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Risks of side-effects increase when you take more than one drug. They also increase when you have more than one medical condition and when you are older.
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The results can be serious. Drug side-effects are the No. 1 reason people stop their medication. They also account for three to seven per cent of all hospital admissions.
Understanding side-effects will help you avoid or cope with them and, consequently, it will help you increase your medication s effectiveness.
Drug side-effects are classified as adverse drug reactions (or ADRs) and include any undesired effects that occur during drug treatment. ADRs are unintended and most often harmful, even toxic. Usually dose related, ADRs occur more often at higher doses, but can be triggered even with low doses.
Side-effects are the most common ADRs and are defined as predictable, dose-related effects occurring within a therapeutic dosage range. Such side-effects are not desirable. For example, you may want to take something to stop the sneezing of your hay fever, but you don t want the drowsiness induced by antihistamines to make you fall asleep at work.
Sometimes, it turns out, you can take advantage of side-effects. Using the above example, for instance, when sneezing keeps you awake at night, the drowsiness side-effects of antihistamines may help you sleep.
Another type of ADR is drug overdose, but this isn t the overdose associated with accidental poisoning or intentional overdose. This ADR is the overdose that occurs within a drug s normal therapeutic dosage range.
The reasons for this kind of overdose range from poorly functioning kidneys or liver to a genetic tendency, or even the specific drug combination. Drugs such as the heart medication digitalis that have a narrow therapeutic index that is, drugs where there is a small difference between a toxic and therapeutic dose are especially prone to this type of ADR.
Drug allergies are also considered ADRs. These may not be dose related, meaning they may occur regardless of the drug dose. Drug allergies range from skin irritation and rashes to anaphylaxis with swelling of the throat and difficulty breathing. With repeated exposure, the allergy may become more severe. If you have a drug allergy, make sure that you wear a medical alert bracelet and that all your health-care professionals know you have the allergy, including dentists, physiotherapists and pharmacists.
Idiosyncratic ADRs occur for no obvious reason and are the most difficult to manage.
Remember, all drugs have a potential for ADRs, and you want to know first how common they are, and then what to do if they occur. Your starting place usually is the information sheets that your pharmacist supplies. Don t toss the pages, read them and ask for an explanation if you don t understand some sections.
Sometimes coping with ADRs is straightforward. Oral liquids, tablets and capsules are swallowed, and it follows that they have the potential to cause gastrointestinal symptoms such as upset stomach, nausea, vomiting and diarrhea. Taking the drug with food is often recommended to manage stomach irritation. Sometimes, however, the symptoms may be more serious. For example, non-steroidal anti-inflammatory pain relievers can cause irritation, but they also may produce gastrointestinal bleeding.
Drugs, such as patches and creams that are applied to the skin, can cause skin irritation. Changing the application site can avoid irritation with patches, but if you have an adhesive tape allergy you may need to use another type of patch or even avoid patches completely. With creams sometimes it s difficult to tell the difference between the original skin problem and the irritation. However, avoiding broken skin areas and not covering the applied cream with a dressing will reduce the risk.
When drugs have been used for longer periods of time, ADRs become well known and more easily managed, but newer drugs don t have the same type of history and unexpected ADRs can occur. If you do experience an ADR, it s a great idea to report it to Health Canada and by reporting it, you will be contributing to the information about the drug. Health Canada s reporting program is MedEffects and you can complete the form online at www.hc-sc.gc.ca.
If you experience an ADR, don t just stop your medication. There may be a better-tolerated drug, another effective dose, or maybe with time the symptoms will diminish. Don t give up. Instead, ask about your symptoms.
Marie Berry is a lawyer/pharmacist interested in health care and education.
