Iatrogenic Disease
iatrogenic - (i-at’ro-jen’ik)
[ G. iatros, physician + G. suffix, gen, producing ]. Resulting from, or in the course of, professional activities of a physician or surgeon; often used to imply autosuggestion resulting from physician’s discussion, examination, or suggestions.
This list was started as a service to the general public to list reports of newer drugs that have been reported to cause side effects that might not be well known by your general practice veterinarian. I have decided to begin adding uncommon as well as more common problems that have been associated with any medication, complementary therapy, and nutritional supplements that seem to be seen recently. Some of this information will be third party reports through e-mail lists, so accuracy is obviously dependent on the original source.
- Aristolochic Acid - FDA Releases Consumer Advisory Warning About Aristolochic Acid (6-23-2001)
- Clomicalm a drug being used by veterinarians for separation anxiety in dogs.
- Ivermectin and Clomicalm given together may cause adverse neurologic effects (i.e. ataxia and tremors).
- Ivermectin which is in Heartgard heart worm preventative and is sometimes used to treat “mange” and ear mites, causes increases in monamine neurotransmitter metabolites which could result in important adverse drug reactions with amitraz (Mitaban topical mange treatment), heterocyclic antidepressants, and benzodiazepines.
- Apparent source is a lecture given by Danny Scott, DVM (a dermatologist at Cornell University).
- Ivermectin which is in Heartgard heart worm preventative and is sometimes used to treat “mange” and ear mites, causes increases in monamine neurotransmitter metabolites which could result in important adverse drug reactions with amitraz (Mitaban topical mange treatment), heterocyclic antidepressants, and benzodiazepines.
- Ivermectin and Clomicalm given together may cause adverse neurologic effects (i.e. ataxia and tremors).
- CCNU Also known as Lomustine, is used as a therapy for various cancers including relapsed lymphoma, hystiocytic sarcoma, and mast cell tumor.
- The drug is very variable in its bone marrow toxicity and interval to demonstrate toxicity. Lomustine is also very hepatotoxic.
- Source is lecture on Chemotherapy and Rationally Targeted Therapies, Mona Rosenberg, DVM, ACVIM, Oncology, Round Robin Seminar, “What’s New In Veterinary Medicine”, Oct. 20, 2004, Long Beach Memborial Medical Center-Van Dyke Theater.
- The drug is very variable in its bone marrow toxicity and interval to demonstrate toxicity. Lomustine is also very hepatotoxic.
- EtoGesic a non-steroidal anti-inflammatory medication being
used by veterinarians to treat arthritic pain and inflammation.- has been associated with the occurrence of keratoconjunctivitis sicca (”dry
eye” or ineffective production of tears). No dose relationship is known
at this time.- Source: Chambers, Elizabeth, B.S., D.V.M., M.S., Slatter, Douglas, B.V.Sc, M.S., Ph.D. Drug Toxicity - Etogesic. Animal Eye Care Today, Vol. 12, No. 1, Pg. 3, Spring 2002.
- has been associated with the occurrence of keratoconjunctivitis sicca (”dry
- flouroquinilones eg. Baytril and Orbax . Antibiotics used for susceptible bacterial infections.
- can trigger seizures in rare cases in human and animal patients, especially in those predisposed to seizures, if given high dosages, and with concurrent administrations of NSAIDs (non-steroidal anti-inflammatory drugs) or theophyllin.
- The association of the concurrent administration of NSAIDs and flouroquinilones precipitating neurological problems including seizures is noted in human patients and not yet reported in veterinary patients.
- Source is e-mail to a list member of a veterinary list from an official of Bayer Animal Health in Canada.
- The association of the concurrent administration of NSAIDs and flouroquinilones precipitating neurological problems including seizures is noted in human patients and not yet reported in veterinary patients.
- can trigger seizures in rare cases in human and animal patients, especially in those predisposed to seizures, if given high dosages, and with concurrent administrations of NSAIDs (non-steroidal anti-inflammatory drugs) or theophyllin.
- Baytril has been increasingly linked to cases of blindness in feline patients. Bayer Animal Health (the developer of Baytril) estimates that the incidence of vision related reports over the past decade in the U.S. is 1 report per 122,414 feline patients treated. No cases have been reported in cats given the lowest dosage. The most severe cases have been observed in cats at 2.5 times the highest recommended dose within 1 week. A study to assess the specific potential effects of Baytril on eyes is currently underway (as of July 6, 2000).
- Source is a direct mailing to veterinarians from the Director of Veterinary
Services, Bayer Corp.
- Source is a direct mailing to veterinarians from the Director of Veterinary
- Kava or kava kava (Piper methysticum) is an herb which may
be contained in dietary supplements for relaxation, insomnia, and premenstrual
syndrome. On Dec. 19, 2001, the FDA distributed an alert to physicians
to report any potential liver disease linked to the use of kava containing
supplements. Letter
to Health Care Professionals about FDA Seeking Information on Liver Injury
and Kava Products. On November 9, 2002, Center for Disease Control and Prevention (CDC) issued a report describing the investigation of cases and the FDA released a public information bulletin on March 25, 2002. - Ketamine is used as a pre-anesthetic or part of a general anesthetic
regime in most veterinary practices. As with any anesthetic, one can have
life threatening side effects. However, a recent topic of discussion has
been an association of Horner’s syndrome after the use of ketamine. Horner’s
syndrome results from an abnormal function of a nerve called the Oculomotor
Nerve. Most often the only thing the owner notices is unequal pupils or
possibly smaller eye opening on the affected side. A review of the FDA
Adverse Drug Experience Reports for 1998 reveals that 2% of adverse reports
about ketamine involved this syndrome (1 report out of 57 total reports).
If the condition resolves, it is usually within a few weeks to a couple
months. However, several other causes of the problem are possible. There
are tests that can attempt to isolate the location of the problem. You
can go to the site of Michael
Zigler DVM, Cert.V.Ophthal. to find out more about Horner’s Syndrome. - Pimobendan Used in refractory cases of heart failure cases, usually in addition to diurectics, ACE inhibitors, and other drugs.
- Adverse reactions include lack of appetite, vomiting, and hypotension.
- However, studies suggest significant improvement in symptoms and survival in Doberman Pinschers with dilated cardiomyopathy when other, more common therapies fail.
- Source is lecture on New Therapies for CHF, Michael Lesser, DVM, DACVIM, Cardiology, SCVMA, Round Robin Seminar, “What’s New In Veterinary Medicine”, Oct. 20, 2004, Long Beach Memborial Medical Center-Van Dyke Theater.
- However, studies suggest significant improvement in symptoms and survival in Doberman Pinschers with dilated cardiomyopathy when other, more common therapies fail.
- Adverse reactions include lack of appetite, vomiting, and hypotension.
- Propulsid Also known as cisapride,
is used commonly for megacolon (a disorder mimicking constipation) in cats,
chronic vomiting due to delayed gastric emptying, and other gastric motility
disorders.- Recent report of cisapride causing arrhythmias (irregular heart beats)
in people and sometimes resulting in fatalities. See 1/25/00 article
from the Associated Press in the Ventura County Star . This may be
of concern in its use in cats since megacolon occurs in middle aged and
older male cats more than any other. And middle aged male cats are more commonly affected by a heart problem called cardiomyopathy.
- Recent report of cisapride causing arrhythmias (irregular heart beats)
- Topical medications
- Ophthalmic ointments
- BNP, bacitracin/neomycin/polymyxin, or triple antibiotic ophthalmic ointment is used commonly for susceptible infections of the eyes. The ointment may also be used by some veterinarians as an agent to lubricate and protect the eyes from drying or trauma during general anesthetic. In a 13 month period preceding June 16, 1999, there were four reported feline deaths associated with the use of this ointment. The deaths were suspected to be due to allergic reactions to one or all the medications used at the
time (one cat also had a topical, ophthalmic, local anesthetic applied during the same visit and another cat had a topical ophthalmic stain applied prior to the use of the antibiotic ointment). Since none of the cats survived, no tests for allergic sensitivity could be conducted on any of the affected cats. However, the patterns seen in all the cats (vomiting initially followed by respiratory sign, and cardiovascular collapse) suggest an allergic reaction. Furthermore, there have been proven cases of human patients that had confirmed tests indicating sensitivity to bacitracin and other antibiotics that caused anaphylaxis in these patients previously from application of ointments to abraded skin.- Source is a paper presented by E. Kathryn Myer, VMD, U.S. Pharmacopeia, Rockville, MD; USP Veterinary Practitioners’ Reporting Program: Program information and Case Studies, presented to the American Association of Feline Practitioners, October 19, 1999, Nashville, Tennessee.
- Recommendations to reduce potential problems are:
- Use of a bland ophthalmic lubricant for cats undergoing anesthetic.
- Consider applying the first dose of topical antibiotic ointment in the hospital prior to sending it home.
- If vomiting and respiratory distress are observed following the application of a triple antibiotic ophthalmic ointment, immediate emergency treatment should be started as soon as possible.
- BNP, bacitracin/neomycin/polymyxin, or triple antibiotic ophthalmic ointment is used commonly for susceptible infections of the eyes. The ointment may also be used by some veterinarians as an agent to lubricate and protect the eyes from drying or trauma during general anesthetic. In a 13 month period preceding June 16, 1999, there were four reported feline deaths associated with the use of this ointment. The deaths were suspected to be due to allergic reactions to one or all the medications used at the
- Ophthalmic ointments
- Vaccines
- Vaccine associated sarcomas
- World Wide Web-based survey of vaccination practices, postvaccinal reactions, and vaccine site- associated sarcomas in cats. Gobar GM, Kass PH., J Am Vet Med Assoc 2002 May 15;220(10):1477-82
- Inflammation associated cancer in cats.
- Feline Vaccines: Benefits and Risks
- White paper published in the Journal of the American Veterinary Medicine Association on March 1, 2001, regarding the current understanding of vaccine-associated feline sarcomas.
- Vaccine associated reactions, non-sarcoma related
- Because of the concerns amongst veterinarians about vaccine associated sarcomas, the use of topical, intranasal vaccines have increased. Because the use of this type of vaccination is relatively new to many veterinarians, side effects to this type of vaccine is not as well known about as side effects to injectable vaccines. For a three year period preceding June 16, 1999 there were 75 reports of side effects from topical, intranasal FVRCP vaccination: nasal ulcers (30), sneezing (15), ocular discharge (14), vomiting (14, including 8 that also received an injectable vaccination at the same time), fever (10), oral ulcers (9), and respiratory distress (4, including 3 that received injectable vaccination at the same visit). All cats recovered from the side effects. Heska, which produces the intranasal FVRCP vaccine indicates that the incidence of reported side effects is 0.0279% (or 2.79 reports for every 10,000 vaccines sold).
- Source is a paper presented by E. Kathryn Myer, VMD, U.S. Pharmacopeia, Rockville, MD; USP Veterinary Practitioners’ Reporting Program: Program information and Case Studies, presented to the American Association of Feline Practitioners, October 19, 1999, Nashville, Tennessee.
- Because of the concerns amongst veterinarians about vaccine associated sarcomas, the use of topical, intranasal vaccines have increased. Because the use of this type of vaccination is relatively new to many veterinarians, side effects to this type of vaccine is not as well known about as side effects to injectable vaccines. For a three year period preceding June 16, 1999 there were 75 reports of side effects from topical, intranasal FVRCP vaccination: nasal ulcers (30), sneezing (15), ocular discharge (14), vomiting (14, including 8 that also received an injectable vaccination at the same time), fever (10), oral ulcers (9), and respiratory distress (4, including 3 that received injectable vaccination at the same visit). All cats recovered from the side effects. Heska, which produces the intranasal FVRCP vaccine indicates that the incidence of reported side effects is 0.0279% (or 2.79 reports for every 10,000 vaccines sold).
If you experience what you feel is an adverse veterinary drug response
and wish to report it, you can get information about reporting from the
following FDA site:Adverse
Drug Experience Reporting InformationAdverse veterinary vaccine responses can be reported to the Animal and Plant Health Inspections Service of the United States Dept. of Agriculture.
- Vaccine associated sarcomas
