Why even great drugs have serious side effects in some patients

Like Ritalin…

Chemiotics II

Finding good drugs is hard enough, but even great ones are often laid low by unexpected side effects.  This has to do with the tremendous genetic variation in people, about which, more later.  But first a true story from the past.

Neurologists treat epilepsy.  There was a period of 17 years when I was in practice when not a single new  drug against epilepsy (anticonvulsant) was introduced in the USA.  Each new drug would seem to be the answer for a small group of patients that nothing had helped before.

Felbamate (Felbatol) was one such anticonvulsant.  It helped people that nothing else touched. In the year after introduction some 150,000 people were taking it.   I had several very happy patients using Felbatol in the 90s.   1 year later the bomb dropped.  Ten cases of total bone marrow failure (aplastic anemia) had developed in patients taking the drug, a…

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