What the Heck is A
Paradoxical Reaction …

A Paradoxical Reaction to any substance can be frightening and uncomfortable. Learn about what these adverse drug reactions are and how to manage them. A Paradoxical reaction is an adverse reaction to a substance, almost always to a drug, that is EXACTLY THE OPPOSITE of the intended effect.

The word 'Paradoxical' is defined as, "… a statement or group of statements that leads to a contradiction or a situation which defies intuition." And that's exactly what these drug reactions are, a seemingly contradictory reaction to a drug that is nonetheless very very real.

A Real Life Problem

A common example of this type of reaction reaction in medicine is the case of a drug called Compazine. Compazine is a drug given intravenously in hospitals for nausea and/or for migraine headaches. Approximately 20% of people have a paradoxical reaction to compazine that then requires the administration of intravenous Benadryl – also called diphenhydramine- to resolve. Compazine, for most people, alleviates their nausea or headache and also has a mild sedative effect.

When someone has these reactions, it is VERY obvious to a knowledgeable medical profession- but less obvious to the patient and family. Patients become restless, agitated and can't sit still. In many cases, they actually do not know what is going on- all they know is that they 'Want to Go Home." They will repeatedly state that they want to go home or that they, "Have to get out of here" over and over.

For the medical professional, the trick is to get a dose of intravenous Benadryl into the patient as quickly as possible, otherwise the attempt to get the patient to stay longer and wait for test results, the doctor to talk to them, etc. can turn into anger for the patient who wants to leave and for the family who wants to honor the patient's request and doesn't understand what is going on.

"I can distinctly remember working as a nurse in a small emergency room when our unit secretary came in on her day off because she was dehydrated after several days of vomiting. I started an intravenous line to give her fluids- and gave her a dose of Compazine as per the doctor's order. Soon, she was stating, "I Want to go home now." Because I had given her a sedative drug, the hospital could not allow her to drive herself home and I called her boyfriend to come and pick her up. After I tended to another patient and returned to my coworker, she was gone and the ambulance door was closing. I opened the ambulance door and saw her running away towards the main street, IV pole being pushed in front, hospital gown billowing out behind. We had to call the police department to get her back. Once she had some Benadryl, she agreed to stay and get the rest of her intravenous fluids. Now THAT is a Paradoxical Reaction! Once I began to recognize the reaction, I dubbed it the 'I Gotta Go's' because that's what everyone with a paradoxical reaction says."
-Kerri Knox, RN
San Francisco, Ca

What to do About A
Paradoxical Reaction

If you have one at home, you can take a dose of Benadryl to help reverse the anxiety and restlessness. But if you understand what it is and that it is not dangerous, then you could simply wait it out or go for a walk until the side effect wears off. If you are at the hospital, you can notify the nurse or doctor what you think is happening and they will be likely to give you some Benadryl to alleviate it.

You'll need to notify your doctor and get a new drug recommended for your initial problem, as you cannot take that drug (or similar drugs in the same class) again. 

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