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Routes of medication administration
There are several different ways drugs can be administered. You’re probably familiar with injections and pills that you swallow, but medications can be given in many other ways as well.

Routes of medication administration are described in the table below.

Route   Explanation
buccal   held inside the cheek
enteral   delivered directly into the stomach or intestine (with a G-tube or J-tube)
inhalable   breathed in through a tube or mask
infused   injected into a vein with an IV line and slowly dripped in over time
intramuscular   injected into muscle with a syringe
intrathecal   injected into your spine
intravenous   injected into a vein or into an IV line
nasal   given into the nose by spray or pump
ophthalmic   given into the eye by drops, gel, or ointment
oral   swallowed by mouth as a tablet, capsule, lozenge, or liquid
otic   given by drops into the ear
rectal   inserted into the rectum
subcutaneous   injected just under the skin
sublingual   held under the tongue
topical   applied to the skin
transdermal   given through a patch placed on the skin
The route used to give a drug depends on three main factors:

the part of the body being treated
the way the drug works within the body
the formula of the drug
For instance, some drugs are destroyed by stomach acid if they’re taken by mouth. So, they may have to be given by injection instead.

Training in medication administration
Not all types of medications can be administered at home or by someone without special training. Doctors, nurses, and other healthcare providers are trained in how to give you medication safely.

Administration of medication requires thorough understanding the drug, including:

how it moves through your body
when it needs to be administered
possible side effects and dangerous reactions
proper storage, handling, and disposal
Healthcare providers are trained in all of these issues. In fact, many healthcare providers keep in mind the “five rights” when they administer drugs:

the right patient
the right drug
the right time
the right dose
the right route
Medication errors happen all too often in the United States, even when drugs are given by professionals. The Food and Drug Administration receives more than 100,000 reports of medication errorsTrusted Source annually through its MedWatch program. These errors can take place when:

prescribing a drug
entering the drug or dosage information into a computer system
a drug is being prepared or dispensed
a drug is taken by or given to someone
The “rights” are a starting point in helping to make sure that medications are given correctly and safely.

Dosage and timing
It’s important to take only the dosage described in the prescription label or other instructions. Dosage is carefully determined by your doctor and can be affected by your age, weight, kidney and liver health, and other health conditions.

For some medications, dosage must be determined by trial and error. In these cases, your healthcare provider would need to monitor you when you first start treatment.

For example, if your doctor prescribes thyroid medications or blood thinners, you would likely need to have several blood tests over time to show if the dosage is too high or too low. The results from these tests would help your doctor adjust your dosage until they find the one that’s right for you.

Many medications need to reach a certain level in your bloodstream to be effective. They need to be given at specific times, such as every morning, to keep that amount of drug in your system.

Taking a dose too soon could lead to drug levels that are too high, and missing a dose or waiting too long between doses could lower the amount of drug in your body and keep it from working properly.

Potential problems
Adverse events, or unwanted and negative effects, can happen with any drug. These effects can include an allergic reaction or an interaction with another drug you’re taking.

To help avoid these problems, be sure to tell your doctor about any other medications you’re taking or any times you’ve had an allergy to drugs or foods.

A drug with high risk of adverse effects may be administered only by a healthcare provider. And in some uncommon cases, your healthcare provider may keep you in their facility so they can observe how the drug affects you.

If you take a medication yourself, it’s up to you to watch for problems, such as a rash, swelling, or other side effects. If you notice any problems, be sure to let your doctor know.

Talk with your doctor
Be sure to take your medications correctly to get the most out them and to reduce your risk of side effects and other problems. Anyone giving you the drug should follow your doctor’s instructions carefully.

Make sure that you understand everything about taking your medication. If you have any questions, talk to your doctor. Some questions you might ask include:

I’m not sure how often I should take this medication. Can you explain your instructions more clearly?
My nurse gives me my medication now. Can I be trained to give it to myself?
I’m having trouble taking my medication. Can a family member or healthcare provider give it to me instead?
Are there any side effects I should watch for?
What time of day should I take this drug? Or does it matter?
Am I taking any medications that this drug could interact with?
Last medically reviewed on March 27, 2019

How we reviewed this article:

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Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Mar 28, 2019

Written By

Christine Case-Lo

Edited By

Frank Crooks

Mar 27, 2019

Medically Reviewed By

Alan Carter, PharmD

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Medically reviewed by Alan Carter, Pharm.D. — Written by Christine Case-Lo — Updated on March 28, 2019
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How to Recognize and Get Help for Hypersensitivity Syndrome
Overview
Symptoms
Risk factors
Causes
Diagnosis
Treatment
Complications
Takeaway
Getty Images/AleksandarNakic
Drug-induced hypersensitivity syndrome (DIHS) is a severe reaction to medication that can cause serious problems in many different body systems. In some cases, the condition can cause complications that lead to death.

DIHS is rare. But because it can become so serious, it’s important to understand what medications are most likely to cause these reactions.

Keep reading to learn what medications might induce a DIHS reaction, what risk factors can make you more vulnerable, and what to do if you suspect that you or someone in your care is experiencing this kind of response.

What is hypersensitivity syndrome?
DIHS is a drug reaction. It happens when your body responds to a drug the way it would respond to an infection.

Infection-fighting T-cells in your immune system are unleashed in response to the medication, causing eruptions on your skin and damage to your internal organs.

Several factors make DIHS different from an ordinary drug reaction. These include when DIHS:

re-activates common herpes viruses (especially HHV-6) that may be dormant in your body
involves more than one organ in your body
symptoms appear to go into remission, but relapses can occur later
causes autoimmune disorders to develop down the line
DIHS vs. drug-related eosinophilia
DIHS shares overlapping symptoms with another condition known as drug-related eosinophilia with systemic symptoms (DRESS).

The major difference between the two conditions is that DIHS involves a re-activation of Herpes viruses in your body, according to a 2019 review, which doesn’t happen with DRESS. Some researchers think DIHS may be a more severe form of DRESS.

One of the things that makes DIHS and DRESS hard to diagnose is that symptoms don’t appear right away, so doctors may not immediately make a connection between the symptoms you’re experiencing and the medication you took.

DIHS also resembles several other disorders
Another difficulty is that DIHS closely resembles several other disorders, including:

infectious mononucleosis
dengue viral infection
Kawasaki syndrome
measles
parvovirus B19 infection
What are the symptoms of hypersensitivity syndrome?
While many drug allergies cause an immediate reaction, DIHS symptoms generally appear 3 weeks to 3 months after the medication was started. Symptoms can come and go for months or even years.

Symptoms can vary depending on which medication caused the reaction. Some symptoms are easier to notice, while others may not be apparent until lab tests reveal a problem.

Here’s a list of the more common symptoms:

a pink or red rash with or without pus-filled bumps or blisters
scaly, flaky skin
fever
facial swelling
swollen or tender lymph nodes
swollen saliva glands
dry mouth
abnormalities in your white blood cell counts
difficulty moving normally
headache
seizures
coma
Damage to internal organs
DIHS and DRESS can damage your internal organs.

According to the 2019 reviewTrusted Source mentioned earlier, in 75 to 94 percent of cases, it’s the liver that sustains the most damage. Approximately 12 to 40 percent of the time, the kidneys are involved. In 4 to 27 percent of cases, the heart is impaired. And about a third of those with DRESS have lung damage.

Who’s at risk for hypersensitivity syndrome?
Researchers have discovered that genes play an important role in whether you’re likely to have a severe drug reaction like DIHS or DRESS. Genetics are not the only factor, though. Studies show you may be more likely to experience DIHS if:

You’re over age 20.
You’ve had a viral infection in the past few weeks, especially a herpes zoster infection.
You’ve had a rheumatic or collagen rheumatic disease before.
You have a condition that requires you to take antibiotics frequently.
What are the causes of hypersensitivity syndrome?
Hypersensitivity syndrome is caused by a complex set of interactions between a medication, your own immune system, and viruses in your body, especially herpes viruses.

Researchers are still learning about these interactions, but what they have discovered so far indicates that certain drugs are more likely to be involved in these reactions:

seizure medications, including carbamazepine, lamotrigine, mexiletine, pheobarbitol, phenytoin, valproic acid, and zonisamide
antibiotics such as dapsone (used to treat skin infections and Hansen’s disease), amoxicillin, ampicillin, azithromycin, levofloxacin, piperacillin/tazobactam, clindamycin, minocycline, and vancomycin
medications used to treat tuberculosis, including Ethambutol, isoniazid, pyrazinamide, rifampin, and streptomycin
sulfasalazine, an arthritis medication
antiretrovirals such as nevirapine and efavirenz
anti-inflammatory medications, including ibuprofen, celecoxib, and diclofenac
drugs used to treat hepatitis C, including boceprevir and telaprevir
cancer therapies, including sorafenib, vismodegib, imatinib, and vemurafenib
rivaroxaban, a blood thinner
allopurinol and febuxostat, which lower uric acid in people with gout, kidney stones, and cancer
omeprazole, an over-the-counter heartburn medication
acetaminophen, an over-the-counter pain reliever
More than 40 different medications, including those listed above, have caused isolated cases of DIHS in children, according to 2019 researchTrusted Source.

Additional risk factors for Black and Han Chinese people
Drugs called aromatic anticonvulsants, which are usually prescribed for seizure disorders, are more likely to cause DIHS in Black people. Allopurinal, a drug that lowers uric acid, is more likely to cause DIHS in Han Chinese people.

How is hypersensitivity syndrome diagnosed?
A doctor or another healthcare professional can diagnose DIHS by conducting:

a physical examination
liver function tests
blood tests
kidney function tests
urinalysis
a skin biopsy
More tests might be necessary if the doctor wants to rule out other conditions.

How is hypersensitivity syndrome treated?
The first step in treating DIHS is to stop the medication that’s causing the reaction. You should be prepared for your symptoms to get worse immediately after you stop taking the medication. That’s one of the hallmarks of this kind of drug reaction.

It’s also important to understand that your symptoms may come and go for some time after you’re treated. That pattern is also common with this condition.

After stopping your medication, your doctor may treat you with corticosteroids to control some of your symptoms. Treatment with corticosteroids isn’t right for everyone, however. It can increase the risk of reactivating an Epstein Barr virus or a cytomegalovirus already in the body, according to 2020 researchTrusted Source.

If you’ve developed a secondary infection as a result of the reaction, you may also need a course of antibiotics.

What are the potential complications of hypersensitivity syndrome?
In rare cases, DIHS or DRESS can cause complications that are potentially life-threatening. Some of these complications include:

gastroenteritis
pneumonia
myocarditis
hepatitis
nephritis
sepsis
type I diabetes
thyroiditis
cytomegalovirus (CMV) reactivation
Epstein-Barr virus reactivation
hemolytic anemia
systemic lupus erythmatosus
alopecia
vitiligo
neuropathy
These complications can arise long after your other symptoms have gone away.

About 10 percentTrusted Source of those with DIHS will die from a complication that develops as a result of the initial reaction. People whose heart, liver, or kidneys are affected are more likely to die from the condition than others.

Because drug reactions can get worse each time you’re exposed to the drug, it’s important to talk with your doctor about any rash or reaction you have to a medication.

Takeaway
DIHS and DRESS are severe drug reactions. Though they’re rare, they can cause lasting, sometimes life threatening organ damage.

Because the symptoms resemble other diseases and drug reactions, it’s important to talk with a health professional any time you experience a skin rash or other symptoms after taking a new medication — even if it’s been weeks since you took the medication.