Many of these drugs have side effects, referred to by physicians as adverse drug reactions, ADRs for short. The ADRs of most drugs are well known and well defined, based on the experience of thousands of people who took the drug during its clinical trials, and on the experience of everyone who took the drug once it was on the market. Although anyone can develop ADRs, for some reason ADRs are more common in people with HIV infection. For instance, trimethoprim-sulfamethoxazole (Bactrim or Septra) causes ADRs in 10 percent of the people without HIV infection and 50 percent of those with HIV infection.     ADRs are classified as either allergic or toxic. Allergic reactions mean that the cells of the immune system have recognized the drug as foreign and have responded by causing a rash, a fever, or both—like the rashes that penicillin causes in some people. In allergic reactions, the dose of the drug is unimportant: the immune system will respond similarly regardless of the dose. Serious allergic reactions often imply that neither that drug nor any related drugs should be taken again.     Toxic reactions are caused, not by the immune system, but directly by the drug itself. An example is the drowsiness caused by Dramamine or other antihistamines or the kidney damage and anemia caused by amphotericin B. Toxic reactions are usually dose-related; lowering the dose will relieve the symptoms.     People usually develop ADRs after they have been taking the drug for one or two weeks. Some people, however, will have a serious ADR after one dose; others will have no ADRs until after they have taken the drug for months or years; some develop ADRs after repeated courses of the same drug. Therefore, ADRs are unpredictable: because a drug was taken once and tolerated does not mean that it can be taken later and cause no ADR.     Sorting out and controlling ADRs will be done by a physician. The physician will either give the person with a suspected ADR what is called a drug holiday—discontinuation of all drugs—or will stop drugs one at a time, starting with those that are most likely to cause ADRs and those that are most dispensable.*180\191\2*

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