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Adverse Drug ReactionAka: Medication Hypersensitivity, Drug Reaction

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  1. See Also
    1. Hypersensitivity Reaction
    2. Anaphylaxis
    3. Penicillin Allergy
    4. Gell and Coombs Classification
    5. Fixed Drug Eruption
  2. Types of medication-induced Hypersensitivity Reaction
    1. See Gell and Coombs Classification
  3. Differential Diagnosis: Non-immune mediated drug reaction
    1. Medication withdrawal (examples)
      1. Antidepressant Withdrawal
      2. Clonidine
    2. Medication intolerance
      1. Significant gastrointestinal upset with codeine
    3. Idiosyncratic reaction (examples)
      1. G6PD Deficiency
    4. Pseudoallergic reaction (direct mast cell activation)
      1. Intravenous Contrast anaphylactoid reaction
    5. Drug Interactions
      1. See Cytochrome P-450
      2. Example: Drug Interactions with Coumadin
    6. Medication Overdose (examples)
      1. Medication Dosing Errors in Children
      2. Dilantin Toxicity
      3. Digoxin Toxicity
    7. Medication toxicity (examples)
      1. Medication Causes of Marrow Toxicity
      2. Medication Causes of Myositis
      3. Nephrotoxic Drugs
      4. Hepatotoxic Medication
      5. Ototoxic Drugs
    8. Medication specific adverse effect (examples)
      1. Medication Causes of Abnormal Uterine Bleeding
      2. Medication Causes of Constipation
      3. Medication Causes of Depression
      4. Medication Causes of Dyspepsia
      5. Medication Causes of Dyspnea
      6. Medication Causes of Edema
      7. Medication Causes of Galactorrhea
      8. Medication Causes of Headache
      9. Medication Causes of Hemolytic Anemia
      10. Medication Causes of Hyperpigmentation
      11. Medication Causes of Impotence
      12. Medication Causes of Jaundice
      13. Medication Causes of Lymphadenopathy
      14. Medication Causes of Macrocytic Anemia
      15. Medication Causes of Myositis
      16. Medication Causes of Neutropenia
      17. Medication Causes of Nightmares
      18. Medication Causes of Phototoxic Reaction
      19. Medication Causes of Pruritus
  4. Risk factors for immune-mediated drug reaction
    1. Drug Hypersensitivity Reaction to related medication
    2. Adults (especially women)
    3. Concurrent viral infection
    4. Comorbid condition
      1. HIV Infection
      2. Asthma
      3. Systemic Lupus Erythematosus
      4. Beta Blocker use
    5. Medications with larger more complicated structure
      1. Non-human proteins
      2. Streptokinase
      3. Insulin
  5. Findings suggestive of drug hypersensitivity
    1. Anaphylaxis
    2. Angioedema
    3. Urticaria
    4. Morbilliform rash (1-3 weeks after exposure)
    5. Bullous Disease
      1. Erythema Multiforme
      2. Toxic epidermal necrolysis
  6. Management
    1. Avoid drug responsible for adverse reaction
    2. Consider testing for allergy if suspect immune-mediated
      1. Type 1 Hypersensitivity Reaction
        1. Skin Testing
        2. RAST Testing
      2. Type 2 Hypersensitivity Reaction
        1. Coombs' Test positive
        2. Complete Blood Count
          1. Hemolytic Anemia
          2. Thrombocytopenia
          3. Neutropenia
      3. Type 3 Hypersensitivity Reaction
        1. Erythrocyte Sedimentation Rate (ESR) increased
      4. Type 4 Hypersensitivity Reaction
        1. Patch Testing
    3. Consider desensitization to offending agent
    4. Consider specific agent management
      1. Penicillin Adverse Drug Reaction
      2. Intravenous Contrast
  7. References
    1. Diasio in Goldman (2000) Cecil Medicine, p. 100-1
    2. Gruchalla (2003) J Allergy Clin Immunol 111:548
    3. Riedl (2003) Am Fam Physician 68:1781

Adverse drug effect (C0041755)

Definition (CSP)unintended, deleterious effects of otherwise licit, therapeutic, properly administered drugs; for effects of illicit and abused drugs, or of environmental chemicals, see TOXICOLOGY or POISONING.
ConceptsInjury or Poisoning (T037)
ICD9995.2
EnglishADR - Adverse drug reaction, adverse drug effect, Adverse drug reaction, Adverse reaction to drug, drug adverse effect, Drug reaction, Drug Side Effects
Spanishefecto adverso de una droga, reaccion adversa a un farmaco, reaccion medicamentosa
Parent Conceptsbeneficial vs adverse drug effect (C0678769), Pharmacology (C0031330), Adverse effects (C0879626), Adverse drug effect (C0041755), Drug-related disorder (C0277579), Beginning (C0439659), Adverse reaction to substance (C0559966), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, DXP, MTH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


DRUGS, MEDICINAL AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE (C0178359)

ConceptsInjury or Poisoning (T037)
ICD9E930-E949.9
Parent ConceptsSUPPLEMENTARY CLASSIFICATION OF EXTERNAL CAUSES OF INJURY AND POISONING (C0376109), Ambiguous concept (C1274012)
SourcesICD9CM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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