CD-ROM Today 1996 January

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$Unique_ID{BRK03004} $Pretitle{} $Title{The New Prescription Drug Reference Guide - Coping with Side Effects} $Subject{Side Effects Ears Eyes Gastrointestinal System Circulatory Nervous Respiratory Skin Kidneys Liver Blood Blood pregnancy breast--feeding management} $Volume{} $Log{ Common Minor Side Effects*0300401.tab} Copyright (C) 1993 Publications International, Ltd. Coping with Side Effects ------------------------------------------------------------------------------ Drugs have certain desirable effects--that's why they are taken. The desirable effects of a drug are known as the drug's activity or therapeutic effects. Drugs, however, have undesirable effects as well. Undesirable effects are called side effects, adverse reactions, or, in some cases, lethal effects. An adverse reaction is any undesirable effect of a drug. It can range from minor to toxic or lethal. Even if you experience minor side effects, it is very important that you take your medication exactly as it was prescribed. You should take the full dose at the appropriate times throughout the day for the length of time prescribed by your doctor. Taking a lesser amount of medication to avoid side effects or because your condition appears to be improving is NOT appropriate. A smaller dose may not provide any benefit whatsoever; that is, half of the dose may not provide half of the therapeutic effects. Some side effects are expected and unavoidable, but others may surprise the doctor as well as the patient. Unexpected reactions may be due to a person's individual response to the drug. Side effects generally fall into one of two major groups--those that are obvious and those that cannot be detected without laboratory testing. Discussion between you and your doctor about your medication should not be restricted to the most easily recognized side effects; other, less obvious side effects may also be harmful. If you know a particular side effect is expected from a particular drug, you can relax a little. Most expected side effects are temporary and need not cause alarm. You'll merely experience discomfort or inconvenience for a short time. For example, you may become drowsy after taking an antihistamine or develop a stuffy nose after taking reserpine or certain other drugs that lower blood pressure. Of course, if you find minor side effects especially bothersome, you should discuss them with your doctor, who may be able to prescribe another drug or at least assure you that the benefits of the drug far outweigh its side effects. Sometimes, side effects can be minimized or eliminated by changing your dosage schedule or taking the drug with meals. Be sure, however, to consult your doctor or pharmacist. Many side effects, however, signal a serious, perhaps dangerous, problem. If these side effects appear, you should consult your doctor immediately. The following discussion should help you determine whether your side effects require attention. OBVIOUS SIDE EFFECTS Some side effects are obvious to the patient; others can be discerned only through laboratory testing. We have divided our discussion according to the body parts affected by the side effects. Ears Although a few drugs may cause loss of hearing if taken in large quantities, hearing loss is uncommon. Drugs that are used to treat problems of the ear may cause dizziness, and many drugs produce tinnitus (a sensation of ringing, buzzing, thumping, or hollowness in the ears). Discuss with your doctor any persistent problem with your hearing or your ears. Eyes Blurred vision is a common side effect of many drugs. Medications such as digoxin may cause you to see a halo around a lighted object (a television screen or a traffic light), and other drugs may cause night blindness. Chlordiazepoxide and clidinium combination makes it difficult to judge distance accurately while driving and also makes the eyes sensitive to sunlight. While the effects on the eyes caused by digoxin are danger signs of toxicity, the effects caused by chlordiazepoxide and clidinium combination are to be expected. In any case, if any eye-related problems occur while you are taking medication, contact your physician. Gastrointestinal System The gastrointestinal system includes the mouth, esophagus, stomach, small and large intestines, and rectum. A side effect that affects the gastrointestinal system can be expected from almost any drug. Many drugs produce dry mouth, mouth sores, difficulty in swallowing, heartburn, nausea, vomiting, diarrhea, constipation, loss of appetite, or abnormal cramping. Other drugs cause bloating and gas, and some cause rectal itching. Diarrhea can be expected after taking many drugs. Diarrhea caused by most drugs is temporary and self-limiting; that is, it should stop within three days. During this time, do not take any diarrhea remedy; drink liquids to replace the fluid you are losing. If the diarrhea lasts more than three days or is accompanied by fever, call your doctor. Diarrhea sometimes signals a problem. For example, some antibiotics can cause severe diarrhea. When diarrhea is severe, the intestine may become ulcerated and begin to bleed. If you have severe diarrhea (diarrhea that lasts for several days, or stools that contain blood, pus, or mucus) while taking antibiotics, contact your doctor. As a side effect of drug use, constipation is less serious and more common than diarrhea. It occurs when a drug slows down the activity of the bowel. Medications such as chlorpromazine and amitriptyline slow bowel activity. Constipation also occurs when drugs cause moisture to be absorbed from the bowel, resulting in a more solid stool. It may also occur if a drug acts on the nervous system to decrease nerve impulses to the intestine--an effect produced, for example, by methyldopa. Constipation produced by a drug can last several days. You may help relieve it by drinking eight to ten glasses of water a day, including more fiber in your diet, and getting plenty of exercise (unless your doctor directs you to do otherwise). Do not take laxatives unless your doctor directs you to do so. If constipation continues for more than three days, call your doctor. Circulatory System Drugs may speed up or slow down the heartbeat. If a drug slows the heartbeat, you may feel drowsy and tired or even dizzy. If a drug accelerates the heartbeat, you probably will experience palpitations (thumping in the chest). You may feel as though your heart is skipping a beat occasionally. For most people, none of these symptoms indicates a serious problem. However, if they occur frequently, consult your doctor, who may adjust your drug dosage or prescribe other medication. Some drugs can cause edema (fluid retention), in which fluid from the blood collects outside the blood vessels. Ordinarily, edema is not a serious condition. But if you are steadily gaining weight or have gained more than three pounds within a week, be sure to talk to your doctor. Drugs may increase or decrease blood pressure. When blood pressure decreases, you may feel drowsy or tired; you may become dizzy, or even faint, especially when you rise suddenly from a sitting or reclining position. If a drug makes you dizzy or light-headed, sit or lie down for a while. To avoid light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising. Push one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Get up slowly, and be careful on stairs. When blood pressure increases, you may feel dizzy, have a headache or blurred vision, hear a ringing or buzzing in your ears, or experience frequent nosebleeds. If these symptoms occur, call your doctor. Nervous System Drugs that act on the nervous system may cause drowsiness or stimulation. If a drug causes drowsiness, you may become dizzy or your coordination may become impaired. If a drug causes stimulation, you may become nervous or have insomnia or tremors. Neither drowsiness nor stimulation is cause for concern for most people. When you are drowsy, however, you should be careful around machinery and should avoid driving. Some drugs cause throbbing headaches, and others produce tingling in the fingers or toes. If these symptoms don't disappear in a few days to a week, call your doctor. Respiratory System Side effects common to the respiratory system include stuffy nose, dry throat, shortness of breath, and slowed breathing. A stuffy nose and dry throat usually disappear several days after starting a medication. If these side effects are bothersome, you may use nose drops (consult your doctor first) or throat lozenges, or you may gargle with warm salt water to relieve them. Shortness of breath is a characteristic side effect of some drugs (for example, propranolol). If shortness of breath occurs frequently, check with your doctor. It may be a sign of a serious side effect, or you may simply be overexercising. Skin Skin reactions include rash, swelling, itching, and sweating. Itching, swelling, and rash frequently indicate a drug allergy. You should NOT continue to take a drug if you develop an allergy to it, but be sure to consult your doctor before you stop taking the drug. Some drugs increase sweating; others decrease it. Drugs that decrease sweating may cause problems during exercise or hot weather when your body needs to sweat to reduce body temperature. If you have a minor skin reaction not diagnosed as an allergy, ask your pharmacist for a soothing cream. Your pharmacist may also suggest that you take frequent baths or dust the sensitive area with a suitable powder. Another type of skin reaction is photosensitivity (also called phototoxicity or sun toxicity)--that is, unusual sensitivity to the sun. Tetracyclines can cause photosensitivity. If, while taking such a drug, you are exposed to the sun for even a brief period of time (10 or 15 minutes), you may experience a severe sunburn. You do not have to stay indoors while taking these drugs, but you should be fully clothed while outside, and you should not remain in the sun too long. Furthermore, you should use a protective sunscreen while in the sun--ask your pharmacist to help you choose one. Since medications may remain in your bloodstream after you stop taking them, you should continue to follow these precautions for two days after treatment with these drugs has been completed. SUBTLE SIDE EFFECTS Some side effects are difficult to detect. You may not notice any symptoms at all, or you may notice only slight ones. Therefore, your doctor may want you to have periodic blood tests or eye examinations to ensure that no subtle damage is occurring while you are on certain medications. Kidneys If one of the side effects of a drug is to reduce the kidneys' ability to remove chemicals and other substances from the blood, these substances begin to accumulate in body tissues. Over a period of time, this accumulation may cause vague symptoms, such as swelling, fluid retention, nausea, headache, or weakness. Obvious symptoms, especially pain, are rare. Liver Drug-induced liver damage may result in fat accumulation within the liver. Since the liver is responsible for converting many drugs and body chemicals into compounds that can be eliminated by other organs of the body (kidneys, lungs, gastrointestinal tract), drug-induced liver damage can result in a buildup of these substances. Because liver damage may be quite advanced before it produces any symptoms, periodic blood tests of liver function are recommended during therapy with certain drugs. Blood A great many drugs affect the blood and the circulatory system but do not produce noticeable symptoms for some time. Some drugs decrease the number of red blood cells--the cells responsible for carrying oxygen and nutrients throughout the body. If you have too few red blood cells, you become anemic; you appear pale and feel tired, weak, dizzy, and perhaps hungry. Other drugs decrease the number of white blood cells--the cells responsible for combating infection. Having too few white blood cells increases susceptibility to infection and may prolong illness. If a sore throat or a fever begins after you start taking a drug and continues for a few days, you may have an infection and too few white blood cells to fight it. Call your doctor. DRUG USE DURING PREGNANCY AND BREAST-FEEDING Before taking ANY medication, it is very important to tell your doctor if you are pregnant (or planning to become pregnant) or are breast-feeding an infant. For most drugs, complete information on safety during pregnancy and while breast-feeding is lacking. This is not due to negligence or lack of concern on the part of regulatory agencies, but to the fact that it would be unethical to conduct drug experiments on pregnant and nursing women. With this in mind, you should discuss with your doctor the risks versus the benefits of taking any medications during pregnancy or while nursing an infant. MANAGEMENT OF SIDE EFFECTS Consult the drug profiles to determine whether the side effects you are experiencing are minor (relatively common and usually not serious) or major (symptoms that you should consult your doctor about). If your side effects are minor, you may be able to compensate for them (see the following table for suggestions). However, consult your doctor if you find minor side effects persistent or particularly bothersome. If you experience any major side effects, contact your doctor immediately. Your dosage may need adjustment, or you may have developed a sensitivity to the drug. Your doctor may want you to switch to an alternative medication to treat your disorder. Never stop taking a prescribed medication unless you first discuss it with your doctor. Common Minor Side Effects ------------------------------------------------------------------------------ Side Effect Management ------------------------------------------------------------------------------ Constipation Increase the amount of fiber in your diet; drink plenty of fluids [*]; exercise [*] Decreased sweating Avoid working or exercising in the sun or under warm conditions Diarrhea Drink lots of water to replace lost fluids; if diarrhea lasts longer than three days, call your doctor Dizziness Avoid operating machinery or driving a car Drowsiness Avoid operating machinery or driving a car Dry mouth Suck on candy or ice chips, or chew sugarless gum Dry nose and throat Use a humidifier or vaporizer Fluid retention (mild) Avoid adding salt to foods; keep legs raised, if possible Headache Remain quiet; take aspirin [*] or acetaminophen [*] Insomnia Take the last dose of the drug earlier in the day [*]; drink a glass of warm milk at bedtime; ask your doctor about an exercise program Itching Take frequent baths or showers, or use wet soaks Nasal congestion If necessary, use nose drops [*] Palpitations (mild) Rest often; avoid tension; do not drink coffee, tea, or cola; stop smoking Upset stomach Take the drug with milk or food [*] ------------------------------------------------------------------------------ * Consult your doctor first ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.