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Hypersensitivity reactions to drugs involve immunological reactions. Large molecules such as vaccines, insulin and dextrans can provoke immune reactions themselves but most drugs are too small to be antigenic on their own. In some patients, something that cannot be predicted is that a drug or drug metabolite can combine with tissue proteins to form an antigenic conjugate. In this situation, the patient shows a response, which can be described under one of the classical definitions of allergic response (that is, type see below).

The antibodies so produced activate the complement system. Complement destroys the blood cells. This can lead to haemolytic anaemia if red blood cells are involved and can occur in response to penicillin. If white blood cells are the target of the reaction then the result is agranulocytosis; this can occur for example with carbimazole (used to treat an overactive thyroid gland, result if the cells involved are platelets; this can happen in response to heparin (used in thrombotic disorders, Other drugs can form immune complexes with antibodies, IgG or IgM, which circulate in the blood and can be deposited in particular areas of the body, for example in the joints, skin or kidneys. See Figure Here the immune complexes can cause a local inflammation by activation of the complement system.

They exist in large amounts in the plasma or tissue fluid and are rapidly cleared by the liver or kidney. In practice, such drugs have little therapeutic use. At equilibrium, drugs are partitioned between plasma, plasma proteins and the different tissues. The rate of distribution to different tissues depends largely on the rate of blood flow through them. Some areas of the body have a relatively good blood supply, for example, the major organs; muscles and skin have a moderate supply; and bone and adipose tissue have a poor supply.