Adverse Drug Reactions Awareness Among Sample of People in Northern Region, Saudi Arabia

Fawwaz Freih Alshammarie1*, Yasmeen Ali Muraizeq2, Rahaf Turki Aldhaban2, Asma Mohammed Almutairi2, Monerah Thaar Alshammari2

1Assistant Professor, Department of Dermatology, College of Medicine, University of Hail, Hail, Saudi Arabia.
2Medical student, College of Medicine, University of Hail, Hail, Saudi Arabia.

*Corresponding author

*Fawwaz Freih Alshammarie, Assistant Professor, Department of Dermatology, College of Medicine, University of Hail, Hail, Saudi Arabia


Background: Drug reactions are a fundamental issue in many branches of medicine. Adverse drug reactions result in high mortality and morbidity globally. There is always the risk of unwanted side effects associated with the use of any substance that has a therapeutic effect. The safe use of drugs remains a critical issue for all health care professionals.

Objective: The current study investigates the level of drug reaction awareness among the public in northern Saudi Arabia.

Materials/methods: This was a questionnaire-based cross-sectional study. Data were collected using Google Forms, which were coded and processed using Microsoft Excel and SPSS version 23. Results: Altogether 475 people participated in this study including 382 women (80.4%) and 93 men (19.6%). Of the 475 participants, 83.6% were aware of drug reactions, 40.4% believed drug reactions are hereditary, 50.9% had received a previous skin allergy test, and 21.3% had received a previous blood test for an allergy.

Conclusion: The public in northern Saudi Arabia are aware of drug reactions. We found that only half of the participants in our study had received a skin allergy test. It is the responsibility of physicians to provide the community with a valuable database of information on the adverse effects of drugs. We recommend that governmental and private institutions in Saudi Arabia carry out more studies with a larger sample to improve the understanding and awareness of drug reactions.

Keywords: Adverse drug reaction, Knowledge, Awareness, North region, Saudi Arabia.


The safe use of drugs remains a critical issue for all health care professionals include physicians, pharmacists and nurses as well as public (1). Drug reaction is defined by World Health Organization (WHO) as a response to a drug which is harms and unintended, occurs at normal doses used in human for the prophylaxis, diagnosis or therapy of disease (2). Multi-type reactions can result, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and eosinophilia associated with drug reactions, or acute generalized exanthemata's pustulosis (3). Some other prevalent adverse reactions include epidermal eruptions, vomiting, diarrhoea, and gastric ulcerations. Death and perpetual disabilities can be caused by adverse drug reactions. It is important to recognize such reactions because they warn of future risks from a particular drug(s) and may require precautionary measures, treatment, dosage changes, or Cancellation of drug license (4,5). The current study investigates the level of drug reaction awareness among the public in northern Saudi Arabia.


Study design and sample:

It was a questionnaire-based cross-sectional study. processed using Microsoft Excel and the  Software Statistical Package for the Social Science (SPSS) version 23. This research study focused  on public who lives in north region, Saudi Arabia.

Data collection:

The data were collected using Google forms service, it took 10 months, at beginning of January to  October 2020.

Data Analysis:

The data were collected using Google forms service, coded and processed using Microsoft Excel and the Software Statistical Package for the Social Science (SPSS) version 23. Descriptive statistics including frequencies and percentages were used to describe the items and the study variables.

Chi square tests were conducted to test the differences of the nominal data.

The p values at 0.05 were considered statistically significant.


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Figure 1: Demographic factors, descriptive of demographic information

As shown in Figure (1) Demographic factors, 475 people participated in this study including 382  female (80.4%) and 93 males (19.6%) (p<0.05). Their age ware ranged between less than 16 and  more than 35 with advantage for age group more than 35 (42.90%).

Table 1: Drug reactions: Descriptive analysis (n=475)

table 1 9

As shown in Table (1) Drug reactions only 43 (9.1%) had drug allergy (p<0.01). The participants  were asked about the medication kinds that they have been used with the reaction which show   the highest for Antibiotics (53.5%), other show less like: NSAI drugs (2.3%), Antiepilepsy (0%),  Analgesics (18.6%), Vitamins (7%), Insulin (2.3%), Aspirin (11.6%), Herbal (16.3%) and other (14%).   Antibiotics reported insignificant (p>0.05) and Antiepilepsy not used. The rest kinds only ranged  between 8 (18.6%) to one (2.3%) of using (p<0.01).  Also, the symptoms that might participants have been stated such as Rash, Skin heat, Itching, Fever, Cough, Shortness of breath, Anaphylaxis, Swelling (mouth - lips - tongue - eyes), Eye tears  , Runny nose, Light headiness and Others, it was clear that they did have that much symptoms as it ranged between only 13(30.2%) for itchiness   to 22(51.2%) for Fever (p<0.01), rash and itching  were insignificant (p>0.05).  Starting Immediately after taking drug was insignificant (p>0.01), 15 (34.9%) indicated that starts  hours, to 1 (2.3%) starts in months (p<0.01), although the symptoms were not much among the  participants, however, it is clear that starts short time more than long time.  The participants reported their time of a health intervention, ranged between once 16(37.2%) which is the highest to 3 times 1(2.3%) (p<0.05).

Table 2: Descriptive analysis (n=475)

table 2 8
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Figure 2: Drug reactions detection.

As shown in Table (2) and Figure (2) knowledge, 83.6% of participants were aware, 56.2% agreed that all the body is affected in drug reaction (p<0.05), then face (34.3%) follows by lips (14.1%). Tongue is lowest one with 6.7% (p<0.05). It is clear that the family history of drug reaction is very small ranged between 8.8% for children and 1.9% for father (p<0.05). 59.6% of Participants did not think that drug reaction is hereditary (p<0.05), however 48.1% thought that drug reaction leads to death (p>0.05). As shown in Figure (2) Drug reactions detection, 50.9% had previous skin general allergy test (p>0.05), and 90.9% reported that they test accurate in identifying the drug (p>0.01). Only 10.7% had experience an allergy after negative test’s result (p<0.05). 21.3% had a previous blood test for an allergy (p<0.01) and just 28% took an allergy's injection vaccine. (p<0.01).


Out of 475 surveys distributed to public, the majorities of the participants were female (80.4%) while male (19.6%). This was consistent with reports in the literature, as most ADRs were reported by female patients (6,7).

The highest percent of age among participants having (42.9%) more than 35 years, followed by (26.3%) in age between 21 to 25 (8).  In our study when we asked public about medications use related to drug reaction, (53.5%) P>0.05 mentioned the antibiotics cause drug reaction when used. Additionally, at a South Korean tertiary care hospital when ask said Antibiotics have been reported to be major causes of adverse drug reactions. Sulfonamides followed by penicillin were the most common causative antibiotics in a study that only included outpatients (9). Nearly 39.5% of the respondents developed adverse reaction immediately after taking the drug, whereas the reminder did within few hours, days or within months as in 34.9%, 23.3% and 2.3% respectively. The majority in this study had reported adverse drug reaction in form of itching and skin rashes in 51.2%, and 48.8% respectively. Furthermore, some of them developed runny nose, cough, and anaphylaxis in 30.2%, 27.9%, and 25.6% respectively. Conversely, another study had found gastrointestinal illnesses were the most common adverse drug reactions (10).

We found that 72.1% needed medical intervention it is just ranged between once (37.2%) to 3 times (2.3%). In our survey 83.6%, of participants think to have knowledge about adverse drug reactions. The whole body is the most site (56.2%) affected by adverse reactions to drugs in the present study followed by the face 34.3%, eyes 14.1%, lips 12.8%, hand 12% and tongue 6.7%. Most participants have no family history of adverse drug reactions. on the other hand, findings showed the higher number of cases found in children 8.8%. The proportion of participants who believe in adverse drug reaction is hereditary was 40.4%, but more than half of them disagreed with that. An individual's gene profile can affect their susceptibility to adverse drug reactions in a dose-dependent or dose-independent manner (11). The confusion was observed between the participants regarding if drug reaction leads to death 48.1% was agreed while 51.9% disagree about that. According to previous international studies have reported the adverse drug reactions are the sixth leading cause of death worldwide (12). Most severe adverse cutaneous reactions to drugs are Stevens-Johnson syndrome and toxic epidermal necrolysis (13). In our study found that 50.9% of people had a previous general skin allergy test, which 90.0% of them show that the test was accurate in determining the drug. The use of a skin allergy test in diagnosing a person how have a drug reaction is not suitable all time and there is no uniform for it. So mostly depend on the symptoms appeared on him (14). According to our survey show that 89.3% have no allergy after a negative result of skin allergy test, and only 10.7% have allergy even when the result is negative, which give us a clue of non-specification of skin allergy test sometimes. Another option for diagnosing a drug reaction is a blood test which found in our study that 78.7% have never had this test. Blood test measures IgE against specific allergen and immunoassay is the most commonly methods used (15). Adverse drug reaction also it can diagnose by different and several tests and have more specification (16). About 72% have not taken allergy injection (vaccine), which is used to adverse the effect of drug reaction. The main idea of allergy injection “allergy immunotherapy” is to reduce response to allergic triggers and inflammatory response which sometimes produce a chronic condition (17).


We can conclude the general public in north region are aware of drug reactions. Our findings that people who did a skin allergy test is half of the participants in our study. The results showed contrasting perceptions about if drug reaction leads to deaths in the current opinion of participants more than half denied that, whereas others believe the drug reaction can lead to deaths. As a final note, it is the responsibility of physicians to provide the public with valuable information about pharmaceutical adverse effects.

Limitations: This was a single-region study involving a limited number of people. Therefore, the study results cannot be generalized directly to people living in the north region who did not participate in this study or those in other regions of Saudi Arabia.

Acknowledgement:  We thank the patients who were all participated in and contributed samples to the study.

Conflicting Interest: We declare that there are no conflicts of interests.

Financial support and sponsorship: Nil.

Informed consent: Written informed consent was obtained from all individual who participate in the study.

Ethical approval: The study was approved by the Medical Ethics Committee of Hail University (ethical approval number:H-2020-256).


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