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After the fifth chemotherapy cycle, the patient decided to go off the protocol because of intolerable side effects, particularly a pharyngeal disesthesia induced by oxaliplatin.
Of the 18 dropout cases in Group 1, 4 patients (22.2%) discontinued therapy by treating physicians because of intolerable side effects and 14 (77.8%) discontinued therapy by themselves.
Though short-term efficacy of opioid use (≤12 weeks) among older adults has been established, almost half of the patients discontinued the medication, mostly because of intolerable side effects [ 90].
The issue with the accepter/modifier distinction was that some patients sought medical advice because of intolerable side effects but continued to take the medicines thought to be responsible unless the doctor prescribed an alternative.
In a survey of 50,869 patients with acute pain, 37% of those treated with a strong opioid discontinued their medication before pain resolved because of intolerable side effects [ 8].
In a opioid rotation study (Freye et al 2007), 42 patients (mean age 64.1 years) receiving high-dose morphine (120 240 mg/day) for chronic pain secondary to neuropathic, musculoskeletal, or malignant etiology were switched to transdermal buprenorphine because of intolerable side effects and insufficient pain relief.
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Patient could stop the first line antipsychotic when relapsing or due to the development of intolerable side effects and switch to a second line antipsychotic.
Vaccination against infectious diseases therefore has always been a tightrope walk between inducing sterile protection and avoidance of intolerable side effects.
Tricyclic antidepressants in primary care are frequently used in low doses that are unlikely to be of benefit in treating depression, generally because of their intolerable side effects [ 21, 22].
The dose per course of cisplatin is limited because of the induction of acute intolerable side effects, in particular acute gastrointestinal (GI) toxicity, ototoxicity and renal dysfunction.
Curiously, it was shown that a genetic variation may be responsible of the intolerable side effects or inadequate analgesia produced by morphine in 10 30% of cancer patients [86].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com