Most side effects of medications are simply part of the risk-benefit decision of using the drug. A usually small percentage of individuals using any medication will have one or more of the drug’s side effects. In some situations there are side effects that can be avoided in various ways. Here are 10 of these that you can now avoid:
- Pill Esophagitis: When you take a pill or capsule be sure to drink it with enough water that it is washed completely into the stomach. Some medications especially are very caustic to the esophageal lining, and cause an ulceration of the esophagus if they dissolve prior to getting to the stomach. This is very painful and completely avoidable. The tetracyclines like doxycycline and the bisphosphonates like Fosamax or Actonel are among the worst causes of pill esophagitis.
- Acute Urinary Retention from decongestants: If you have BPH, or even minor symptoms of slower urine stream as you age men, avoid pseudoephedrine (Sudafed) and similar decongestants. Any minor benefit from nasal congestion is not worth it if you end up at the ER getting a urinary catheter placed. Other drugs can also cause this problem, but Sudafed is the one I see most often.
- Allergic Reaction from Neosporin: Just yesterday I was reminded how miserable the contact dermatitis from Neosporin can be when a young woman came in looking like she had poison ivy all over her face. She didn’t. She had used Neosporin for a minor scratch. Neosporin allergy is far more common than allergy to Bacitracin, an equally effective topical antibiotic. Just don’t use Neosporin.
- Rhinitis Medicamentosa: A medical jargon name for addiction to vasoconstrictor nose sprays. Afrin is the best known brand, but every pharmacy and grocery store has a store brand of these nose sprays. They are tempting to use because they do give short term relief of nasal congestion. The hard-and-fast rule is only use them for 3 days. Longer makes you at risk for rebound congestion and being highly addicted to their use. If you stop after longer term use your nose feels like it is blocked with concrete. Read the fine print. 3 days only no matter how much relief they give you.
- Opioid induced constipation: Maybe avoid is too strong a promise here, but you can reduce this nearly universal side effect of opioid pain meds. See my prior post on this subject
- SSRI withdrawal syndrome: Stopping the SSRI and SNRI antidepressants suddenly often leads to a discontinuation syndrome that ranges from mild dizziness to being very disconcerting. Most patients do better to taper off these drugs. Discuss the details with your doctor for details that depend on which med you are using. See — for more info.
- Rebound Hyperacidity from Proton Pump Inhibitors: The PPI class of meds for reducing stomach acid including Prilosec (omeprazole), Prevacid, Aciphex, Nexium, and others are incredibly effective at reducing or eliminating symptoms of heartburn or acid dyspepsia. They are also well documented to cause an increase of stomach acid production when they are stopped after use for as little as 2 months. These drugs play an important role in treatment of stomach acid related problems, but if you have mild to moderate heartburn or dyspepsia consider use of the less potent but still quite effective H2 Receptor blockers like Zantac (ranitidine) or Pepcid (famotidine) instead of a PPI for daily use. If you need to use a PPI see if you can use short intermittent courses instead of longer daily regimens. If you have Barrett’s esophagus, serious ulcers, etc discuss treatment with your doctor. Long term PPI use is sometimes appropriate.
- Serious Drug Interactions: Many drugs can cause major problems when combined with various other drugs. Many OTC and supplements are also well known to cause drug interactions. When you get a prescription from your doctor make sure they know of your drug allergies, all the drugs and supplements you use, and also ask your pharmacist as a second check. If you start a supplement check for drug interactions with any medications you are using. Carry a current medication list when you see doctors.
- Don’t Borrow Drugs: It seems like many otherwise bright and informed patients come to the office after using prescription drugs from family, friends or left over from prior treatments of themselves for treatment of their symptoms. In general this is risky behavior, and you risk drug interactions, side effects, and can make diagnosis and management of your condition much more complex. If you feel tempted to experiment with borrowed or left over drugs, just say no.
- Drugs and Alcohol: Many medications are fine to use with a drink or two, but many others are not. In general any drugs for anxiety, pain, sleep, depression or allergies may have additive sedation, uncoordination and toxicity when used with alcohol. It’s best to avoid medication and alcohol unless you ask your physician or pharmacist if it is safe.
I’d love to hear your comments on drug side effects you have noted and ways you think you could have avoided them. Leave a comment and add to this discussion.