Sep 29, 2009

Take The Bitter Pill? (Drug Side Effects)

From a reader:

"I am so tired of taking medications that seem to cause more problems than my diagnosed disease."
This is one of the trickiest problems in doctoring: all medicines have side effects. Doctors treat diseases, but we unintentionally cause a lot of suffering with our treatments.

Some medicines cause frequent side effects. Some medicines cause them only occasionally. Some patients very rarely get side effects. Some people seem to get a side effect from everything they take. Any one person's reaction to any one medicine is impossible to predict. It gets pretty complicated.

It's important to understand that having a side effect doesn't mean it was a "bad medicine." It may work great for lots of other people. You should also realize that a bad side effect doesn't necessarily mean you had an incompetent doctor. Doctor D can't count how many patients have told him, "I'm never going back to Dr. SoAndSo, because he gave me a prescription for a poison. It made me feel terrible." (Patients have probably said this about Doctor D too.) The doctor who diagnosed you and gave the medicine is often in the best position to help you approach the problem of side effects.

In the end, only you can decide if it is worth taking any particular medicine, but your doctor can help you understand the pros and cons of any medicine or treatment.

A few common situations involving medicines:
  • Dangerous Disease, Few Symptoms: Some diseases like Hypertension cause almost no symptoms until it is too late. Lots of people stop blood pressure medicine for mild side effects just because they just cannot feel the pressure destroying their arteries. Low-symptom diseases like Hypertension, Type II Diabetes, and High Cholesterol kill millions even though we have lots of great medicines. People have a hard time taking medicine when they don't feel sick. If you have medicine side effects with one of the "silent killers" you really need to talk to your doctor about switching medicines. Going without any treatment is a bad idea.
  • Benign Disease, Miserable Symptoms: A lot of conditions from the Common Cold to Fibromyalgia never kill anyone, but they can make you feel horrible. The symptoms are the disease and therefore if you can handle the disease better than the medicine the choice is obvious. Just be sure your doctor agrees you have a benign condition before making this decision.
  • Bad Disease, Bad Medicine: This is always a difficult place to be. A horrible disease that is treated with medicines that make most people miserable. Many cancers fall into this category. Your doctor can help you understand the probable risks of the disease as well as the expected side effects of the medicine, but remember the decision is yours.
  • Mixed Diseases: Some diseases cause some difficult symptoms now and often vary in the amount of long-term damage they cause. Rheumatoid Arthritis is an example of such a condition. Treatments are aimed at current symptoms, at long-term damage, or both. Decisions about medicines in such conditions are never as clear cut as the other diseases. If you have trouble tolerating a medicine, you should ask your doctor if stopping it would have any long-term ramifications.
All these decisions belong to you, but doctors are useful for educating you. If a medicine makes you miserable ask you doctor, ""I'd love to stop this med because of side effects, what might I risk by doing this? Are there other medicines that I could try?"
Have you ever quit a treatment that was working because of side effects? Was your doctor helpful in your decision-making process? Doctor D would love to hear your stories.


Amanda said...

This is so hard and why I'm learning to stay in contact with my doctor after starting a new medicine. Sometimes you don't even realize that why you're feeling miserable is related to the medication and adjustments can be made.

Thanks for the info!

tottergirl said...

I no longer take ACE inhibitors for my hypertension (they work wonderfully) because they cause me to cough constantly. Also, in our search for another drug to use, I had to stop with the ARD we tried because it made it very hard to think. I could barely function.

Now I am on a beta blocker and take it at night before bed, because it causes me to be very sleepy for the first several hours. When I take it in the morning, I can barely function at work and morning is usually my best time. Besides which, I work an early shift.

It is about what you can or cannot live with and how to manage any side effects you still have.

The Good Cook said...

I have high cholesterol and cannot tolerate any of the drugs available. I just can't. They all make me sick within a few weeks of taking them. Was just at my cardiologists yesterday and we discussed yet another drug. (Niaspan) I said no. I'm sticking to Red Yeast Rice, Lovaza, low fat, low cholesterol diet and that's the way it is. I'm only 50 and a bit afraid of the consequences but I just can't tolerate the side effects.

Anonymous said...

Dr D - Can I encourage your patients to ask their pharmacists any & all questions about their medications? As a pharmacist, I can often clarify what is a side effect or an expected effect, how long a side effect might last, when to contact the physician & give monthly, weekly & daily (for tobacco cessation) support when needed.

We're a resource thats always available & will alay your fears, but get you back to the Dr ASAP if needed.

Doctor D said...

Thanks to everyone for the stories.

Cook -Yes Cholesterol is the only one of the "silent killers" where I have totally run out of medicine options because some people just cannot tolerate any. Diet and exercise is important for everyone, but even more so for people in your shoes.

Anonymous -Thanks for the great reminder! It's true that pharmacists are an excellent option for learning about drug side-effects. They probably know more about it than most MD's since they are focused solely on medicines.


I have learned different techniques over the years to remedy side effects from my daily drugs.

Cyclazine/marzine/nausicalm an anti emetic (anti nausea) tablet.

I learned with this when had I.V it causes some pretty devastating side effects. Hives after injection, intense burning while being injected, Increased nausea, dizziness etc, sometimes tachycardia. However I have stuck with this med for many years now.

I have learned to do relaxation techniques after it being administered to offset said side effects. To lie very still until waves of nausea settle and as soon as possible (within an hour) have something sugary or eat carbs as it seems to cause my blood sugars to crash a bit which worsens nausea. The same goes for oral tabs however the side effects are much less and more tolerable.

With the tablet for my diarrhoea and stomach cramps(12 hourly 1-2 tabs), I take the tablet 1 hour before food, you can take up to two of these slow release meds however I found that if I do that and the pain abates side effects (itching, burning skin, increased nausea, drowsiness) kicks in, so I take a much lower dose of the same type of opiate based medicine which is shorter acting, so if the pain goes I'm not left with side effects.This is the only medication I take daily. The anti nausea is for when needed.

Antibiotics gah. To take those I'm practically living off antifungals for all areas. Now I start them as soon as my course of A.Bs starts. Probiotics really helped with all of that but they are too expensive to use on a regular basis. I always take an anti emetic an hour before taking hem to avoid throwing up.

have I ever wanted to stop meds due to side effects? yes many times, but I will always call the practice nurse, speak to a pharmacist or my Dr.
Side effects or intolerances are hard and even harder if you have to take a drug for a disease that doesn't usually affect you.
I spent a year on antihypertensives, got fat, felt sluggish, dry mouth, nasty stuff, was glad when I could stop them :)

I have never changed a Dr because of meds etc. But I have changed surgeon because of their mismanagement and abusive conduct.

WarmSocks said...

New dr prescribed tramadol 100mg qid, said it would be most effective if taken regularly. When I took the first dose the room started spinning, then I started vomitting. I thought I was going to die. Maybe it worked (I slept like a rock that night; didn't wake up in pain), but I never took another dose. The doctor was not at all helpful; neither he nor his nurse would return my phone call.

Helen said...

When I tried sulfasalazine, admittedly not for very long, I felt like I'd been hit with a brick. I fell asleep on the floor at one point while I was putting my shoes on. I've been fortunate to experience very minimal side effects with other drugs including methotrexate and Enbrel.

My BP meds made me very nauseous at first, but I did stick with them and now, aside from occasional diziness when I stand up, I tolerate them well. I guess there are some side effects that I'm more willing to "tough out" than others.

Nurse K said...

Remember, everyone, to list all slight deviations from normal experienced greater than 0 times (eg. cough, funny taste in mouth) after taking a pill as an "allergy".

Just kidding, please don't do that.

Anonymous said...

hey, ya! I was given sertraline. for strange Kinds of depression attacks I face....

Sertraline and most of antidepressant medications have unpleasant side effects on me. LIke anxiety and insomnia. I was young then to understand this, niether did my doc tell me this.
The very first day i took it, I couldn't sleep whole night and felt weird and miserable. I quit the medicine.
I tend to suffer side effects with most of medicine actually. so it's rather tricky.

Perhaps could have taken sertraline with alprazolam for few days and then discontinued it?

I still suffer occaisional attacks of depression that lasts for 6-7 days at a time. it pretty much ruins my work. I mean I am a medical student. and though I have been able to manage things, things get pretty bad when my depression attacks happen during exam times. it sucks when you can't revise what you have studied through the year, and end up performing not so well.

and anti-depressants make me feel horrible.
have tried many SSRIs....

BTW, love your blog :)

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