









































Pa
ge

 
1



Pa
ge

 
1

American Journal of  
Chemistry and Pharmacy (AJCP)

Adverse Drug Reactions in Nigeria’s Geriatric Population and its Prevalence, Etiologies, 
Implications: A Systematic Review 

Uyiose Fortress Ufuah1, Aloysius Obinna Ikwuka2*, Angus Nnamdi Oli3, Brian Ogbonna3

Volume 3 Issue 1, Year 2024
ISSN: 2834-0116 (Online)

DOI: https://doi.org/10.54536/ajcp.v3i1.3197
https://journals.e-palli.com/home/index.php/ajcp

Article Information ABSTRACT

Received: July 23, 2024
Accepted: August 18, 2024
Published: August 21, 2024

Adverse drug reactions (ADRs) are a significant public health concern. Although the 
prevalence of  ADRs in the general adult population in Nigeria has been studied and 
documented, there is limited research on ADRs among the geriatric population. This study 
conducted a systematic review of  existing research to determine the prevalence, etiologies 
and implications of  ADRs among Nigerian geriatric population. A comprehensive search 
was undertaken using PubMed, ResearchGate, and Google Scholar databases. The Preferred 
Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used 
for reporting this systematic review. Six studies met the eligibility criteria for inclusion in 
this review. The prevalence of  ADRs among the geriatrics ranged from 4.4% to 31.1%. 
The gastrointestinal system was the most commonly affected system, with non-steroidal 
anti-inflammatory drugs (NSAIDs) being the most frequently implicated class of  drugs 
contributing to ADRs. The prevalence of  ADRs in the Nigerian geriatric population is 
underreported. There are insufficient policies and healthcare personnel specialized in caring 
for geriatric patients. Strategies should be implemented to reduce the incidence of  ADRs 
among geriatric patients.

Keywords
Adverse Drug Reactions, 
ADRs, Nigeria, Geriatric, 
Population, Prevalence, 
Etiologies, Implications, 
Systematic Review

1 Faculty of  Pharmacy, University of  Ibadan, Ibadan, Nigeria
2 College of  Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia
3 Faculty of  Pharmacy, Nnamdi Azikiwe University, Awka, Nigeria
* Corresponding author’s e-mail: momohshaibu3@gmail.com

INTRODUCTION
The health and well-being of  the elderly have become 
significant concerns in public health. Globally, the 
population is aging rapidly, resulting in a decline in 
health as individuals grow older. In developing countries, 
the elderly population faces significant morbidity and 
disability burdens due to poverty, inadequate health 
facilities, and insufficient care policies. The geriatric 
population defined as individuals aged 65 and above, 
is considered a special population as they differ greatly 
from other age groups. They are more vulnerable to co-
morbidities, drug interactions, polypharmacy, and adverse 
drug reactions (ADRs) (WHO, 2019). 
Diabetes mellitus and arterial hypertension remain two of  
the most common diseases in the world. Today, diabetes 
mellitus (DM) ranks third in the overall structure of  
morbidity and mortality after cardiovascular diseases 
and oncological diseases (Virstyuk & Ikwuka, 2021a). 
Moreover, the nexus, pathogenetic mechanisms, roles, 
and effects of  metabolic syndrome diseases on aging 
(and vice versa) are still being investigated by different 
researchers. 
Metabolic disorders, e.g. Hypertension, Adiposity, 
Diabetes mellitus and Dyslipidemia, collectively known 
as Metabolic Syndrome Diseases (MSDs) are diseases 
related to one another (Ikwuka, 2015; Ikwuka, 2017a; 
Ikwuka, 2017c; Ikwuka & Virstyuk, 2023c; Ikwuka et 
al., 2023f; Virstyuk et al., 2016). T-helper 17 (Th17) cells 
secrete interleukin-17 (IL-17) which act on fibroblasts 
and endothelial cells to increase inflammation (Ikwuka, 
2023b). Different studies have shown that MSDs are 
associated with asymptomatic hyperuricemia, systemic 
immune inflammatory processes, and fibrogenesis all 

of  which can lead to nephropathy (Ikwuka & Haman, 
2017d; Ikwuka et al., 2017e; Ikwuka, 2018c; Ikwuka & 
Paliy, 2018d; Ikwuka, 2019a; Ikwuka & Virstyuk, 2019c; 
Ikwuka & Virstyuk, 2022; Ikwuka et al., 2023d; Virstyuk 
& Ikwuka, 2017a; Virstyuk & Ikwuka, 2018a; Virstyuk 
& Ikwuka, 2019; Virstyuk & Ikwuka, 2021a; Virstyuk et 
al., 2021b) and different rheumatological disorders in the 
elderly e.g. gouty arthritis, osteoarthritis, etc. 
Thus, age is an independent risk factor for chronic non-
communicable diseases, which have high morbidity and 
mortality rates (Jaspinder et al., 2014). Aging is associated 
with increasing oxidative stress. Linked to the induction 
of  oxidative stress are major free radicals. Among 
these major free radicals, superoxide anions, hydroxyl 
radicals, and hydroperoxyl radicals are of  physiological 
significance. A non-radical of  physiological significance 
is hydrogen peroxide (Ama et al., 2023; Baysah et al., 2023; 
Ekechi et al., 2023a; Uche et al., 2023). 
Increased oxidative stress can lead to mutation which is 
an alteration in the DNA sequence which produces new 
alleles. One common type of  single gene mutation is the 
missense mutation which results in the substitution or 
replication of  a single amino acid in the polypeptide chain 
e.g. sickle cell disease is caused by a missense mutation 
that produces a substitution of  valine for glutamate in the 
two β-globin polypeptide chains (Ikwuka, 2023a; Musa et 
al., 2023). Sickle cell disease is characterized with different 
severities of  anemia (Inya et al., 2023a; Inya et al., 2023b).
Research also shows that disorders in individuals aged 
60 and above, account for 23% of  the global disease 
burden (Prince et al., 2015). 60 years and above is also a 
risk factor for the development of  different myelo- and 
lymphoproliferative disorders such as myelodysplastic 



Pa
ge

 
2

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

syndrome, multiple myeloma, and non-Hodgkin 
lymphoma (Ikwuka, 2023e). Therefore, there is a high 
demand for health services to meet the needs of  this 
age group, requiring special attention to their treatment 
process (Davies & O’mahony, 2015).
In addition, there is also a need for new and effective 
treatment options in patients with Metabolic Syndrome 
Diseases. Sodium-Glucose Linked Transporter 2 
(SGLT-2) inhibitors e.g. Dapagliflozin and Glucagon-
like Peptide 1 Receptor Agonists (GLP-1 RAs) e.g. 
Liraglutide have been found to improve the efficacy of  
treatment and clinical course of  type 2 diabetes mellitus 
and hypertension in patients with such comorbidities 
(Ikwuka, 2017b; Ikwuka, 2018a; Ikwuka, 2018b; Ikwuka, 
2019b; Ikwuka & Virstyuk, 2021; Ikwuka, 2024; Virstyuk 
et al., 2017b; Virstyuk et al., 2018b; Virstyuk & Ikwuka, 
2018c). It has also been reported that coconut water has 
hepatorenal protective functions against alloxan-induced 
type 1 diabetes mellitus (Ekechi et al., 2023b). 
Adverse drug reaction (ADR) is defined as “an 
appreciably harmful or unpleasant reaction resulting from 
the use of  a medicinal product; adverse effects usually 
predict future hazards and require prevention, specific 
treatment, alteration of  dosage regimen, or withdrawal 
of  the product” (Aronson & Ferner, 2005). ADRs are 
common in clinical practice, with some cases being severe 
and leading to unscheduled hospital admissions and even 
death (Coleman & Pontefract, 2016; Alhawassi et al., 
2014). 
Adverse drug reactions in the geriatric population pose 
a significant problem in managing elderly patients. This 
is due to the decline in physiological functions (such as 
decreased renal and hepatic clearance), co-morbidity, 
pharmacodynamic and pharmacokinetic changes, frailty, 
polypharmacy, and memory problems commonly 
observed in this population. Multiple drug therapies for 
co-morbidities increase the risk of  drug interactions and 
inappropriate medication prescribing. Studies have shown 
that prescription medication use among elderly patients 
has doubled in recent years (Charlesworth et al., 2015).
The prevalence of  ADRs in older adults has been 
documented in African countries with several studies 
highlighting the major drug classes responsible for ADRs. 
However, global studies on the prevalence of  ADRs in 
the general adult population are more extensive than 
those focused on the elderly population, despite their 
higher susceptibility to ADRs (Alhawassi et al., 2014; Saka 
et al., 2017; Mekonnen et al., 2018; Zazzara et al., 2021). 
Systematic reviews conducted on the prevalence of  
adverse drug reactions in elderly patients in other parts 
of  the globe reported ADR prevalence of  11%-22% 
(Alhawassi et al., 2014; Jennings et al., 2020; Yadesa et al., 
2021). There is paucity of  systematic reviews conducted 
on the elderly in Africa. A systematic review on ADRs 
in both children and adults in African hospitals reported 
that 8.4% of  patients have experienced an adverse drug 
reaction at hospital admission while 2.8% of  admissions 
were caused by adverse drug reactions (Mekonnen et al., 

2018).  In Nigeria, very few studies focused on the general 
adult population with none on the geriatric population 
that suffers ADRs the most. Therefore, this study aimed 
to systematically review the published literature to 
determine the prevalence, etiologies, and implications of  
ADRs in the Nigerian geriatric population.

METHODOLOGY
Information Sources
Online databases and PROSPERO were searched initially 
to ensure that the review topic had not been researched 
earlier. When that was established, the research question, 
selection strategy, and selection criteria were defined. 
The data collection form was designed in Microsoft 
Excel, the search strategies were run in the databases, 
and all references and abstracts were collected in a single 
file. Search strings were constructed using Boolean 
Operators ANDs and ORs. Using subject headings 
obtained from journals and databases, reference lists for 
primary literature, grey literature and proceedings from 
conferences were obtained.

Question Structure
The population (geriatric/elderly) and clinical outcomes 
(ADRs, drug therapy problems) were considered. 
Prevalence studies and those focusing on the challenges 
of  ADRs were also considered.

Search Strategy and Selection Process
Results from the searches revealed 100 studies. A total of  
87 articles on ADR in specific diseases, in other African 
countries, on polypharmacy, and potentially inappropriate 
medications (PIMs) were eliminated leaving 13 studies on 
ADR in the elderly in Nigeria. 4 duplicate studies and 3 
incomplete texts were eliminated which gave rise to 6 
studies that met the inclusion criteria (see Figure 1).

Inclusion Criteria and Its Reliability
Articles were selected for the review if  they: (1) are 
research articles reporting primary data collected by the 
authors; (2) are published in English and full-text articles 
were available; (3) cover geriatrics in Nigeria; and (4) 
studied populations are 60 years or older. Cohen Kappa 
statistics was used to discuss and resolve disagreements 
between the authors who reviewed the articles during 
selection (Cohen, 1968).

Exclusion Criteria
All studies on geriatric ADRs in Nigeria with incomplete 
information on study methods or unclear methodology 
were excluded, including studies without comprehensive 
summaries.        
                                                                                                                             
Data Extraction
Eligible studies and literature were assessed using two 
parallel reviewers who utilized the eligibility criteria 
consistently. All data on authors and year conducted, 
age range, setting/geographical zone, study design, 



Pa
ge

 
3

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

prevalence, medications implicated, system, and organ 
most implicated in ADRs of  the population were 
extracted to form the evidence-based table. Data was 
summarized using Microsoft Excel. Comparisons of  
extracted data were made and disagreements were 
resolved with sensitivity analysis, predominantly by 
further investigation and arbitration.

Data Items (Outcomes)
Data items on ADRs among geriatrics covering 1980 
to 2022 were searched. The geriatric population was 
searched. However, elderly and older adults were also 
searched in parallel and in series. The etiologies of  ADRs 
and their implications were also searched.

Publication Risk of  Bias Assessment
Grey literature and conference proceedings scanning 
were utilized, in addition to the careful use of  search 
terms in parallel and in series to minimize the risk of  bias.

Quality Assessment/Risk of  Bias 
The full texts were screened further for explicit of  
methodological descriptions of  ADRs, drug therapy 
problems, geriatrics and the elderly. Studies were graded 
based on strong and weak recommendations of  the study 
characteristics and quality to enhance critical appraisal.

Certainty Assessment
Publication bias, imprecision, inconsistency, and 
indirectness of  evidence in the assessment were utilized 
for certainty of  the study.

Data Collection
Literatures that reported the incidence of  ADRs 
among Nigeria’s geriatric population were reviewed. 
The databases utilized were Google Scholar, PubMed, 
and ResearchGate with no specific gate window. The 
references of  some articles were also manually searched 
to identify more studies. The keywords “geriatric” 
[MeSH Terms], “adverse drug reaction” [MeSH Terms], 
“incidence” [MeSH Terms], “prevalence” [MeSH Terms], 
“older adults” [MeSH Terms], and “elderly” [MeSH 
Terms] were used. The free text included adverse drug 
reactions in the elderly in Nigeria and the incidence of  
adverse drug reactions in Nigeria. The selection was not 
restricted to a specific study design. However, the study 
was restricted to geriatric/elderly population for which 
the study could be generalized. Nonetheless, it is also 
possible that some studies may have been omitted due to 
this limitation and restricting the generalization. 
The review concentrated on the prevalence, incidence, 
and challenges of  adverse drug reactions in the elderly 
in Nigeria. Other age groups, however, were not 
overlooked. The literature and research on various elderly 
disease states were reviewed. Author, year of  publication, 
age range, population size, study design, geopolitical 
zone, and most implicated medication were all extracted 
from the publications. Each conflict was discussed in the 

cases of  disagreements until agreement was reached. The 
resulting data was kept open and detailed. Meta- analysis 
was not carried out because it is outside the scope of  this 
study. Hence, heterogeneity was not assessed.

Data Synthesis 
All the results of  the primary studies were collated and 
summarized. A combination of  descriptive synthesis 
with quantitative summary was utilized. The population, 
causes of  ADR, comparisons, and outcomes were used as 
a framework. The study characteristics, causes of  ADRs, 
and comparisons of  implications and outcomes were 
tabulated in a spread sheet. Summary statistics of  studies 
were also tabulated, while those without comprehensive 
summaries were excluded. Descriptive statistics was used 
to summarize the qualitative and quantitative data based 
on their homo- and heterogeneity. Sub-group analysis was 
used to explore heterogeneity. To assess the robustness 
of  the synthesized result, range of  values and alternatives 
were substituted for arbitrary and unclear decisions to 
ensure that decisions taken were rational and consistent.

Data Analysis
A descriptive analysis was performed to summarize the 
published articles. The studies and their characteristics 
were summarized based on the following: authors and 
year conducted, age range, setting/geographical zone, 
study design, prevalence, medications implicated, system, 
and organ most implicated in ADRs. The articles were 
evaluated for heterogeneities among the population 
group. Finally, an evidence-based table was synthesized.
 
Ethical Consideration
Published and freely available online literature and data 
on ADRs among geriatrics in Nigeria were reviewed 
online. Hence, ethical approval does not apply. This study 
was carried out strictly with the PRISMA-2020 Guideline 
for Systematic Reviews.

RESULTS & DISCUSSION

Figure 1: The PRISMA flow diagram for selection of  
articles



Pa
ge

 
4

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

Out of  the 100 reports initially identified, only thirteen 
reported adverse drug reactions in elderly patients 
in Nigeria. Articles that focused on adverse drug 
reactions in specific diseases, studies conducted in other 
African countries, studies on polypharmacy, potentially 
inappropriate medications (PIMs); and knowledge, 
attitude and practice (KAP) studies were excluded. 
Duplicate studies and studies without full texts available 
were also removed. Finally, six studies were included in 
the analysis.

Study Characteristics
Two of  the six studies were conducted on the general 

adult population but provided specific information about 
older adults (Adedapo et al., 2021; Akhideno et al., 2018). 
All the studies were conducted among hospitalized 
patients, primarily in the Internal Medicine wards. The 
studies had a prospective, retrospective, or mixed design. 
The incidence of  ADRs among elderly patients ranged 
from 6.2% to 31.1%. The gastrointestinal system was the 
most affected, and non-steroidal anti-inflammatory drugs 
(NSAIDs) were the most commonly implicated group of  
drugs causing ADRs. The majority of  the studies were 
conducted in a single center (see Table 1). A summary of  
the factors responsible for ADRs in the included studies 
is shown in Table 2.

Table 1: Summary of  studies on the incidence of  ADRs among the elderly in Nigeria

Author 
(Year 
conducted)

Age Range Population 
Size

Setting/ 
Geopolitical 
Zone 

Study 
Design

Prevalence 
of  ADRs

Three Most 
Implicated 
Medications

System/
Organ 
Most 
Implicated 
In ADR

A
kh

id
en

o 
et 

al.
, 2

01
8 

(2
01

3-
20

14
) 

17
-8

9 
(a

du
lts

) e
ld

er
ly

 
as

 >
64

50
7 

(a
du

lts
) 1

25
 

(e
ld

er
ly

)

U
ni

ve
rs

ity
 o

f 
Be

ni
n 

Te
ac

hi
ng

 H
os

pi
ta

l, 
Be

ni
n 

C
ity

, E
do

 S
ta

te
/

So
ut

h-
So

ut
h 

Pr
os

pe
ct

iv
e 

st
ud

y

4.
4%

In
su

lin
, N

SA
ID

s a
nd

 
an

tih
yp

er
te

ns
iv

es
 

in
 a

du
lt 

po
pu

la
tio

n 
st

ud
ie

d

N
eu

ro
lo

gi
ca

l. 
G

as
tro

in
te

st
in

al
 a

nd
 

de
rm

at
ol

og
ic

al
 sy

st
em

s

A
m

ad
i e

t a
l.,

 2
02

1

60
 a

nd
 a

bo
ve

12
6

U
ni

ve
rs

ity
 o

f 
Po

rt
-H

ar
co

ur
t 

Te
ac

hi
ng

 H
os

pi
ta

l, 
Po

rt
-

H
ar

co
ur

t, 
Ri

ve
rs

 S
ta

te
/

So
ut

h-
So

ut
h

C
ro

ss
-s

ec
tio

na
l s

am
pl

in
g

19
.8

%

C
hl

or
oq

ui
ne

, A
m

lo
di

pi
ne

In
te

gu
m

en
ta

ry
/S

ki
n,

 
C

en
tra

l N
er

vo
us

 S
ys

te
m

, 
G

as
tro

in
te

st
in

al
 sy

st
em

Sa
ka

 et
 a

l.,
 (2

01
7;

 
20

18
)

60
 a

nd
 a

bo
ve

26
8

N
ot

 S
ta

te
d

C
ro

ss
-s

ec
tio

na
l 

re
tro

sp
ec

tiv
e

13
.8

%

N
SA

ID
s 

(D
ic

lo
fe

na
c)

, 
ca

rd
io

va
sc

ul
ar

 
m

ed
ic

at
io

ns

D
ig

es
tiv

e 
sy

st
em

, 
va

sc
ul

ar
 sy

st
em

, 
ne

rv
ou

s s
ys

te
m

A
de

da
po

 et
 a

l.,
 

20
21

 (2
01

2-
20

13
)

60
 a

nd
 a

bo
ve

12
80

 (t
ot

al
 a

du
lt 

po
pu

la
tio

n)
41

8 
(e

ld
er

ly
 

po
pu

la
tio

n)

U
ni

ve
rs

ity
 C

ol
le

ge
 

H
os

pi
ta

l, 
Ib

ad
an

/
So

ut
h-

W
es

t

Pr
os

pe
ct

iv
e 

co
ho

rt
 

st
ud

y

4.
9%

N
SA

ID
s, 

hy
po

gl
yc

em
ic,

 
an

tib
ac

te
ria

l

G
as

tro
in

te
st

in
al

, 
ce

nt
ra

l n
er

vo
us

 
sy

st
em

, a
nd

 sk
in

/
cu

ta
ne

ou
s s

ys
te

m



Pa
ge

 
5

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

N
w

an
i &

 Is
ah

, 2
01

7 
(2

00
9)

65
 a

nd
 a

bo
ve

34
5

N
na

m
di

 A
zi

ki
w

e 
U

ni
ve

rs
ity

 
Te

ac
hi

ng
 H

os
pi

ta
l, 

N
ne

w
i/

So
ut

h-
E

as
t

Pr
os

pe
ct

iv
e 

st
ud

y

6.
7%

N
SA

ID
s, 

st
er

oi
ds

, a
nd

 
hy

po
gl

yc
em

ic
 a

ge
nt

s

G
as

tro
in

te
st

in
al

 sy
st

em
, c

en
tra

l 
ne

rv
ou

s s
ys

te
m

, e
nd

oc
rin

e 
an

d 
m

et
ab

ol
ic

 sy
st

em

E
ze

 et
 a

l.,
 2

01
1 

(2
00

8)

60
 a

nd
 a

bo
ve

37
5

O
la

bi
si 

O
na

ba
nj

o 
U

ni
ve

rs
ity

 T
ea

ch
in

g 
H

os
pi

ta
l, 

Sa
ga

m
u,

 O
gu

n 
St

at
e/

So
ut

h-
W

es
t

Re
tro

sp
ec

tiv
e 

an
d 

pr
os

pe
ct

iv
e

31
.1

%

C
ar

di
ov

as
cu

la
r 

m
ed

ic
at

io
ns

N
ot

 sp
ec

ifi
ed

 

Table 2: Summary of  the factors responsible for ADRs in the included studies
Author (Year conducted) Factors responsible for ADR
Akhideno et al., 2018
(2013-2014) 

Number of  medications
Number of  co-morbidities

Amadi et al., 2021 Polypharmacy
Multi-morbidity
Alcohol intake

Saka et al., (2018; 2017) Abrupt stoppage of  medications
Use of  antiemetics
Decreased potassium levels below 2.5mmol/L

Adedapo et al., 2021 (2012-2013) Outpatient medication errors
Overdose
Self-medication and drug misuse
Multi-morbidity
Duration of  hospital stay
Polypharmacy (≥3 medications)

Nwani & Isah, 2017
(2009)

Not reported

Eze et al., 2011
(2008)

Polypharmacy (≥5 medications)

In one study on the general adult population (aged 17 
years and older), elderly patients (65 and older) accounted 
for 24.7% of  the study participants, and adverse drug 
reactions were observed in 22% of  these elderly patients. 
Although the specific drug most implicated in elderly 
patients was not specified, the drugs most frequently 
associated with adverse drug reactions in the general 
adult population were insulin (27.5%), NSAIDs (19.6%), 
antihypertensives (15.7%), and antimalarials. Age was 
found to be a significant risk factor for adverse reactions 
to medications among the elderly, with those aged 
65 years and older being at a higher risk than younger 
patients (Akhideno et al., 2018). 

A prospective cohort study was conducted, involving a 
total of  1,280 adult patients who were admitted to the 
hospital. It was found that patients aged 60 and older 
constituted approximately one-third (32.7%) of  the study 
participants. Among patients aged 65 years and older, 
4.9% experienced adverse drug reactions that resulted 
in hospitalization, while 1.3% developed adverse drug 
reactions during their admission. The study did not specify 
the most affected organ or system or the specific classes 
of  drugs implicated in adverse drug reactions in the older 
population, but in the general adult population, the most 
implicated drug classes were NSAIDs, antidiabetics, and 
antibacterials. The gastrointestinal tract, central nervous 



Pa
ge

 
6

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

system, and skin were the organs and systems most 
commonly affected (Akhideno et al., 2018).
In a retrospective cross-sectional study of  elderly patients, 
out of  268 admitted patients, 43 cases of  adverse drug 
reactions (13.8%) were reported, with the digestive system 
being the most affected by these reactions. Only 9.3% of  
the total observed cases were formally documented as 
adverse drug reactions. The most implicated medication 
in these reactions was diclofenac (Saka et al., 2018).
Another study found that 19.8% of  the elderly population 
experienced adverse drug reactions. The most common 
adverse reactions included itching (22%), drowsiness, 
dizziness, and restlessness. The drug most implicated in 
these reactions was chloroquine, and hypertension was a 
major medical ailment. It was observed that 96% of  the 
patients had multiple morbidities, and 96% of  those with 
adverse drug reactions were taking more than five drugs, 
compared to 86.14% of  those without adverse drug 
reactions (Nwani & Isah, 2017). 
Another prospective study evaluated 345 patients aged 
65 years and older. Out of  these patients, 23 (6.7%) 
experienced adverse drug reactions, with 73.9% of  
these cases recovering and 26.1% resulting in death. 
The most common adverse drug reaction observed was 
gastrointestinal bleeding (39.1%). The most implicated 
drug classes were NSAIDs, steroids, and hypoglycemic 
agents. The gastrointestinal system, central nervous 
system, and endocrine and metabolic systems were the 
organ systems most frequently involved. Adverse drug 
reactions were responsible for 1.7% of  deaths among 
elderly patients who were admitted to the hospital (Nwani 
& Isah, 2017). 
A study conducted by (Eze et al., 2011) focused on 
identifying drug therapy problems (DTPs) among elderly 
inpatients. The study utilized both retrospective and 
prospective methods. It reported that 31.1% of  the total 
DTPs recorded was adverse drug reactions, but it did not 
provide further details on the drug classes responsible. 
However, cardiovascular medications were the therapeutic 
group most commonly associated with DTPs. 
This present study evaluated the prevalence of  adverse 
drug reactions among the elderly in Nigeria, and revealed 
a wide variation in the prevalence of  ADRs. This 
variability may be due to factors such as differences in the 
methods used to identify an ADR, the sample size and 
study design. In this review, some of  the studies relied 
on the identification of  ADRs during routine hospital 
care or on self-reporting methods. However, this is prone 
to under-identification and under-reporting of  ADRs, 
and such methods are likely to underestimate the true 
prevalence of  ADRs (Kongkaew et al., 2008; Brvar et 
al., 2009; Ramia et al., 2021). These results are similar to 
the results of  a systematic review of  ADR in the elderly 
(Alhawassi et al., 2014). 
NSAIDS are one of  the most commonly used class of  
drugs for self-medication (Oriavwote & Ikwuka, 2022). 
NSAIDs are implicated in most of  the ADRs and are 
the major causes of  peptic ulcer diseases and worsening 

hypertensive conditions (Drini, 2017). Similar to 
(Kongkaew et al., 2008; Oscanoa et al., 2017; Hadia et al., 
2022), NSAIDs and cardiovascular medications caused 
most ADRs in the elderly. However, (Jennings et al., 2020) 
reported diuretics and antibacterials for systemic use as 
the most implicated medications. Polypharmacy has also 
been shown by other systematic reviews conducted on 
the elderly as the major risk factor for ADRs in the elderly 
population (Davies et al., 2020; Hadia et al., 2022).
The incidence and prevalence of  ADRs is under-reported 
in Nigeria, particularly among the geriatric population 
(Ogar et al., 2019). According to a study conducted in 
Nigeria, only 32% of  health professionals report adverse 
drug reactions (Okezie & Olufunmilayo, 2008). Several 
reasons have been identified for the under-reporting of  
ADRs in Nigeria, including staff  shortages, time required 
to assess and submit reports, lack of  information, 
difficulties in diagnosing or identifying adverse reactions, 
ignorance of  the importance of  reporting, limited or no 
training for healthcare workers on ADR observation and 
reporting, lack of  awareness of  the reporting form, poor 
knowledge of  the reporting procedure, and uncertainty 
of  causality (Aderemi-Williams et al., 2015; Miediegha & 
Bunu, 2020; Okezie & Olufunmilayo, 2008; Oreagba et 
al., 2015). 
The poor knowledge of  healthcare professionals 
regarding ADRs is a cause for concern. In a study by 
(Adisa & Omitogun, 2019), only 15% of  healthcare 
workers had adequate knowledge of  ADRs. In another 
study, only 24.9% of  respondents were aware of  the 
national ADR reporting form (commonly known as the 
Yellow Form), and just 20.1% had received training in 
pharmacovigilance (Udoye et al., 2018).
Another challenge is developing policies and appointing 
staff  who can understand and respond to the needs of  
the aging population. There are limited centers dedicated 
to the care of  geriatric patients in Nigeria, resulting 
in inadequate attention to their specific needs before 
initiating treatment. Often, they are treated alongside 
adult patients under the age of  60. The prevalence 
of  polypharmacy and the prescription of  potentially 
inappropriate medications (PIMs) pose significant 
problems in the pharmacotherapy of  older adults, leading 
to a significant increase in ADRs among the elderly. 
Studies conducted on the elderly in Nigeria have reported 
high rates of  polypharmacy and PIMs, resulting in a 
high incidence of  adverse drug reactions (Borodo et al., 
2022). 
The negative impact of  adverse drug reactions on health 
outcomes in the geriatric population cannot be overstated. 
In developing countries like Nigeria, these effects are 
more pronounced due to high health outcome indicators. 
Older adults are more susceptible to ADRs compared to 
younger adults due to the increased risk associated with 
aging. It has been suggested that ADRs should be treated 
as a geriatric syndrome in themselves. The potential 
consequences of  adverse drug reactions (ADRs) are 
multifaceted and include longer hospital stays, which in 



Pa
ge

 
7

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

turn increase morbidity and mortality rates, as well as 
healthcare costs (Fasipe et al., 2019). 
Strategies must be put in place to reduce the incidence 
of  ADRs (adverse drug reactions) among the elderly in 
Nigeria. One of  the first steps in reducing the incidence 
of  ADRs in Nigeria would be the proper reporting of  
cases. This would help to identify the particular classes of  
drugs responsible for adverse drug reactions in geriatrics, 
and strategies can be put in place to reduce their use or 
research safer pharmacological alternatives. A study in 
the United States among adults aged ≥65 years observed 
that three drug groups - medicines that help prevent 
blood clots, antidiabetic medications, and medications 
with morphine-like effects - were found to be involved in 
about 60% of  Emergency Department visits for adverse 
drug reactions (Shehab et al., 2016). 
The reporting of  adverse drug reactions in Africa 
has been strengthened through the establishment of  
“National Pharmacovigilance Centers (NPCs)” in several 
countries (Ogar et al., 2019). The NPC in Nigeria has made 
available procedures for the proper reporting of  ADRs 
(NPC, 2014). Furthermore, activities and programs such 
as public enlightenment and education of  patients and 
caregivers on ADRs, as well as spontaneous reporting of  
ADRs by health professionals, should be implemented to 
increase the reporting rate.
The poor knowledge of  ADRs among healthcare workers 
highlights the need for continuous mandatory education 
and training of  health workers on adverse drug reactions 
and pharmacovigilance concepts. The curriculum of  
health professionals during undergraduate training 
should also emphasize the identification, prevention, 
and documentation of  adverse drug reactions. To tackle 
the problem of  limited centers dedicated to the care of  
geriatric patients, the leadership of  various hospitals and 
clinics should advocate for the establishment of  geriatric 
centers in their facilities equipped with trained staff  
across all states in Nigeria.
Reducing pill burden, referred to as deprescribing, is 
one of  the most effective steps to reducing adverse 
drug reactions among the elderly. Deprescribing refers 
to the process of  withholding unnecessary medicines or 
minimizing their dosages at the discretion of  a healthcare 
professional, probably a medical doctor or a pharmacist. 
This is aimed at managing polypharmacy and in turn, 
improving health outcomes. There should be an increase 
in awareness among Nigerian prescribers regarding 
rational prescribing (Oli et al., 2021) and the use of  
checklists (or Trigger Tools) for ADR detection among 
the elderly (Borodo et al., 2022). 
Reports on the incidence of  adverse drug reactions 
in the geriatric population in Nigeria are very limited. 
Thus far, only two reports are documented solely on 
ADRs in geriatrics in Nigeria. Most studies are focused 
on ADRs in the general adult population and potentially 
inappropriate prescribing. However, high quality reports 
investigating the drug classes most responsible for ADRs 
in the elderly are lacking. Furthermore, interventions to 

reduce ADRs and improve healthcare among geriatric 
patients in Nigeria are limited.
This present study is not without limitations as it utilized 
heterogeneous studies (prospective, retrospective, and 
mixed) in the review and this poses a bias. Although 
retrospective studies have been shown to detect lower 
ADRs compared to prospective studies because they are 
subject to failure in gathering and proper documentation 
of  data in the medical charts (De Figueiredo et al., 2017), 
however, this was not so in this present study as those 
that used a prospective study design had lower ADR 
prevalence rates compared to those with a retrospective 
design. Another limitation of  this present study is the 
variation in the age brackets of  the elderly patients 
included in the review. There is a need for further studies 
on the detection of  ADRs and trigger tools/medications 
that cause a significant burden of  morbidity and mortality 
in Nigeria’s geriatric population.

CONCLUSION
The geriatrics are highly susceptible to adverse drug 
reactions due to the decline in cellular functions, co-
morbid conditions, and polypharmacy. These factors 
contribute to increased risk of  hospitalizations and 
deaths resulting from medication-related adverse events. 
Despite the high risks involved, approaches to addressing 
ADRs have not focused solely on the geriatric population. 
Interventional studies on safer non-pharmacological and 
pharmacological alternatives to drug classes associated 
with ADRs are necessary in order to reduce the occurrence 
of  ADRs among the geriatric population in Nigeria.

Acknowledgments
Special thanks to everyone who contributed in one way or 
the other to make this research a success. Your assistance 
in conducting this research is highly appreciated.

REFERENCES
Adedapo, A. D., Adedeji, W. A., Adedapo, I. A., & 

Adedapo, K. S. (2021). Cohort study on adverse 
drug reactions in adults admitted to the medical 
wards of  a tertiary hospital in Nigeria: Prevalence, 
incidence, risk factors and fatality. British Journal of  
Clinical Pharmacology, 87(4), 1878-1889. https://doi.
org/10.1111/bcp.14577.

Aderemi-Williams, R., Awodele, O., & Boyle, C. (2015). 
Adverse drug reactions amongst adult patients 
admitted in Lagos State University Teaching Hospital 
Lagos, Nigeria. Current Drug Safety, 10(2), 136-144. 
https://doi.org/10.2174/1574886309666140601211
211. 

Adisa, R., & Omitogun, T. I. (2019). Awareness, 
knowledge, attitude and practice of  adverse drug 
reaction reporting among health workers and patients 
in selected primary healthcare centres in Ibadan, 
Southwestern Nigeria. BMC Health Services Research, 19, 
1-14. https://doi.org/10.1186/s12913-019-4775-9.

Akhideno, P. E., Fasipe, O. J., & Isah, A. O. (2018). The 



Pa
ge

 
8

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

incidence and prevalence of  adverse drug reactions 
among medical inpatients in a Nigerian University 
Teaching Hospital. Journal of  Current Research in 
Scientific Medicine, 4(2), 86-93. 

Alhawassi, T. M., Krass, I., Bajorek, B. V., & Pont, L. G. 
(2014). A systematic review of  the prevalence and 
risk factors for adverse drug reactions in the elderly 
in the acute care setting. Clinical Interventions in Aging, 
9, 2079-2086. https://doi.org/10.2147/CIA.S71178.

Ama, M. I., Ikwuka, A. O., Udeh, F. C., Ekechi, H. O., & 
Eteudo, A. N. (2023). Sperm Parameters and Testicular 
Histology of  Male Wistar Rats Treated with Phoenix 
dactylifera After Consumption of  Local Mmahi Salt. 
American Journal of  Bioscience and Bioinformatics, 2(1), 41-
51. https://doi.org/10.54536/ajbb.v2i1.2275.

Amadi, E. S., Pepple, E. F., Otike-Odibi, B., & Bell-
Gam, H. I. (2021). Adverse drug reactions amongst 
admitted advanced age Africans. World Journal of  
Advanced Research and Reviews, 12(3), 427-433. https://
doi.org/10.30574/wjarr.2021.12.3.0712.

Aronson, J. K., & Ferner, R. E. (2005). Clarification of  
terminology in drug safety. Drug Safety, 28, 851-870.

Baysah, P. V., Ikwuka, A. O., Udeh, F. C., Bleh, D. P., 
& Viloria, T. (2023). Pathophysiological effects 
of  alcohol and tobacco consumption on semen 
parameters of  men attending a fertility clinic in 
West Africa. American Journal of  Biomedical and Life 
Sciences, 11(4), 73-81. https://doi.org/10.11648/j.
ajbls.20231104.13.

Borodo, S. B., Jatau, A. I., Mohammed, M., Aminu, 
N., Shitu, Z., & Sha’aban, A. (2022). The burden 
of  polypharmacy and potentially inappropriate 
medication in Nigeria: a clarion call for deprescribing 
practice. Bulletin of  the National Research Centre, 46(1), 
1-8. https://doi.org/10.1186/s42269-022-00864-3.

Brvar, M., Fokter, N., Bunc, M., & Mozina, M. (2009). 
The frequency of  adverse drug reaction related 
admissions according to method of  detection, 
admission urgency and medical department specialty. 
BMC Clinical Pharmacology, 9, 1-8.

Charlesworth, C. J., Smit, E., Lee, D. S., Alramadhan, F., 
& Odden, M. C. (2015). Polypharmacy among adults 
aged 65 years and older in the United States: 1988–
2010. Journals of  Gerontology Series A: Biomedical Sciences 
and Medical Sciences, 70(8), 989-995. https://doi.org/ 
10.1093/gerona/glv013.

Cohen, J. (1968). Weighted kappa: nominal scale 
agreement provision for scaled disagreement or 
partial credit. Psychological Bulletin, 70(4), 213. https://
doi.org/10.1037/h0026256.

Coleman, J. J., & Pontefract, S. K. (2016). Adverse drug 
reactions. Clinical Medicine, 16(5), 481. https://doi.
org/10.7861/clinmedicine.16-5-481.

Davies, E. A., & O’mahony, M. S. (2015). Adverse drug 
reactions in special populations–the elderly. British 
Journal of  Clinical Pharmacology, 80(4), 796-807. https://
doi.org/10.1111/bcp.12596.

Davies, L. E., Spiers, G., Kingston, A., Todd, A., 

Adamson, J., & Hanratty, B. (2020). Adverse outcomes 
of  polypharmacy in older people: systematic review 
of  reviews. Journal of  the American Medical Directors 
Association, 21(2), 181-187.

de Figueiredo, T. P., de Souza Groia, R. C., Barroso, S. 
C. C., do Nascimento, M. M. G., & Reis, A. M. M. 
(2017). Factors associated with adverse drug reactions 
in older inpatients in teaching hospital. International 
Journal of  Clinical Pharmacy, 39, 679-685.

Drini M. (2017). Peptic ulcer disease and non-steroidal 
anti-inflammatory drugs. Aust Prescr, 40(3), 91-93. 
https://doi.org/10.18773/austprescr.2017.037. 

Ekechi, H. O., Ikwuka, A. O., Udeh, F. C., & Abraham, J. 
C. (2023a). Effects of  Ethanol Extract of  Rauwolfia 
vomitoria Leaf  on Lipid Profile and Cerebellar 
Histology in Cisplatin-induced Oxidative Stress. 
British Journal of  Medical and Health Research, 10(5), 16-
39. https://doi.org/10.5281/zenodo.8042521. 

Ekechi, H. O., Ikwuka, A. O., Udeh, F. C., Epete, M. 
A., & Uche, V. U. (2023)b. Hepatorenal Protective 
Functions of  Coconut Water in Alloxan-Induced 
Type 1 Diabetes Mellitus. World Journal of  Current 
Medical and Pharmaceutical Research, 5(4), 114-122. 
https://doi.org/10.37022/wjcmpr.v5i4.276.

Eze, U. I. H., Oparah, C. A., & Lawal, F. A. (2011). 
Identification of  Drug Therapy Problems among 
Elderly in-patients of  a Nigerian Teaching Hospital. 
Nigerian Journal of  Pharmaceutical Research, 9(1), 49-56.

Fasipe, O. J., Akhideno, P. E., & Owhin, O. S. (2019). 
The observed effect of  adverse drug reactions on the 
length of  hospital stay among medical inpatients in 
a Nigerian University Teaching Hospital. Toxicology 
Research and Application, 3, 2397847319850451. 
https://doi.org/10.1177/2397847319850451.

Hadia, R., Joshi, D., Bhil, D., & Maheshwari, R. (2022). 
Incidence of  adverse drug reactions among elderly 
patients: A systematic review and meta-analysis. 
Journal of  the Scientific Society, 49(2), 91-102.

Ikwuka, A. O. (2015). Risk factors for the pathogenesis of  
diabetes mellitus type 2. Materials of  84th Scientific and 
Practical Conference of  Students and Young Scientists with 
International Participation “Innovations in medicine”, p. 19. 
Available online: http://www.ifnmu.edu.ua/images/
snt/files/konferenciya/Tezu_2015.pdf

Ikwuka, A. O. (2017a). Dyslipidemia risk severity in 
patients with diabetes mellitus type 2 and essential 
hypertension. Journal of  the 21st International Medical 
Congress of  Students and Young Scientists, p. 59.

Ikwuka, A. O. (2017b). Effectiveness of  dapagliflozin in 
patients with diabetes mellitus type 2 and essential 
hypertension. Book of  abstracts of  the 7th International 
Students’ Scientific Conference of  Young Medical Researchers, 
p. 102. Available online: http://www.stn.umed.wroc.
pl/files/lm/Accepted_papers.16113.pdf

Ikwuka, A. O. (2017c). Influence of  dyslipidemia in 
patients with diabetes mellitus type 2 and essential 
hypertension. The Pharma Innovation Journal, 6(3), 101-
103. Available online: http://www.thepharmajournal.



Pa
ge

 
9

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

com/archives/?year=2017&vol=6&issue=3&part=B
Ikwuka, A. O., & Haman, I. O. (2017d). Features of  

kidney damage in patients with diabetes mellitus type 
2 and essential hypertension. Journal of  86th Scientific 
and Practical Conference of  Students and Young Scientists 
with International Participation “Innovations in medicine”, 
p. 144. Available online: http://www.ifnmu.edu.ua/
images/snt/86-konf-tezi%20(1).pdf

Ikwuka, A. O., Virstyuk, N. G., & Luchko, O. R. (2017)e. 
Features of  the functional state of  kidneys in patients 
with diabetes mellitus type 2 and essential arterial 
hypertension. Materials of  scientific-practical conference with 
international participation “Babenkivski reading”, p. 48.

Ikwuka, A. O. (2018a). Clinical dynamics in patients with 
diabetes mellitus type 2 and concomitant essential 
hypertensive disease treated with dapagliflozin. Journal 
of  the 22nd International Medical Congress of  Students and 
Young Scientists, p. 32.

Ikwuka, A. O. (2018b). Clinical effectiveness of  SGLT-
2 inhibitors in patients with diabetes mellitus type 
2 and essential hypertensive disease. Endocrine 
Practice, 24(1), 74. https://doi.org/10.1016/S1530-
891X(20)47129-0.

Ikwuka, A. O. (2018c). Features of  kidney damage in 
patients with arterial hypertension and type 2 diabetes 
mellitus and optimization of  treatment. Specialized 
Academic Council IFNMU, Available online: http://
www.ifnmu.edu.ua/images/zagalna_informacia/
spec_vcheni_radi/2017-2019/%D0%9420.601.01/
Ikvuka/Avtoreferat.pdf

Ikwuka, A. O., & Paliy, Yu. (2018d). Structural changes 
of  the left ventricular myocardium in patients with 
essential arterial hypertension and diabetes mellitus 
type 2. Abstracts of  the 87th Scientific Conference 
of  Students and Young Scientists with International 
Participation “Innovations in medicine”, p. 25-26. Available 
online: https://www.ifnmu.edu.ua/images/snt/
zaproshennia_eng.pdf

Ikwuka, A. O. (2019a). Clinical dynamics of  nephropathy 
in patients with diabetes mellitus type 2 and 
concomitant essential hypertensive disease. Clinical 
Medicine, 19(2), s39. https://doi.org/10.7861/
clinmedicine.19-2-s39.

Ikwuka, A. O. (2019b). Clinical effectiveness of  GLP-1 
RAs in patients with metabolic syndrome diseases. 
Endocrine Practice, 25(1), 104-105. https://doi.
org/10.1016/S1530-891X(20)46611-X.

Ikwuka, A. O., & Virstyuk, N. G. (2019c). Pattern of  
cardiac remodelling of  the left ventricle in patients 
with essential hypertensive disease and concomitant 
type 2 diabetes mellitus. Clinical Medicine, 19(3), s92. 
https://doi.org/10.7861/clinmedicine.19-3-s92.

Ikwuka, A. O., & Virstyuk, N. G. (2021). Influence of  
SGLT2 inhibitor and A2RB (AT1) on fibrogenesis 
and heart failure in patients with essential 
hypertensive disease combined with diabetes mellitus 
type 2. E-Poster No. 143 of  the 44th & 45th Annual 
General and Scientific Meeting of  the West African College 

of  Physicians (WACP), 1 - 3 November, 2021. https://
doi.org/ 10.13140/RG.2.2.26912.87047.

Ikwuka, A. O., & Virstyuk, N. (2022). Prognostic markers 
of  nephropathy in patients with dual metabolic 
syndrome diseases (essential hypertensive disease 
and concomitant type 2 diabetes mellitus). Endocrine 
Practice, 28(5), S65-S66. https://doi.org/10.1016/j.
eprac.2022.03.164.

Ikwuka, A. O. (2023a). Dr. Aloy’s Core Essential Series 
(DACES) Medical Genetics. 1st Edition. Science and 
Education Publishing, USA, p. 9-10. ISBN: 978-1-
958293-02-7.

Ikwuka, A. O. (2023b). Dr. Aloy’s Core Essential Series 
(DACES) Immunology. 1st Edition. Science and 
Education Publishing, USA, p. 48. ISBN: 978-978-
795-866-7.

Ikwuka, A. O., & Virstyuk, N. (2023c). Patterns and 
Influence of  Cardio-Metabolic Insufficiency in 
Patients with Essential Hypertensive Disease and 
Concomitant Type 2 Diabetes Mellitus. https://
doi.org/(5), S32-S33. https://doi.org/10.1016/j.
eprac.2023.03.076.

Ikwuka, A. O., Virstyuk, N. G., Luchko, O. R., & 
Kobitovych, I. (2023d). Heterogeneity Of  Renal 
Pathogenicity On The Background Of  Asymptomatic 
Hyperuricemia In Patients With Dual Metabolic 
Syndrome Diseases (Essential Hypertensive Disease 
and Type 2 Diabetes Mellitus). British Journal of  
Medical and Health Research, 10(2), 1-9. https://doi.
org/10.5281/zenodo.7690636.

Ikwuka, A. O. (2023e). Dr. Aloy’s Core Essential Series 
(DACES) Hematology. 1st Edition. Science and 
Education Publishing, USA, p. 47-60. ISBN: 978-1-
958293-09-6. 

Ikwuka, A. O., Omoju, D. I., & Mahanera, O. K. (2023)
f. Profiling of  Clinical Dynamics of  Type 2 Diabetes 
Mellitus in Patients: A Perspective Review. World 
Journal of  Current Medical and Pharmaceutical Research, 
5(5), 210-218. https://doi.org/10.37022/wjcmpr.
v5i5.294.

Ikwuka, A. O., Virstyuk, N., Luchko, O., & Kobitovych, 
I. (2024). Optimization of  treatment in MSD 
patients using a combination of  HMG-CoA 
reductase inhibitor, SGLT-2 inhibitor and A2RB 
(AT1): Resultant clinical effectiveness. Endocrine 
Practice, 30(5), S60-S61. https://doi.org/10.1016/j.
eprac.2024.03.243.

Inya, A. U., Achara, A. P., Ikwuka, A. O., Udeh, F. C., Chi-
kadibia, U., & Onazi, O. (2023a). Clinical Dynamics 
of  Anemia in Pregnancy: A 16-week Cross-sectional 
Study of  Pregnant Women Who Attended Antenatal 
Clinic of  Federal Medical Center, Keffi, Nasarawa 
State, Nigeria. American Journal of  Clinical Medicine 
Research, 11(1), 1-9. https://doi.org/10.12691/
ajcmr-11-1-1.

Inya, A. U., Achara, A. P., Ikwuka, A. O., Udeh, F. C., 
Chi-kadibia, U., & Onazi, O.  (2023b). Patterns, 
Peculiarities and Associated Risk Factors of  Anemia 



Pa
ge

 
10

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

in Pregnancy: A Case Study of  Pregnant Women 
Attending Antenatal Clinic in North-Central Nigeria. 
European Journal of  Preventive Medicine, 11(2), 21-31. 
https://doi.org/10.11648/j.ejpm.20231102.12.

Jaspinder, K., Sargun, S., & Kawaljit, K. (2014). Impact of  
age on the prevalence of  chronic diseases in geriatric 
population. International Research Journal of  Biological 
Sciences, 3(9), 79-85.

Jennings, E. L., Murphy, K. D., Gallagher, P., & O’Mahony, 
D. (2020). In-hospital adverse drug reactions in 
older adults; prevalence, presentation and associated 
drugs—a systematic review and meta-analysis. Age 
and Ageing, 49(6), 948-958.

Kongkaew, C., Noyce, P. R., & Ashcroft, D. M. (2008). 
Hospital admissions associated with adverse drug 
reactions: a systematic review of  prospective 
observational studies. Annals of  Pharmacotherapy, 42(7-
8), 1017-1025.

Mekonnen, A. B., Alhawassi, T. M., McLachlan, A. J., 
& Brien, J. A. E. (2018). Adverse drug events and 
medication errors in African hospitals: a systematic 
review. Drugs - Real World Outcomes, 5, 1-24. https://
doi.org/ 10.1007/s40801-017-0125-6

Miediegha, O., & Bunu, S. J. (2020). Pharmacovigilance 
framework and extent of  medications adverse reaction 
surveillance in Southern Nigeria. World Journal of  
Pharmaceutical Research, 9(6), 2009-2017. https://doi.
org/10.20959/wjpr20206-17727.

Musa, S., Ikwuka, A. O., Udeh, F. C., Musa, A. A., & 
Chukwuezie, U. C. (2023). CRISPR-Cas9 Genomic 
Editing as an Innovation in the Management of  Sickle 
Cell Disease: A Systematic Review. American Journal of  
Medical Science and Innovation, 2(2), 36-48. https://doi.
org/10.54536/ajmsi.v2i2.1760.

National Pharmacovigilance Center (NPC), Nigeria. 
(2014). Guide for Reporting Adverse Reactions to Marketed 
Drugs. Available online: http://www.rrfa.co.za/
wp-content/uploads/2014/01/PV-Guideline-
received-2012.pdf

Nwani, P. O., & Isah, A. O. (2017). Frequency and 
patterns of  adverse drug reactions among elderly in-
patients in a Nigerian teaching hospital. J Basic Clin 
Pharm, 8, 245-250.

Ogar, C. K., Abiola, A., Yuah, D., Ibrahim, A., Oreagba, 
I. A., Amadi, E. C.. & Oshikoya, K. A. (2019). A 
retrospective review of  serious adverse drug reaction 
reports in the Nigerian VigiFlow database from 
September 2004 to December 2016. Pharmaceutical 
Medicine, 33, 145-157. https://doi.org/10.1007/
s40290-019-00267-2.

Okezie, E. O., & Olufunmilayo, F. (2008). Adverse drug 
reactions reporting by physicians in Ibadan, Nigeria. 
Pharmacoepidemiology and Drug Safety, 17(5), 517-522. 
https://doi.org/10.1002/pds.1597.

Oli, A. N., Onyeaso, N., Emencheta, S. C., Ofomata, 
C. M., Kretchy, J. P., Okhamafe, A., & Ele, G. N. 
(2021). Evaluating antimicrobial prescribing in a 
Tertiary Healthcare Institution in Nigeria. Journal of  

Pharmaceutical Policy and Practice, 14(1), 1-6.
Oreagba, I. A., Bada, S. O., & Chuka-Ebene, V. (2015). 

An intensive study of  adverse events in the Medical 
Unit of  a Nigerian Teaching Hospital. Value in 
Health, 18(3), A86-A87. https://doi.org/10.1016/j.
jval.2015.03.506

Oriavwote, P. E., & Ikwuka, A. O. (2022). Patterns and 
factors influencing self-medication among students 
of  the American International University West Africa 
(AIUWA), The Gambia. European Journal of  Clinical 
Medicine, 3(2), 33-37. https://doi.org/10.24018/
clinicmed.2022.3.2.181.

Oscanoa, T. J., Lizaraso, F., & Carvajal, A. (2017). 
Hospital admissions due to adverse drug reactions in 
the elderly: A meta-analysis. European Journal of  Clinical 
Pharmacology, 73, 759-770.

Prince, M. J., Wu, F., Guo, Y., Robledo, L. M. G., 
O’Donnell, M., Sullivan, R., & Yusuf, S. (2015). The 
burden of  disease in older people and implications for 
health policy and practice. The Lancet, 385(9967), 549-
562. https://doi.org/10.1016/S0140-6736(14)61347-
7.

Ramia, E., Zeenny, R. M., Hallit, S., & Salameh, P. (2021). 
A population-based study of  self-reported adverse 
drug events among Lebanese outpatients. Scientific 
Reports, 11(1), 7921.

Saka, S. A., Nlooto, M., & Oosthuizen, F. (2018). 
American Geriatrics Society-Beers Criteria and 
adverse drug reactions: a comparative cross-sectional 
study of  Nigerian and South African older inpatients. 
Clinical Interventions in Aging, 13, 2375-2387. https://
doi.org/10.2147/CIA.S176899.

Saka, S. A., Oosthuizen, F., & Nlooto, M. (2017). 
Interventions towards reducing adverse drug reactions 
among geriatric population in Africa: a scoping review 
of  the literature from 1990–2016. PULA: Botswana 
Journal of  African Studies, 31(1), 180-194. 

Shehab, N., Lovegrove, M. C., Geller, A. I., Rose, K. O., 
Weidle, N. J., & Budnitz, D. S. (2016). US emergency 
department visits for outpatient adverse drug events, 
2013-2014. JAMA, 316(20), 2115-2125. https://doi.
org/ 10.1001/jama.2016.16201.

Uche, V. U., Ikwuka, A. O., Udeh, F. C., Okorocha, A. 
E., Epete, M. A., Ekechi, H. O., Abraham, J. C., & 
Igwe, E. C. (2023). Associated Risks and Pathogenic 
Effects of  Consumption of  Calcium Carbide-
Ripened Banana Before and/or During Pregnancy 
on Maternal and Neonatal Livers. American Journal 
of  Food Science and Technology, 2(2), 54-64. https://doi.
org/10.54536/ajfst.v2i2.2197.

Udoye, J. A., Ozolua, R. I., & Nwokike, J. (2018). 
Assessment of  the knowledge, attitude and practice 
of  pharmacovigilance by pharmacists in two states in 
southeastern Nigeria. Tropical Journal of  Pharmaceutical 
Research, 17(5), 937-945. https://doi.org/10.4314/
tjpr.v17i5.25.

Virstyuk, N. G., Ikwuka, A. O., Haman, I. O., & Adebomi, 
M. S. (2016). Diabetes mellitus type 2, arterial 



Pa
ge

 
11

https://journals.e-palli.com/home/index.php/ajcp

Am. J. Chem. Pharm. 3(1) 1-11, 2024

hypertension and dyslipidemia. Materials of  2nd 
International Scientific and Practical Conference “Therapeutic 
readings: modern aspects of  diagnosis and treatment of  diseases 
of  internal organs”, p. 46-47.

Virstyuk, N. G., & Ikwuka, A. O. (2017a). Diagnostic 
and prognostic markers of  the diabetes mellitus 
type 2 course in connection with essential arterial 
hypertension taking into account the kidney function. 
Precarpathian Journal Pulse, 8(44), 53-62. 

Virstyuk, N. H., Ikwuka, A. O., Losyuk, L. V., Kobrynska, 
O. Ya., & Markiv, H. D. (2017b). Dapagliflozin utility 
in patients with diabetes mellitus type 2 and essential 
hypertensive disease. Actual Problems of  Modern 
Medicine, 4(60)1, 76-79. Available online: http://www.
umsa.edu.ua/journal2stat4_2017_eng.html

Virstyuk, N. G., & Ikwuka, A. O. (2018a). Features of  
asymptomatic hyperuricemia in patients with diabetes 
mellitus type 2 and concomitant essential arterial 
hypertension. Clinical and Experimental Pathology, 
1(63), 22-26. https://doi.org/10.24061/1727-4338.
XVII.1.63.2018.5.

Virstyuk, N. G., Ikwuka, A. O., & Didushko, O. M. 
(2018b). Effect of  dapagliflozin on the level of  uric 
acid during asymptomatic hyperuricemia in patients 
with diabetes mellitus type 2 and concomitant arterial 
hypertension. Art of  Medicine, 1(5), 21-26. Available 
online: https://art-of-medicine.ifnmu.edu.ua/index.
php/aom/article/view/179/150

Virstyuk,  N. H., & Ikwuka, A. O. (2018c). Dapagliflozin 
influence on the clinical course of  diabetes mellitus 
type 2 and essential hypertension in patients. Recent 
Advances in Environmental Science from the Euro-
Mediterranean and Surrounding Regions, p. 2007-
2008. https://doi.org/10.1007/978-3-319-70548-
4_582.

Virstyuk, N. G., & Ikwuka, A. O. (2019). Nephropathic 
characteristics in patients with diabetes mellitus 
type 2 and essential hypertensive disease. Art of  
Medicine, 1(5), 44-47. https://doi.org/10.21802/
artm.2019.1.9.44.

Virstyuk, N. G., & Ikwuka, A. O. (2021a). Asymptomatic 
hyperuricemia and functional state of  the kidneys 
in patients with essential arterial hypertension and 
concomitant diabetes mellitus type 2. European 
Journal of  Clinical Medicine, 2(3), 100-104. https://doi.
org/10.24018/clinicmed.2021.2.3.65.

Virstyuk, N. H., Ikwuka, A. O., Luchko, O. R., & 
Kocherzhat, O. I. (2021b). Peculiarities of  renal 
insufficiency in patients with diabetes mellitus type 2 
and arterial hypertension. Materials of  scientific-practical 
conference with international participation “Achievements and 
prospects of  experimental and clinical endocrinology” Twentieth 
Danilevsky readings, p. 86-87.

World Health Organization (WHO). (2019). Medication 
Safety in Polypharmacy. (WHO/UHC/SDS/2019.11). 
Available online: https://www.who.int/docs/default-
source/patient-safety/who-uhc-sds-2019-11-eng.pdf

Yadesa, T. M., Kitutu, F. E., Deyno, S., Ogwang, P. E., 
Tamukong, R., & Alele, P. E. (2021). Prevalence, 
characteristics and predicting risk factors of  adverse 
drug reactions among hospitalized older adults: 
A systematic review and meta-analysis. SAGE 
Open Medicine, 9, 20503121211039099. https://doi.
org/10.1177/20503121211039099.

Zazzara, M. B., Palmer, K., Vetrano, D. L., Carfì, A., 
& Graziano, O. (2021). Adverse drug reactions in 
older adults: a narrative review of  the literature. 
European Geriatric Medicine, 12, 463-473. https://doi.
org/10.1007/s41999-021-00481-9.


