Rare Drug Side Effects Your Doctor Should Warn You About

The Ethics of Informed Consent in High-Risk Medications - Rare Does Not Mean Trivial

Informed Consent for Medications With Low-Frequency but High-Severity Risks

As is common for me when I'm writing and just living life, topics come up during one article or conversation that deserve more attention than a single paragraph, so I then make a decision to expand on them in another article.  This happened when I was preparing my presentation on the oral consequences of pharmaceuticals.  I ultimately devoted more than 1/4 of my presentation to the issues surrounding bisphosphonates and the importance of informed consent in the process.  It then occurred to me that there are other pharmaceuticals that have low frequency, high-severity risks, and I decided the subject deserved a library article of its own.   I THOUGHT I had finished populating our resource library with a comprehensive list of articles, but this one begged to be written.

Modern medicine depends on medications that can save lives, prevent fractures, control infection, and reduce suffering. Many of these drugs are appropriate, mostly effective, and—when used thoughtfully—necessary.

This article is not anti-medication.  It exists to address a persistent problem in healthcare: the minimization of rare but serious adverse drug effects in the name of consumer reassurance.

Some medications carry a low probability of harm—but when harm occurs, it can be life-altering, irreversible, or life-threatening. When that is the case, informed consent must rise to meet the seriousness of the potential outcome.

The Problem With “It’s Very Rare”

Patients are often reassured by their medical providers with phrases like:

• “It’s less than 1%.”

• “I’ve never seen it happen.”

• “The benefits outweigh the risks.”

These statements may be "statistically accurate"—and still ethically incomplete.  As I like to say, 1% sounds like such a small number, until YOU happen to be the one experiencing it and it certainly doesn't FEEL small at that point.  Probability alone does not define importance.  Severity, reversibility, and long-term impact matter just as much.

A low-probability risk of a mild, reversible side effect is not ethically equivalent to a low-probability risk of permanent tissue damage, chronic disability, or complex medical complications that are difficult—or impossible—to reverse.  I have seen patients within my own practice who have experienced the "rare" issues.  I'm not talking about one single patient among thousands either.  I'm talking at LEAST a couple in EACH category of injury I'm listing below, among a few thousand patients.  And I'm not alone. I'm quite certain that most medical and dental providers have seen patients who have experienced "rare" issues with pharmaceuticals, including Stevens-Johnson Syndrome, Guillain-Barré syndrome, Medication-Related Osteonecrosis of the Jaw, and a few others that I can name off the top of my head because they are NOT as rare as the "statistics" would have me believe.  So rather than continue to depend on the medical establishment to be honest, I decided it would be best to write an honest article that can at the least inform and educate those members of our platform that could potentially be affected by these issues.

 

A More Honest Risk Framework

A more complete way to think about medication risk is:  Risk = Probability × Severity

Medicine often emphasizes probability and downplays severity.  This article exists to rebalance that equation.

What “Rare But Serious” Actually Means

When clinicians say a complication is “rare,” patients often hear “not a big deal.”

That interpretation is false.

A rare adverse event can still involve:

• organs failing,

• tissue dying,

• months in intensive care,

• permanent disability,

• lifelong pain,

• or death.

Probability does not erase severity.

Medications That Fall Into the “Rare but Serious” Category

The following medication classes are commonly prescribed and clinically useful, yet are also associated with well-documented, RARE BUT SEVERE adverse outcomes. Most patients will never experience these effects—but when they do occur, they matter profoundly. This is precisely why informed consent must be explicit and individualized.

Modern medicine saves lives. It also causes harm—sometimes profound, permanent harm—in a small percentage of patients. Both statements can be true at the same time.  This article is not anti-medication.  It is anti-minimization.  Some medications carry low-frequency but catastrophic risks. When those risks occur, they are not inconveniences. They are life-altering medical disasters. When that is the case, ethical informed consent requires specificity, honesty, and emotional realism, not reassurance.

If reading about these risks is uncomfortable, that discomfort is part of informed consent.

1. Antiresorptive Bone Medications

The purpose of these medications 

To slow down the cells that break down bone (osteoclasts), helping to preserve bone density and reduce fracture risk. 

What they’re prescribed for:

Osteoporosis, metastatic bone disease, fracture prevention.

Commonly Used (Oral & IV) :

• Alendronate: Fosamax, Binosto

• Risedronate: Actonel, Atelvia (delayed-release)

• Ibandronate: Boniva (oral tablet & IV infusion)

• Zoledronic Acid: Reclast (annual IV infusion), Zometa (for cancer-related bone issues) 

Other Bisphosphonates

• Pamidronate: Aredia (used for cancer-related bone issues, Paget's)

• Etidronate: Didronel (older drug, used less for osteoporosis now)

• Incadronic Acid (Incadronate): Investigated for cancer-related conditions 

Key Types & Forms

• Oral (Pills): Alendronate, Risedronate, Ibandronate.

• Intravenous (IV Infusions): Zoledronic Acid (annual), Ibandronate (quarterly). 

The Serious Complication:

Medication-related osteonecrosis of the jaw (MRONJ).  

What that actually looks like:

1. Jaw bone dies because normal bone healing is suppressed.

2. Bone becomes exposed through the gums and does not heal.

3. The exposed bone becomes chronically infected.

4. Patients may experience:

• constant pain,

• foul taste or odor,

• drainage of pus,

• difficulty eating or speaking.

What treatment actually looks like:

• Long-term or repeated antibiotic courses

• Antimicrobial rinses used indefinitely

• Repeated surgical debridement of dead jaw bone

• Partial jaw resection in severe cases

• Hyperbaric oxygen therapy (often 20–60+ dives)

• Chronic pain management

• Possible permanent facial disfigurement

• In some cases, lifelong exposed bone that never heals

This is not a sore jaw. This is chronic, destructive bone disease of the face. Once MRONJ develops, it is not easily reversible.

Studies on Antiresorptive Bone Medications and MRONJ Issues

There are NUMEROUS studied on this issue.  It's not rare.  It's well studied. And yet, these medications are treated trivially by the medical community.  We ask that doctors and patients alike do their reading and research and really weigh the risks, benefit, pros, cons and consequences of taking this with their functional medicine doctors. 

1.  Brunner C, Arvandi M, Marth C, et al. PMID: 39163561. 

https://pubmed.ncbi.nlm.nih.gov/39163561. 

Austrian breast cancer study found jaw bone death in 16.3% of patients who got bisphosphonates then switched to denosumab, 11.6% with denosumab alone, and 2.8% with bisphosphonates alone over 20 years.

2.  Kujanpää M, Vuollo V, Tiisanoja A, et al. PMID: 40389539. https://pubmed.ncbi.nlm.nih.gov/40389539. 

Finnish study found 9% jaw bone death rate in high-dose cancer patients versus 0.3% in low-dose osteoporosis patients. Denosumab users had 5 times higher risk than bisphosphonate users.

3.  Ferreira SS, Amaral JBD, Pacheco JJ, et al. PMID: 38731207. https://pubmed.ncbi.nlm.nih.gov/38731207. 

Portuguese study of multiple myeloma patients found 15.2% developed jaw bone death from bisphosphonates. Tooth extraction was the trigger in 82.4% of cases. All patients had exposed bone.

4.  Ehrenstein V, Heide-Jørgensen U, Schiødt M, et al. PMID: 34310704. https://pubmed.ncbi.nlm.nih.gov/34310704. 

Scandinavian cancer study found 6.6% jaw bone death in patients who switched from zoledronic acid to denosumab, 5.7% with denosumab alone, and 1.4% with zoledronic acid alone over 5 years.

5.  Ikesue H, Mouri M, Tomita H, et al. PMID: 33527228. 

https://pubmed.ncbi.nlm.nih.gov/33527228. 

Japanese cancer patients with bone metastases had 12.6% jaw bone death rate with denosumab versus 4.4% with zoledronic acid. Tooth extraction and age over 65 were major risk factors.

6.  Yokoo S, Kubo S, Yamamoto D, et al. PMID: 40647539. https://pubmed.ncbi.nlm.nih.gov/40647539. 

Breast cancer patients with bone metastases had 31.2% jaw bone death rate from denosumab. Risk increased dramatically after 32 doses. Tooth extraction increased risk 4.4 times.

7.  Hoff AO, Toth B, Hu M, et al. PMID: 20946574. 

https://pubmed.ncbi.nlm.nih.gov/20946574. 

Review found jaw bone death rates of 1.7% to 15% in multiple myeloma patients and 0.6% to 6.2% in breast cancer patients treated with high-dose bisphosphonates.

8.  Van Poznak CH, Unger JM, Darke AK, et al. PMID: 33527228. https://pubmed.ncbi.nlm.nih.gov/33527228. 

Large cancer study found 4.3% jaw bone death in myeloma patients, 2.8% overall at 3 years with zoledronic acid. Dosing more often than every 5 weeks increased risk 4.65 times.

9.  Yarom N, Shapiro CL, Peterson DE, et al. PMID: 31059396. https://pubmed.ncbi.nlm.nih.gov/31059396.   

ASCO guideline on jaw bone death from bone medications. Occurs in 1-9% of cancer patients. Risk factors include tooth removal, gum disease, dentures, smoking, and diabetes. Good dental care before starting medication reduces risk.

10.  Eastell R, Rosen CJ, Black DM, et al. PMID: 30907953. https://pubmed.ncbi.nlm.nih.gov/30907953. 

Endocrine Society guideline on osteoporosis treatment. Jaw bone death risk is 1 in 10,000 to 1 in 100,000 for osteoporosis patients, but increases to 21 in 10,000 after 4+ years of treatment.

11.  Ayers C, Kansagara D, Lazur B, et al. PMID: 36634332. https://pubmed.ncbi.nlm.nih.gov/36634332. 

Bisphosphonates increase jaw bone death risk 3-fold after 2-3 years. Risk is 0.01-0.3% of users. Higher risk with longer use, especially over 2 years of treatment.

12.  Srivichit B, Thonusin C, Chattipakorn N, Chattipakorn SC. PMID: 35199244. https://pubmed.ncbi.nlm.nih.gov/35199244. 

Bisphosphonates kill bone cells and damage blood vessels and gum tissue. This causes jaw bone death. Long-term use is the main problem for developing this serious complication.

13.  Shannon J, Shannon J, Modelevsky S, Grippo AA. PMID: 22091898. https://pubmed.ncbi.nlm.nih.gov/22091898. 

Jaw bone death involves dead exposed bone, pain, infection, swelling, and painful sores. Good oral hygiene, regular dental visits, and avoiding tobacco help prevent it. Treatment includes mouth rinses and antibiotics.

14.  Lee ES, Tsai MC, Lee JX, et al. PMID: 38001626. 

https://pubmed.ncbi.nlm.nih.gov/38001626. 

Bisphosphonates increase bone density but cause jaw bone death after dental procedures. IV bisphosphonates have higher risk than pills. Prevention requires good oral health and careful dental planning.

15. Stelea CG, Bologa E, Boișteanu O, et al. PMID: 40648820. https://pubmed.ncbi.nlm.nih.gov/40648820. 

10-year study found 83% of jaw bone death patients had cancer. Tooth removal was the main trigger. High blood pressure, diabetes, and chemotherapy made it worse. Surgery was often needed.

16.  Chen TY, Deng YL, Chen IC, et al. PMID: 41106713. 

https://pubmed.ncbi.nlm.nih.gov/41106713. 

Real-world study found denosumab has highest jaw bone death risk, then zoledronic acid, then ibandronate (lowest). Cancer patients had much higher risk than osteoporosis patients taking same medications.

17.  Kujanpää M, Vuollo V, Tiisanoja A, et al. PMID: 40389539. https://pubmed.ncbi.nlm.nih.gov/40389539. 

Finnish study: jaw bone death occurred in 0.3% of low-dose and 9% of high-dose users. Denosumab users had 5 times higher risk than bisphosphonate users. Steroids doubled the risk.

18.  Anastasilakis AD, Pepe J, Napoli N, et al. PMID: 34922381. https://pubmed.ncbi.nlm.nih.gov/34922381. 

Jaw bone death risk is much higher in cancer patients than osteoporosis patients because of higher doses, more frequent dosing, and worse overall health. Benefits still outweigh risks in all patient groups.

19.  Coropciuc R, Coopman R, Garip M, et al. PMID: 36858337. https://pubmed.ncbi.nlm.nih.gov/36858337. 

After tooth removal, jaw bone death occurred in 2.7% of osteoporosis patients and 26.4% of cancer patients. Dental infections increased risk 23-fold. Antibiotics and special membranes reduced risk by 84-93%.

20.  Bacci C, Manera C, Roccuzzo F, et al. PMID: 41441971. https://pubmed.ncbi.nlm.nih.gov/41441971. 

Breast cancer patients on hormone therapy had 4.5% jaw bone death rate. Poor oral hygiene, leftover tooth roots, and severe gum disease were major risk factors. Preventive dental visits helped.

21.  Amigues C, Fresse A, Roux CH, et al. PMID: 37271278. https://pubmed.ncbi.nlm.nih.gov/37271278. 

French study: zoledronic acid caused jaw bone death in 9.6 per 100,000 patients yearly—higher than alendronate (5.1) or risedronate (2.0). Dental work triggered over 40% of cases.

22.  Beth-Tasdogan NH, Mayer B, Hussein H, et al. PMID: 35866376. https://pubmed.ncbi.nlm.nih.gov/35866376. 

Cochrane review found limited evidence for treating jaw bone death. Regular dental exams every 3 months may prevent it. No clear best treatment once it develops. More research needed.

23.  Abdolrahmani A, Epstein JB, Samim F. PMID: 38443685. https://pubmed.ncbi.nlm.nih.gov/38443685. 

New treatments like pentoxifylline, vitamin E, teriparatide, and laser therapy show promise for healing jaw bone death. These should be tried before surgery to improve outcomes.

24.  Fujimori M, Toriyabe Y, Sakakibara N, et al. PMID: 39013476. https://pubmed.ncbi.nlm.nih.gov/39013476. 

Surgery healed jaw bone death in 95.8% of patients versus 70.7% without surgery. Stopping the bone medication improved healing to 87.2% versus 37.4% when continued.

25.  Walker MD, Shane E. PMID: 37991929. 

https://pubmed.ncbi.nlm.nih.gov/37991929. 

Bisphosphonates reduce spine and hip fractures but cause stomach irritation in 20-30% of patients. Jaw bone death and unusual thigh fractures are rare but serious long-term risks.

26.  Morin SN, Leslie WD, Schousboe JT. PMID: 39841854. https://pubmed.ncbi.nlm.nih.gov/39841854. 

Oral bisphosphonates cause stomach upset in 20-30% and muscle pain in 30%. Jaw bone death and unusual fractures don't increase above placebo in first 2 years of treatment.

27.  Deardorff WJ, Cenzer I, Nguyen B, Lee SJ. PMID: 34807243. https://pubmed.ncbi.nlm.nih.gov/34807243. 

Bisphosphonates can cause stomach problems and muscle pain. Jaw bone death and unusual thigh fractures are rare but serious. Benefits of preventing fractures outweigh these small risks.

28.  Obermeier KT, Dewenter I, Schnödt EM, et al. PMID: 41188163. https://pubmed.ncbi.nlm.nih.gov/41188163. 

Bisphosphonates and denosumab treat osteoporosis and cancer bone disease but cause jaw bone death. Preventive dental care, patient education, and teamwork between doctors and dentists are essential.

2. Fluoroquinolone Antibiotics

The purpose of these medications

Broad-spectrum antibiotics that kill bacteria by disrupting DNA replication.

What they’re prescribed for

• Urinary tract infections

• Respiratory infections

• Gastrointestinal infections

• Prostatitis

Commonly Used

• Ciprofloxacin (Cipro)

• Levofloxacin (Levaquin)

• Moxifloxacin (Avelox)

• Ofloxacin

The Serious Complications

Tendon, nerve, and central nervous system injury

What that actually looks like

1.  Tendons may degenerate and rupture, sometimes suddenly while walking.

2.  The Achilles tendon is most commonly affected, but any tendon can be involved.

3.  Patients may develop:

• chronic tendon and joint pain

• inability to walk normally

• long-term physical disability

4. Peripheral nerves may be damaged, causing:

• burning or electric pain

• numbness

• loss of sensation that may never resolve

5.  Central nervous system effects may include:

• severe anxiety

• confusion or delirium

• psychosis

• seizures

These effects can occur after short courses, may appear weeks after stopping, and can be permanent.

What treatment actually looks like

• Immediate drug discontinuation (damage may already be done)

• Long-term physical therapy

• Orthopedic surgery for ruptured tendons

• Chronic pain management

• Neurology care for nerve damage

• Lifelong activity limitations for some patients

There is no antidote. Recovery is unpredictable and often incomplete.

Studies on Fluoroquinolones Issues

1.  Huruba M, Farcas A, Leucuta DC, et al. PMID: 34257376. https://pubmed.ncbi.nlm.nih.gov/34257376. 

Global database study found fluoroquinolones caused disabling muscle and tendon problems. Most common were joint pain, tendonitis, limb pain, and muscle pain. Levofloxacin and ciprofloxacin caused most cases.

2.  Shu Y, Zhang Q, He X, et al. PMID: 36147351. 

https://pubmed.ncbi.nlm.nih.gov/36147351. 

FDA database study found 1,771 tendonitis cases and 1,018 tendon ruptures from fluoroquinolones. Ciprofloxacin caused most tendonitis cases. Levofloxacin caused most tendon ruptures. Half of tendonitis patients became disabled.

3.  Duman E, Müller-Deubert S, Pattappa G, et al. PMID: 40005998. https://pubmed.ncbi.nlm.nih.gov/40005998. 

Fluoroquinolones kill tendon cells and damage blood vessels, causing tendons to degenerate and rupture. Long-term use is the biggest risk factor. The exact mechanism is still unclear.

4.  Bidell MR, Lodise TP. PMID: 27138564. 

https://pubmed.ncbi.nlm.nih.gov/27138564. 

Levofloxacin has the highest risk of tendon damage among fluoroquinolones. Higher doses and longer treatment increase risk. Tendon injuries cause chronic pain, mobility problems, and may require surgery.

5.  Morales D, Pacurariu A, Slattery J, et al. PMID: Not available (JAMA Neurology 2019). https://jamanetwork.com/journals/jamaneurology/fullarticle/2731456. 

Fluoroquinolones increased nerve damage risk by 47%. Risk increased 3% for each additional day of treatment. Nerve damage persisted up to 180 days after stopping the antibiotic.

6.  Muanda FT, Sood MM, Weir MA, et al. PMID: Not available (JAMA Network Open 2022). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795088. 

Older adults with kidney disease had higher rates of serious side effects from fluoroquinolones, including nerve problems, low blood sugar, delirium, and tendon rupture when given higher-than-recommended doses.

7.  Xie WL, Ge ML, Chen D, et al. PMID: 39469624. 

https://pubmed.ncbi.nlm.nih.gov/39469624. 

FDA database found 27,816 psychiatric side effects from fluoroquinolones. Most common were anxiety, depression, and delirium. Some patients had suicidal thoughts. Ciprofloxacin caused most depression cases; moxifloxacin caused most delirium.

8.  Wierzbiński P, Hubska J, Henzler M, et al. PMID: 37631020. https://pubmed.ncbi.nlm.nih.gov/37631020. 

Fluoroquinolones cause mental disorders in 1-4.4% of patients, including anxiety, psychosis, insomnia, and depression. They interfere with brain chemicals GABA and glutamate, affecting mood and thinking.

9.  Hällgren J, Tengvall-Linder M, Persson M, Wahlgren CF. PMID: 14576649. https://pubmed.ncbi.nlm.nih.gov/14576649. 

Swedish study found ciprofloxacin caused Stevens-Johnson syndrome and toxic skin reactions in 0.045 per 100,000 patients yearly. These are severe skin blistering conditions. One patient died.

10.  Das S, Rudra O, Sharma S, Mallick S. PMID: 34414908. https://pubmed.ncbi.nlm.nih.gov/34414908. 

First reported case of moxifloxacin causing erythema multiforme affecting only the mouth. This is a painful blistering condition of the lips and mouth lining, different from typical skin reactions.

11.  FDA Cipro Label. PMID: Not applicable. 

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=888dc7f9-ad9c-4c00-8d50-8ddfd9bd27c0. 

FDA black box warning states fluoroquinolones cause disabling, potentially permanent side effects including tendon rupture, nerve damage, and brain problems like hallucinations, anxiety, depression, and confusion. Can happen within hours.

12.  FDA Levofloxacin Label. PMID: Not applicable. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=70c87464-1806-480a-8ebd-3f02987ff436. 

FDA warns levofloxacin can cause life-threatening allergic reactions after first dose, severe liver damage, dangerous heart rhythm problems, and serious blood disorders. Also causes tendon, nerve, and brain damage.

3. Medications Associated With Stevens–Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)

The purpose of these medications

Treatment of infections, seizures, gout, pain, and mood disorders.

Common Triggers

Antibiotics

• Trimethoprim–sulfamethoxazole (Bactrim, Septra)

• Penicillins

• Cephalosporins

• Fluoroquinolones

Other Medications

• Lamotrigine — Antiepileptic

• Carbamazepine — Antiepileptic

• Phenytoin — Antiepileptic

• Allopurinol — Gout Medication

• Certain NSAIDs (e.g., piroxicam)

The Serious Complication

Stevens–Johnson Syndrome / Toxic Epidermal Necrolysis

What that actually looks like:

1.  The immune system attacks skin and mucous membranes.

2.  Skin cells die and separate from the body.

3.  Skin sloughs off in sheets, similar to severe second and third degree burns.

4.  The same destruction occurs internally:

• mouth

• eyes

• throat

• lungs

• gastrointestinal tract

• genitals

5.  Patients experience:

• excruciating pain

• inability to eat, drink, or speak

• high risk of infection and sepsis

What treatment actually looks like

• Emergency hospitalization (ICU or burn unit)

• Mechanical ventilation if airway is involved

• Feeding tubes

• IV fluids and electrolyte replacement

• Aggressive pain control

• Infection and sepsis management

• Skin grafting in severe cases

• Long-term ophthalmologic care to prevent blindness

Hospitalization often lasts weeks to months.
Mortality ranges from 5% to over 30%.  UP TO 30% OF PEOPLE WHO GET THESE SYNDROMES DIE!!!

This is not a rash.
THIS IS A LIFE-THREATENING MEDICAL CATASTROPHE!!!

Studies associated with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis

1.  Zhou L, Lu Y, Zou Y, et al. PMID: 40579172. 

https://pubmed.ncbi.nlm.nih.gov/40579172. 

Chinese study of 103 patients found 9.7% overall mortality, 15.6% in TEN group. Carbamazepine, levofloxacin, ibuprofen, aspirin, amoxicillin, metronidazole, and lamotrigine were most common triggers. Pneumonia, kidney failure, and heart problems increased death risk.

2.  Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. PMID: 29188475. https://pubmed.ncbi.nlm.nih.gov/29188475. 

SJS/TEN causes painful skin blistering, eye damage, mouth and genital sores, and organ failure. Sepsis is the leading cause of death in acute phase. Long-term complications include permanent eye damage, skin scarring, and strictures.

3.  Noe MH, Micheletti RG. PMID: 33341195. 

https://pubmed.ncbi.nlm.nih.gov/33341195. 

Mortality ranges from 15-25% despite treatment. Drug-specific killer T-cells attack skin cells causing massive cell death. Patients need intensive care or burn unit care immediately. No single treatment proven superior for all patients.

4.  Lee EY, Knox C, Phillips EJ. PMID: Not available. https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2022.6378. 

Antibiotic-associated SJS/TEN carries up to 50% mortality. Trimethoprim-sulfamethoxazole, allopurinol, aromatic anticonvulsants, and NSAIDs are highest-risk drugs. Prompt drug withdrawal decreases death risk compared to cases where trigger remains unknown.

5.  Micheletti RG, Chiesa-Fuxench Z, Noe MH, et al. PMID: 29758282. https://pubmed.ncbi.nlm.nih.gov/29758282. 

US study of 377 patients found trimethoprim-sulfamethoxazole caused 26.3% of medication-related cases. Observed mortality was 14.7%, lower than predicted 21%. Most patients needed intensive care or burn unit admission.

6.  Kridin K, Brüggen MC, Chua SL, et al. PMID: Not available. https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2021.3154. European study of 212 patients found 63.7% developed severe complications including kidney failure, sepsis, and need for mechanical ventilation. Antibiotics (21.2%), anticonvulsants (18.9%), NSAIDs (11.8%), and allopurinol (11.3%) were most common triggers.

7.  Lu Y, Zhou L, Zou Y, et al. PMID: 39091503. 

https://pubmed.ncbi.nlm.nih.gov/39091503. 

Among antibiotic-induced cases, cephalosporins (31.7%), penicillins (25.4%), and quinolones (19.0%) were most common triggers. TEN group had 20% mortality. Liver, lung, and kidney damage occurred in 50.8%, 31.7%, and 23.8% respectively.