Archive for December 2018

Those Dreaded Side Effects

“So, it seems like the prednisone cleared up your allergic rash pretty well.  Did you have any side effects from it?”

My thirtyish female patient looked at me with a little smile and responded, “Does the term, ‘Psycho Chick’ mean anything to you? I stuck with it because it was clearing up my rash and itching so nicely.  But I was moody, couldn’t sleep, and was biting everybody’s head off.  My husband couldn’t wait for me to be done with it.”

On the other hand, in answer to the same question about side effects for the same medicine I’ve gotten the answer, “I love that stuff.  I had tons of energy, all my joints felt better and my mood was great.  My house is spotless.  I just wish I could stay on it.”

It never ceases to amaze me how differently people respond to the same medicine.  There are those who never seem to have a negative reaction to anything.  Then there are some who have reacted to 20 or 30 different med.  These are the patients where we are trying to find one antibiotic they still can tolerate, or the one blood pressure medicine that doesn’t make them feel badly.

And what about the endless list of dire reactions mentioned in television advertisements for certain medicines? The announcer rattles off possible side effects that seem to include everything from liver failure to growing a second head and usually ending with “death”.  You think to yourself, “Why in the world would anyone even think about taking that medicine if it can do all that?”

So how do we take a reasonable approach when sifting possible side effects and deciding whether or not to take a medicine or not?  First of all, realize that the rapidly-listed side effects on t.v., or the long list on the package insert serve more as legal statements than helpful medical information.  They want to mention every possible problem anyone could encounter with this medicine, whether it is at all likely or not.  Most of us are aware that if they ever did the same for something like aspirin and gave it some other name we didn’t recognize, few would take it.

The key is always to compare the likelihood and severity of the possible side effects with the likely benefit of the medicine.  For example, statin cholesterol medicines can bump the liver enzymes in about 1 out of every 100 patients taking them.  Varying quoted frequencies for muscle aches can range up to 10% or more.  However both of these side effects are easy to identify and generally clear quickly when the med is stopped.  On the other side of the coin, for a person at substantial risk for heart attack or stroke, studies show that statins can substantially lower the likelihood of these two devastating events and extend one’s lifespan considerably.

So, for the right person, the benefits far outweigh the possible side effects.  Yet occasionally someone who could clearly benefit from treatment states something to the effect of, “Statins?  Those things blow out your liver don’t they?”  And so a more informed discussion is needed.  Hopefully you can get a fair amount of feedback on these kinds of questions from your doctor as well.

Side effects of medicines can run the gamut from trivial to severe to even desirable (such as anti-depressants that help with sleep or certain diabetes medicines that usually result in weight loss).  It can be pretty complicated sorting through it all.  So, sit down with your doc when needed and weigh the pros and cons – it’s worth some thought before you either reject a very helpful medicine on the one hand, or take one where the cure might be worse than the disease.

Andrew Smith, MD is board-certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835