesis should be widely accepted are discussed. The American Society for Pharmacology and Experimental Therapeutics