Date when adverse drug reactions occurred

Risk factors present?*

Treatment administered

Symptom duration

Case Study One [16]

October 2002

1. Alcohol. Yes. Narrative account declares regular use of beer.

2. Dehydration. Likely. Symptoms emerged after some months’ residence in India.

3. Contraceptive pill/hormonal therapy. No.

4. Recreational drugs. Yes. Prior drug misuse declared.

5. Other liver-damaging agents. None described.

6. Other risk factors. None described.

Hospitalisation (3 days)

Sedative drugs administered

>11 years (gradually abating)

Case Study Two [17] [18]

December 1989

1. Alcohol. Yes. Narrative account describes regular use of beer, brandy, champagne, vodka, whisky.

2. Dehydration. Likely. Symptoms worsened after long flight to Kenya.

3. Contraceptive pill/hormonal therapy. No.

4. Recreational drugs. Yes. Narrative account describes prior use of LSD.

5. Other liver-damaging agents. Yes. Previous use of morphine.

6. Other risk factors. Yes. Prior hepatitis A. Also, following the onset of adverse drug effects, the quinoline antimalaria drug (either amodiaquine or chloroquine) was accidentally administered in overdose for several days, while the user was hospitalized.

Hospitalisation (2 months)

Antipsychotic medication (chlorpromazine hydrochloride) administered

>2 months (gradually abating)

Case Study Three [19] [20]

March 2012

1. Alcohol. Yes. Narrative account describes concurrent use of whisky (Jack Daniels).

2. Dehydration. Likely. Symptoms emerged acutely after some months’ residence in Afghanistan.

3. Contraceptive pill/hormonal therapy. No (but see 5 below).

4. Recreational drugs. No.

5. Other liver-damaging agents. Yes. Concurrent use of a synthetic anabolic steroid (stanozolol), for muscle building.

6. Other risk factors. Yes. There was probable prior use of chloroquine in Iraq, over a period of, potentially, several years. In addition, traumatic brain injury (a putative risk factor) had been experienced in the past.

Unknown

Unknown