Do you know the most common and the most serious side effects of all the medicine you are taking? Was the information presented in a way you could actually understand what symptoms to look out for? What about delayed reactions? Most people can recognize things like diarrhea or headache, if they happen within a few days. How can you avoid drug side effects that take weeks, months or years to develop?
Here’s a Quiz: Will You Pass or Fail?
The Most Prescribed Drugs in the World:
If you are taking one of more of these medicines do you know the top five side effects associated with your drug(s)? We have provided links to each one of those medicines so you can see whether you passed or failed our pop quiz. Just click on the name of your medicine to find out about potential adverse reactions.
Has Your Doctor Helped You Avoid Drug Side Effects?
You can’t have surgery without signing forms, especially something called “informed consent.” When you sign your name to that document, you are agreeing that your doctor has told you what you need to know about your condition, the proposed treatment and its known benefits and risks.
What about when your doctor prescribes a medication? You don’t usually have to sign a formal document to accept a prescription. All the same, your doctor is supposed to tell you what is wrong, how the drug will help and what potential adverse reactions you might encounter. By being informed in advance, you may be better able to avoid drug side effects.
The JAMA Mandate from 50 Years Ago:
Decades ago, an editorial in JAMA (Jan. 26, 1970) urged colleagues:
“When a physician prescribes a drug, he has an obligation to warn the patient about the drug’s potential for causing adverse reactions, especially the more serious ones. For example, the possibility of drowsiness resulting from an antihistamine can be serious for an automobile driver. He should be instructed to refrain from driving until, by personal observation, he notes whether the drug will have that effect on him. If it does, adjustment of dosage or of time of driving will solve the problem.”
Can You Tell If You Are Impaired?
Actually, most people are very poor judges of how their medicine is affecting their reflexes or driving skill. There are literally scores of drugs that can impair road performance (Annals of Pharmacotherapy, April, 2014).
They include antihistamines, anticholinergic drugs (see this list of dozens of such medications), anti-anxiety agents, antidepressants, sleeping pills, pain relievers, muscle relaxants and anticonvulsants.
But we digress. The main point of the JAMA editorial is as valid today as it was 50 years ago. For patients to be able to avoid drug side effects, they must be fully informed.
Delayed Adverse Drug Reactions:
As we stated at the top of this article, most people are pretty good at detecting side effects if they occur within a few days of starting a medicine. But what about delayed reactions? That is far more challenging for both patients and physicians.
One of the most challenging adverse drug reactions we have encountered is angioedema. Typically, it can happen around the mouth and throat. The lips, tongue, eyes, eyelids, cheeks or throat can swell. In extreme situations the reaction can make it hard to breathe.
ACE inhibitors like captopril, enalapril or lisinopril can trigger this reaction. These drugs are prescribed for hypertension.
Dan had just such a delayed reaction. He wasn’t warned what to watch out for so he could avoid drug side effects.
“I had my first episode of angiodema about 5 months after starting lisinopril. My upper lip swelled up over the course of an hour or so and slowly shrank down to normal over the next 24 hours. I had no idea what was happening, and neither did my sister who is an RN. I talked to my provider, a Physician’s Assistant who prescribed lisinopril in the first place. She didn’t make the connection either and sent me for an allergy blood test, which came up negative.
“After a couple more bouts, another provider in the office recognized the connection to the drug and switched me to another, but in the same class. Up to this point the attacks were unpleasant but not life-threatening. In a few days I was in the ER getting IV Benadryl and some others I don’t remember because my tongue was swelling at the back of my throat.”
Dan is lucky to have survived.
A pharmacist reports a really delayed reaction to lisinopril:
“I am a pharmacist and experienced angioedema after taking the drug for over 15 years. Fortunately, I was not on an extended flight or far away from medical care. By the time I got to the ER I was unable to talk and was having difficulty breathing. I say Black-Box the damn drug, and require the warning in large type on every label. A warning should be given verbally on each refill.”
An even more challenging condition is angioedema of the abdomen. This occurs when the tissues of the abdomen start to swell because of a delayed drug reaction. Doctors often have a hard time diagnosing this problem.
L.B. shared this delayed reaction:
“I went to the ER and they told me my abdominal pain was gas.. The third time I passed out and the ambulance had to take me to the hospital. Finally I had a CT scan. The radiologist said to take me off lisinopril because it causes intestinal swelling. From my CT scan you could see the intestinal swelling. They thought it was Crohn’s disease.”
We hope these stories will help you avoid drug side effects by being well informed. Always ask if there can be a sneaky delayed adverse reaction when you learn about symptoms to be alert for.
Financial Side Effects
It’s not just drug side effects. There is also financial harm. A perspective published in The New England Journal of Medicine (March 19, 2020) is titled:
“The Dishonesty of Informed Consent Rituals”
Dr. Matt Bivens is an emergency physician at Beth Israel Deaconess Medical Center and Harvard Medical School.
He chastises his medical colleagues for prescribing combination medications that cost far more than the patient can afford. In the essay, he describes an interaction with a patient with extremely high blood pressure (around 200/100).
Another doctor had prescribed Hyzaar DS, but she hadn’t filled it when she found that it would cost her more than $1000 a year. By prescribing the two components of the drug separately and searching for coupons, Dr. Bivens was able to get the price down to about $6 a month. The patient was indignant that the first physician had not told her about the less expensive option.
“we still routinely prescribe combined medications that we must know by now will cost patients 10 times as much as the separate components. And when patients ask, ‘What will this cost?,’ we shrug helplessly. This happens every day throughout the country — doctors mocking the very idea of informed consent, as we inflict avoidable and potentially catastrophic financial harms. It gives the lie to our sworn pledge to do no harm.”
Doctors spend less time with each patient than they did 50 years ago. But the drugs have become more complex. If you watch TV, you know that the list of side effects for certain medications may include heart attacks, cancer and death.
It’s almost impossible to evaluate the benefits and risks of drugs based on this type of information. That’s especially true when it’s presented quickly with distracting visual images. We doubt these messages are designed to help people avoid drug side effects.
That’s why your doctor must take time to review potential side effects of your medicine as well as the cost. We provide a checklist for your physician to fill out in our book, Top Screwups Doctors Make and How to Avoid Them. It is available in our bookstore.