Gastrointestinal symptoms are common side effects from a variety of medications. Some can be anticipated such as constipation with opioids, while others reflect variation in drug metabolism, drug allergy, or complications that arise because of the effect of drugs on immune function, coagulation, or the intestinal microbiome. However, adverse drug reactions are unexplained in many patients and are currently labelled as idiopathic (idiosyncratic) or attributed to patient “sensitivity.” This chapter outlines gastrointestinal complications that have been associated with ten groups of drugs that are commonly used in medical and surgical practice. Groups of drugs of particular relevance for surgeons include antibiotics, non-steroidal anti-inflammatory drugs, antithrombotic agents, and opioids.
Adverse drug reactions Antibiotics Clostridium difficile colitis Non-steroidal anti-inflammatory drugs (NSAIDs) Aspirin Clopidogrel Dipyridamole Prasugrel Ticagrelor Heparins Coumadins Direct thrombin inhibitors (dabigatran) Direct factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) Opioids Chemotherapy drugs Laxatives Glucocorticoids Biologicals Biophosphonates Cannabinoids
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