A drug as a two-faced Janus: dose-effect, adverse events

Authors

DOI:

https://doi.org/10.18413/rrpharmacology.11.561

Abstract

Introduction: In the pharmaceutical industry, the 21st century was marked by the creation of new highly effective drugs: synthetic, immunobiological, genetic engineering, etc. Pharmacotherapy with highly effective drugs leads to a detailed study of their safety and pharmacoepidemiological studies, both in our country and abroad.

Materials and Methods: The work used content analysis, monitoring of scientific articles using the databases PubMed, Scopus, Google Scholar, ResearchGate, analysis of the nomenclature of the State Register of Medicines of the Russian Federation (2017-2024) and the Register of Medicines of Russia (2017-2024).

Results and Discussion: Adverse drug reactions (ADRs). Adverse drug reactions (ADRs) are diverse in their clinical manifestations, mechanisms of action and frequency of occurrence. The main factors from the use of drugs that cause ADRs and influence on often irreversible complications. Safety of pharmacotherapy when using optically active drugs. Safety of pharmacotherapy when using antioxidants. Pharmacovigilance for monitoring and safety of medicinal products.

Conclusion: Irrational pharmacotherapy with highly effective drugs (antioxidants, optically active drugs) without taking into account individual doses leads to errors both by medical personnel and to errors in self-medication especially for the treatment of central nervous system diseases. The problem of safety of pharmacotherapy is solved with the introduction of rational pharmacovigilance and safety monitoring programs.

Graphical Abstract

Keywords:

adverse drug reactions (ADRs), safety of pharmacotherapy, central nervous system diseases, enantiomers, antioxidants, individual doses, pharmacovigilance, monitoring

References

Astakhova AV, Lepakhin VK (2008) Medicines. Adverse adverse reactions and safety monitoring, 2 nd edition, revised and expanded. Ser. Professional medicine. Eksmo, Moscow, 225 рр. [in Russian]

Astakhova AV, Lepakhin VK, Pereverzev AP (2008) Publications as a source for identifying adverse side reactions to drugs. Drug Safety and Pharmacovigilance [Bezopasnost' Lekarstv i Farmakonadzor] 2: 4–12. [in Russian]

Astakhova AV, Lepakhin VK, Pereverzev AP (2010) Sibutramine: possible side effects and recommendations for their management prevention. Drug safety and pharmacovigilance [Bezopasnost Lekarstvennyh Sredstv i Farmakonadzor] 1: 4–11. [in Russian]

Baranova IA (2008) Glucocorticoid-induced osteoporosis: pathogenesis, prevention, treatment. Modern Rheumatology [Sovremennaya Revmatologiya] 2(1): 31–39. https://doi.org/10.14412/1996-7012-2008-455 [in Russian]

Brady DJ, Gu Q (2020) Antidepressant use among adults: United States. National Center for Health Statistics Data Brief 377: 1–8. [PubMed]

Campos AI, Mulcahy A, Thorn JG, Wray NR, Byrne EM, Land PA, Midland SE, Martin NG, Hickie IB, Renteria ME (2021) Understanding genetic risk factors for common side effects of antidepressant medications. Commun Med (Lond) 9(1): 45. https://doi.org/10.1038/s43856-021-00046-8 [PubMed] [PMC]

Checha OA, Buniatyan ND, Tentsova AI (2012) Stereo specificity of drugs is one of the factors of effectiveness and safety of drugs. Pharmacy [Farmaciya] 8: 40–43. [in Russian]

Czeizel AE (2007) Pharmacoepidemiology and drugs safety. International Society for Pharmacoepidemiology. 9: 183–197. https://doi.org/org/10.1002/pds.1471

Derave W, Tipton KD (2014) Dietary supplements for aquatic sports. International Journal of Sport Nutrition and Exercise Metabolism 24(4): 437–449. https://doi.org/10.1123/ijsnem.2014-0017 [PubMed]

Belle DJ, Singh H (2008) Genetic factors in drug metabolism. American Family Physician. 77(11): 1553–1560. [PubMed]

Draeger CL, Naves A, Marques N, Baptistella AB, Carnauba RA, Paschoal V, Nicastro H (2014) Controversies of antioxidant vitamins supplementation in exercise: ergogenic or ergolytic effects in humans? Journal of the International Society Sports Nutrition. 11(1): 4. https://doi.org/10.1186/1550-2783-11-4 [PubMed] [PMC]

Frijhoff J, Winyard PG, Zarkovic N, Davies SS, Stocker R, Cheng D, Knight AR, Taylor EL, Oettrich J, Ruskovska T, Gasparovic AC, Cuadrado A, Weber D, Poulsen HE, Grune T, Schmidt HH, Ghezzi P (2015) Clinical relevance of biomarkers of oxidative stress. Antioxid Redox Signaling. 23(14): 1144–1170. https://doi.org/10.1089/ars.2015.6317 [PubMed] [PMC]

Kishi T, Ikuta T, Sakuma K, Okuya M, Hatano M, Matsuda Y, Iwata N (2023) Antidepressants for the treatment of adults with major depressive disorder in the maintenance phase: a systematic review and network meta-analysis. Molecular Psychiatry 28(1): 402–409. https://doi.org/10.1038/s41380-022-01824-z [PubMed] [PMC]

Koch OR, Pani G, Borrello S, Colavitti R, Cravero A, Farrè S, Galeotti T (2004) Oxidative stress and antioxidant defenses in ethanol-induced cell injury. Molecular Aspects of Medicine 25(1-2): 191–198. https://doi.org/10.1016/j.mam.2004.02.019 [PubMed]

Koroteev MP, Pozdeev AO. Koroteev AM, Kaziev G Z, Teleshev AT, Ofitserov (2014) ENChemical modification of dihydroquercetin (taxifolin) and biological activity of its derivatives. Butlerov Communications 39(10): 94–120. [in Russian]

Kukes VG (2009) The creative path of half a century as a doctor, teacher, scientist. Russian doctor, Moscow, 109 рр. [in Russian]

Kukes VG, Svistunov AA, Mironova AN, Sycheva DA (2012) Clinical and pharmacological aspects of drug interactions from the standpoint of personalized medicine, Publishing House of the First Moscow State Medical University named after I.M. Sechenov, Moscow, 112 рр. [in Russian]

Lepeshko PN, Semenov IP (2019) Study of acute toxicity of the pharmaceutical substance cyclophosphamide. Medical Journal [Medicinskiy Zhurnal] 2: 92–96. [in Russian]

Lutai MI, Lysenko AF, Moiseenko OI (2009) The use of optical isomers of known cardiovascular drugs is a way to increase their effectiveness and tolerability. Ukrainian Journal of Cardiology 4: 13–20. [in Russian]

Marrocco I, Altieri F, Peluso I (2017) Measurement and clinical significance of biomarkers of oxidative stress in humans. Oxidative Medicine and Cellular Longevity. 2017: 6501046. https://doi.org/10.1155/2017/6501046 [PubMed] [PMC]

Mashkovsky MD (2013) Medicines. 16th ed, New Wave, Moscow, 172 рр. [in Russian]

Mortaz Hejri S, Faizi M, Babaeian M (2021) Zolpidem-induced suicide attempt: a case report. Daru. 21(1): 77. https://doi.org/10.1186/2008-2231-21-77 [PubMed] [PMC]

Musina MG, Kilin VV, Mingazov AA (2010) Fatal poisoning with zaleplon. Problems of Drug Examination in Medicine [Medicinski Problemy Ekspertizy Lekarstvennyh Sredstv v Mediciney Zhurnal] 10(1-2): 37–38 [in Russian]

Pillinger T, Howes OD, Correll CU, Leucht S, Huhn M, Schneider-Thoma J, Gaughran F, Jauhar S, McGuire PK, Taylor DM, Young AH, McCutcheon RA (2023) Antidepressant and antipsychotic side-effects and personalised prescribing: a systematic review and digital tool development. Lancet Psychiatry 10(11): 860–876. https://doi.org/10.1016/S2215-0366(23)00262-6 [PubMed] [PMC]

Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, Beck K, Natesan S, Efthimiou O, Cipriani A, Howes OD (2020) Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry 7(1): 64–77. https://doi.org/10.1016/S2215-0366(19)30416-X [PubMed] [PMC]

Raj U, Aier I, Varadwaj PK (2017) Taxifolin: A wonder molecule in making multiple drug targets. Annals Pharmacology and Pharmaceytics 2(8): 1083.

Ristow M, Zarse K, Oberbach A, Klöting N, Birringer M, Kiehntopf M, Stumvoll M, Kahn CR, Blüher M (2009) Antioxidants prevent health-promoting effects of physical exercise in humans. Proceedings of the National Academy Sciences of the United States of America 106(21): 8665–8670. https://doi.org/10.1073/pnas.0903485106 [PubMed] [PMC]

Rudakova IP, Ilyina IG, Skachilova SYa, Melentyeva TA, Mikhalev OV, Samylina IA (2009) Polymorphism and properties of drugs. Pharmacy [Farmaciya] 8: 42–44. [in Russian]

Schröder AS, Müller F, Gehl A, Sehner S, Anders S (2012) Post-mortem development of conjunctival petechiae following temporary prone position. Forensic Science International. 223(1-3): e53–e55. https://doi.org/10.1016/j.forsciint.2012.08.045 [PubMed]

SB (2004) Lectures on pharmacogenetics. Medical Information Agency, Moscow, 261 рр. [in Russian]

Shokhin IE, Yarushok TA, Medvedev YuV, Savchenko AYu, Ramenskaya GV, Malashenko EA (2015) Biopharmaceutical classification of strategically important drugs. Biopharmaceutical Journal [Biofarmacevticheskij Zhurnal] 7(5): 30–34. [in Russian]

Sies H (2015) Oxidative stress: a concept in redox biology and medicine. Redox Biology 4: 180–183. https://doi.org/10.1016/j.redox.2015.01.002 [PubMed] [PMC]

Skachilova SYa, Shilova EV (2019) Polymorphic modifications and optical enantiomers of drugs, pharmacotherapy. XIX International Interdisciplinary Congress Neuroscience for medicine and psychology, Sudak, Crimea (Russia) June 2023, LLC "MAX Press", 327 рр. [in Russian]

Skachilova SYa, Shilova EV (2020) Antioxidants in the 21st century benefit or harm? XIX International Interdisciplinary Congress Neuroscience for medicine and psychology, Sudak, Crimea (Russia) June 2023, LLC "MAX Press", 327 рр. [in Russian]

Skachilova SYa, Shilova EV (2023) Drug safety in the 21st century. The quality of life. Adverse events. XIX International Interdisciplinary Congress Neuroscience for medicine and psychology, Sudak, Crimea (Russia) June 2023, LLC "MAX Press", 327 рр. [in Russian]

Skachilova SYa, Shilova EV, Pavlov VM, Molostova TN (2017) Broncholytic and tocolytic properties of β2-agonists. Development and Registration [Razrabotka i Registraciâ Lekarstvennyh Sredstv] 1(1): 182–186. [in Russian]

Skachilova SYa, Yasnetsov VV (2022) Antioxidants are as inexhaustible as electrons. Structure - activity https. XIX International Interdisciplinary Congress Neuroscience for medicine and psychology, Sudak, Crimea (Russia) June 2023, LLC "MAX Press", 327 рр. [in Russian]

Stephens TD, Bunde CJ, Fillmore BJ (2000) Mechanism of action in thalidomide teratogenesis. Biochemical Pharmacology 59(12): 1489–1499. https://doi.org/10.1016/s0006-2952(99)00388-3 [PubMed]

Stvolinsky S, Toropova K, Gordeeva M, Kazey V, Sato T, Meguro K, Boldyrev A (2012) Carnosine and its (S)-Trolox™ derivative protect animals against oxidative stress. Amino Acids 43(1): 165–170. https://doi.org/10.1007/s00726-012-1256-4 [PubMed]

Sukhanova AM (2021) Development of methods for determining Sibutramine in the composition of multicomponent drugs and dietary supplements for anorexigenic food. PhD thesis, Moscow, Russia: University of Sechenov, 30 pp. [in Russian]

Tandon R, Lenderking WR, Weiss C, Shalhoub H, Barbosa CD, Chen J, Greene M, Meehan SR, Duvold LB, Arango C, Agid O (2020) The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey. Annals of General Psychiatry 13: 19–42. https://doi.org/10.1186/s12991-020-00292-5 [PubMed] [PMC]

Williams MH (2004) Dietary supplements and sports performance: Introduction and vitamins. Journal of the international society of sports nutrition. 1(2): 1–6. https://doi.org/10.1186/1550-2783-1-2-1 [PubMed] [PMC]

Yatsinyuk BB, Sentsov VG, Brusin KM, Volkova NA (2008) Disturbances of atrioventricular conduction and central hemodynamics in acute poisoning with Veropamil. 3rd Congress of Toxicologists of Russia. Ministry of Health and Social Sciences. Moscow (Russia) January 2008, development of the Russian Federation, 471 рр. [in Russian]

Author Contribution

Sofia Ya. Skachilova, All-Union Scientific Center for the Safety of Biologically Active Substances JSC

Doctor of Chemical Sciences, Professor, Head of the Department of Chemistry and Technology of Synthetic Drugs and Analytical Control, All-Union Scientific Center for the Safety of Biologically Active Substances JSC, Staraya Kupavna, Russia; e-mail: skachilova@mail.ru; ORCID ID: https://orcid.org/0000-0003-4486-8883. The author proposed the concept of the article, was engaged in search for and collection of factual material.

Ekaterina A. Simakina, ll-Union Scientific Center for the Safety of Biologically Active Substances JSC

Senior Research Fellow of the Department of Chemistry and Technology of Synthetic Drugs and Analytical Control, All-Union Scientific Center for the Safety of Biologically Active Substances JSC, Staraya Kupavna, Russia; e-mail: katerinasimakina@mail.ru; ORCID ID: https://orcid.org/0000-0003-1248-202Х. The author analyzed the actual data.

Andrey V. Denisenko, D. Mendeleev University of Chemical Technology of Russia

PhD in Chemical Sciences, Engineer of the Department of Technology of Inorganic Substances and Electrochemical Processes, Mendeleev University of Chemical Technology of Russia, Moscow, Russia; e-mail: andreydenisenko92@gmail.com; ORCID ID: https://orcid.org/0000-0003-1162-7493. The author formatted the materials in accordance with the profile of the journal.

Elena V. Shilova, All-Union Scientific Center for the Safety of Biologically Active Substances JSC

Doctor of Biological Sciences, Professor, Leading Researcher, Department of Quality Control of Scientific Research, All-Union Scientific Center for the Safety of Biologically Active Substances JSC, Staraya Kupavna, Russia; e-mail: eshilova@mail.ru; ORCID ID: https://orcid.org/0000-0002-0682-8883. The author wrote the text of the article.

Anna L. Motailo, Belgorod State National Research University

Medical student, Belgorod State National Research University, Belgorod, Russia; e-mail: 1468748@bsuedu.ru; ORCID ID: https://orcid.org/0009-0007-5118-5964. The author was engaged in conducting the literature analysis.

Aleksey A. Khentov, Belgorod State National Research University

Postgraduate student of the Department of Pharmacology and Clinical Pharmacology, Belgorod State National Research University, Belgorod, Russia; e-mail: alexeyhentov@gmail.comORCID ID: https://orcid.org/0009-0006-4315-0828. The author was engaged in conducting the literature analysis.

Downloads

Published

30-09-2025

How to Cite

Skachilova SY, Simakina EA, Denisenko AV, Shilova EV, Motailo AL, Khentov AA (2025) A drug as a two-faced Janus: dose-effect, adverse events. Research Results in Pharmacology 11(3): 61–76. https://doi.org/10.18413/rrpharmacology.11.561

Issue

Section

Pharmacological reviews

Most read articles by the same author(s)