Light therapy adverse effects

Assess the patient s subjective complaints and objective information for adverse effects. For NSAID therapy, be alert for new-onset epigastric pain, dark or tarry stools, blood in vomitus, dizziness or light-headedness, development of edema, decreased urine output by more than 50% over a 24-hour period, or shortness of breath. For colchicine, monitor for nausea or vomiting, diarrhea, easy bruising, cold or flulike symptoms, light-headedness, muscle weakness, or pain. Counsel the patient to inform you of any new medications started or stopped while taking colchicine. 

Light-headedness, dizziness, or nausea occurs in approximately 15% of patients, paresthesias and numbness in 9%, and tremor in 8%. These adverse effects are generally mild in intensity, transient, and dose related. Overall, however, approximately 20% of patients prescribed tocainide discontinue therapy because of such effects. Serious immune-based side effects, such as pulmonary fibrosis, have been reported, and blood dyscrasias, such as agranulocytosis and thrombocytopenia, may occur in up to 0.2% of patients. 

Symptomatic adverse effects Topical pilocarpine therapy produces blurred vision or myopia, poor vision in dim light or sometime painful spasm. Many patients on pilocarpine may experience ciliary or conjunctival congestion, headache, photophobia. Some patient may develop pupillary dilatation following use of pilocarpine. 

The most common adverse effects of topical retinoic acid are erythema and dryness that occur in the first few weeks of use, but these can be expected to resolve with continued therapy. Animal studies suggest that this drug may increase the tumorigenic potential of ultraviolet radiation. In light of this, patients using retinoic acid should be advised to avoid or minimize sun exposure and use a protective sunscreen. Allergic contact dermatitis to topical retinoic acid is rare. 

Brown M, Korb S, Light JA, Light T, Jonsson J, Aquino A. Low-dose OKT3 induction therapy following renal transplantation leads to improved graft function and decreased adverse effects. Transplant Proc 1993 25(1 Pt l) 553-5. 

Some patients experience dizziness or light-headedness, especially during the first few days of therapy or when a rapid diuresis has occurred. Fhtients who are dizzy but are allowed out of bed are assisted by the nurse with ambulatory activities until these adverse drug effects disappear. 

Diet should be modified only in cases where foods have been proven to elicit symptoms. Patients with mastocytosis and Hymenoptera venom exposure are at risk for severe anaphylaxis. Thus, specific immunotherapy should be considered in patients with Hymenoptera venom allergy and then administered under close supervision [31]. The majority of patients with mastocytosis reportedly tolerate immunotherapy without significant side effects and appear protected following this approach [33,40]. However, there does appear to be some increased risk for adverse reactions during initiation of immunotherapy, as well as for therapy failures [31, 33]. An increased maintenance dose of insect venom has been reported to carry better success rates by sting provocation [41]. Also, in the light of 2 fatal cases of anaphylaxis after discontinuation of SIT in patients with mastocytosis [30], lifelong immunotherapy should be considered [26]. 

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