D Veerandra Kumar

Diclofenac, a widely prescribed nonsteroidal anti-inflammatory drug (NSAID), remains one of the most commonly used analgesics and anti-inflammatory medications worldwide. Despite its therapeutic efficacy, diclofenac is associated with a spectrum of adverse drug reactions (ADRs) ranging from common gastrointestinal and cardiovascular effects to rare but serious complications, including cutaneous hyperpigmentation and Nicolau syndrome. This comprehensive review examines the drug profile, mechanism of action, pharmacokinetics, and detailed analysis of reported ADRs. Special attention is given to uncommon but clinically significant reactions such as Nicolau syndrome following intramuscular administration and drug-induced hyperpigmentation. The review provides evidence-based management strategies, risk factor identification, and monitoring protocols essential for safe clinical practice. Through systematic analysis of clinical trials, case reports, and pharmacovigilance data, this review highlights the importance of appropriate patient selection, route optimization, and vigilant monitoring in minimizing diclofenac-associated morbidity.

Telmisartan is a long-acting angiotensin II receptor blocker widely used for hypertension management. Although generally well tolerated, it has been associated with various adverse drug reactions (ADRs) ranging from mild symptoms to serious events. To review telmisartan’s ADR profile from a clinical pharmacist’s perspective and illustrate key insights through a case of drug-induced acute kidney injury (AKI). A comprehensive literature review and analysis of the Pharmacovigilance Programme of India data were conducted. A 40-year-old male who developed pre-renal AKI following dose escalation of telmisartan is presented. Common ADRs include dizziness, headache, diarrhoea, and respiratory symptoms. Serious reactions encompass hyperkalemia, angioedema, hypotension, and AKI. PvPI reports have highlighted rare cutaneous reactions such as lichenoid keratosis. In the case study, serum creatinine rise from 1.3 to 1.8 mg/dL within 48 hours of increasing the telmisartan dose and normalized after discontinuation. Vigilant monitoring and pharmacist-led interventions are essential to detect and manage telmisartan-related ADRs, optimize therapy, and ensure patient safety.

Omeprazole, a widely prescribed proton pump inhibitor (PPI), is a cornerstone therapy for acid?related gastrointestinal disorders, including gastroesophageal reflux disease, peptic ulcer disease, and Zollinger–Ellison syndrome. While generally safe and effective, prolonged or inappropriate use has been linked to a spectrum of adverse drug reactions (ADRs). Common ADRs include headache, abdominal discomfort, nausea, diarrhea, and flatulence, which are usually mild and self?limiting. However, serious complications—such as Clostridioides difficile infection, interstitial nephritis, hypomagnesemia, vitamin B12 deficiency, bone fractures, hepatotoxicity, and severe cutaneous reactions—though rare, pose significant clinical challenges. Risk factors influencing ADR incidence include treatment duration, high dosage, advanced age, polypharmacy, comorbid conditions, and genetic polymorphisms in CYP2C19 metabolism, which alter drug bioavailability and efficacy. Clinical pharmacists play a crucial role in mitigating these risks through therapeutic optimization, monitoring of laboratory parameters, early identification of drug interactions, and patient education. Evidence?based deprescribing strategies and routine safety surveillance are essential to minimize preventable harm while preserving therapeutic benefit. This review highlights the clinical significance of omeprazole?associated ADRs from a pharmacist’s perspective, emphasizing the importance of rational prescribing, vigilant monitoring, and interdisciplinary collaboration in ensuring patient safety.