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Some of these genes are known as proto-oncogenes. They were given this name because they can be altered by mutation, carcinogens or viruses to become oncogenes.

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Idiosyncratic reactions occur when the patient experiences an effect unrelated to the expected action of the drug. The effect is usually harmful and occurs in a very small proportion of individuals.

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Factors affecting compliance in older people are many and include the complexity of multiple therapy, possible difficulty in understanding instructions, ambiguous or unclear patient information or labelling, preconceived ideas about medicines and their benefits, previous bad experience, difficult dosing regimes, unpalatable formulations and real or imagined side effects. As we get older, there are physiological changes that can alter the effect a drug has on the body.

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Treatment is by replacement therapy with thyroxine.

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Biguanides do not affect insulin production but they do require some functioning β-cells to work.

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