Adverse drug reactions (ADRs) are a response to a drug that is noxious and unintended. They are a frequent cause of hospitalization and mortality in the UK, resulting in a significant financial burden for the NHS. Between one-third to a half of ADRs are avoidable. To minimize their occurrence, each patient's susceptibility should be assessed by evaluating risk factors such as age, comorbidities and potential drug interactions before a medication is administered. Pharmacogenetics is an area of increasing interest which is likely to play a role in this assessment and enable clinicians to target drugs, with improved precision, to only the patients they are likely to benefit.

Anaesthetists and intensivists hold a crucial role in managing ADRs. Firstly, we are responsible for patient safety throughout the perioperative period, during which we often administer multiple medications which could potentially cause an ADR. Fortunately, we also meticulously observe physiological changes during this period, increasing the likelihood of detecting such events. Secondly, several ‘atypical’ drug reactions, such as anaphylaxis and toxic epidermal necrolysis, are so severe that they often necessitate management in an intensive care environment. Therefore, we have a professional responsibility to ensure we are familiar with recognizing, managing, and reporting ADRs.