Management of adverse drug reactions

Successful management of adverse drug reactions requires early identification and prompt treatment of anaphylaxis, whether due to immunoglobulin (Ig) E- or non-IgE-mediated mechanisms of mast cell mediator release. Acute therapy is directed toward enhancement of oxygenation and maintenance of normotension. Requisite measures include the use of epinephrine, oxygen, and adequate fluid replacement; in some instances, vasopressors or corticosteroid drug therapy may be warranted. Emergency measures may be needed to maintain the airway. Although the offending drug is usually discontinued, a necessary drug for which there is no satisfactory alternative occasionally may be continued without danger of further anaphylaxis as long as therapy is not interrupted. Other nonemergent adverse drug reactions requiring an early decision include accelerated urticarial and late maculopapular eruptions, in both of which the patient may tolerate a necessary drug with schedule manipulation. Differentiation of an adverse drug reaction from problems unrelated to the drug is essential so that needed medication is not inappropriately discontinued. Good management also requires anticipation of adverse reactions whenever a therapeutic program is instituted. Familiarity with the drug groups most commonly responsible for immunologic reactions is helpful, as is knowledge of satisfactory alternatives for these drugs in the presence of known hypersensitivity. An adverse reaction can often be minimized through use of established protocols for premedication. Desensitization, when essential, may be achieved for most drugs with graduated dosage schedules and maintained through continued administration of the drug. Identification to avoid inadvertent exposure to agents that have caused immunologic reactions in the past is essential.