An approach to the evaluation and documentation of adverse drug reaction.

This paper reviews an approach to the evaluation and documentation of suspected adverse drug reaction (ADR). I propose an algorithm for the evaluation of suspected ADR. I recommend that the adverse drug reaction scoring system(ASS) or the adverse drug reactions probability scale(APS) be used when evaluating suspected ADR. In these two scoring systems, points are allotted according to response to a series of questions on events relating to the clinical manifestations of the suspected ADR. Depending on the total points scored the probability of the suspected ADR are classified as definite, probable, possible and unlikely. When a patient's suspected ADR is classified as definite, then no further investigation is necessary. The patient should be considered sensitive to the drug. In a case where the suspected ADR is classified as probable or possible then further investigations should be considered to confirm the diagnosis. If the nature of ADR is life threatening only in-vitro test should be done. If the nature of ADR is not life threatening, in-vivo and oral provocative test dosing may be considered. It should be considered if the suspected drug in question cannot be substituted and when it is very frequently prescribed.