Medication Side Effects and Their Prevention
Many people are concerned about medication side effects. Their concern is warranted since the risk of side effects with many medications is high. In fact, year after year, medication side effects are the #4 leading cause of death in America. More than one million people are hospitalized annually because of reactions to medications.
For more than two decades, Dr. Cohen has been writing books and articles about the side-effect epidemic. He has lectured at the U.S. Food and Drug Administration on strategies for making our medications safer. In his consultations with individuals, Dr. Cohen explains what you and your doctor can do to prevent medication side effects and what to do if side effects occur.
A Safer Approach
Dr. Cohen has a different perspective on side effects than other doctors. Dr. Cohen believes that doctors are not adequately trained to treat people as individuals. Too often, doctors prescribe the same strong medication doses to a 105?pound woman, a 90 year?old, 90-pound, great?grandmother taking 15 other drugs, a skinny 12 year?old ?? and a 300?pound football player. You don't have to be an expert to realize that such methods do not make sense.
Unfortunately, doctors employ these same one-size-fits-all methods with statin cholesterol-lowering drugs, drugs for high blood pressure, anti-inflammatory drugs (NSAIDs), hormones, gastrointestinal medications, antidepressants, sleep remedies, migraine drugs, and more.
In contrast, Dr. Cohen advises a flexible, individualized method that often begins with very low doses of medication. He selects therapies and doses based on each person's individual characteristics: age, gender, size, state of health, use of other medications, history of previous problems with medications, family medication history, and other factors. When handled with an emphasis on safety, medication treatment (or natural therapies) can make a big difference in your quality of life.
People with normal tolerances to medications can also run into side effects. This often occurs when a medication dosage needs to be increased. For example, you may be taking 40 mg per day of Lipitor (for elevated cholesterol), and your doctor may want to increase the dosage to 80 mg. This is a big increase, a 100 percent jump. Many people have difficulty when drug doses are increased in 100 percent gradations. Yet, this is common practice in mainstream medicine. People get side effects and many of them discontinue treatment. This is unfortunate, because better, safer methods can prevent these problems and allow you to reach your treatment goal.
Are You Sensitive to Medications?
Approximately 10 percent of adults, that is 20 million Americans, are medication sensitive. These individuals are sensitive to just about every medication they receive. As one pharmacist said: "You run into patients all of the time who don't tolerate standard drug doses."
If you are medication?sensitive, you may also be sensitive to many types of chemicals. For one woman, coffee causes a painful flaring of the cystic disease of her breasts. One doctor gets depressed whenever he takes one Motrin tablet. A woman is sedated by Claritin (which is supposedly nonsedating, but actually sedates 1 in 12 people). Many medication-sensitive individuals cannot handle alcohol.
Medication?sensitive individuals often think they are the only ones who are intolerant of medications. Yet they have plenty of company.
The majority of medication?sensitive individuals are women. Sometimes, medication sensitivities runs among the women of a family. According to a specialist in women's medicine, "If their mothers are sensitive to a drug, many of my female patients are sensitive, too."
Medication sensitivities are frequently seen in older people. A highly experienced pharmacist noted, "As people age, nearly all of them become medication?sensitive."
Doctors and Side Effects
Some doctors are very helpful when patients develop side effects to medications, but other doctors are not. Part of the problem is that the majority of doctors were not adequately trained about identifying side effects and working with patients.
Attitude can also be a problem. Some doctors believe medication?sensitive individuals are hypochondriacs. Doctors often ignore or dismiss patients' complaints. Dr. Cohen teaches patients how to discuss their medication reactions with their doctors, so that they will get proper treatment. Some patients ask Dr. Cohen to speak with their doctors, which can be very helpful.
One medication?sensitive woman told Dr. Cohen, "I react to everything. I don't know what will happen when I really need treatment."
Her concern is warranted. When patients develop side effects, they are often switched from drug to drug. The drugs are prescribed at strong, standard doses. The result is a series of unpleasant reactions. A letter published in the Peoples' Pharmacy column illustrates the problem.
We visited my mother over the holidays, and she just isn't her old self. I'm convinced the problem is her medicine. She has been on Prozac, Paxil, Effexor, Zoloft, and Celexa. She has suffered from anxiety and restlessness, insomnia, dry mouth, and nausea. Her doctor is ready to give up. She is currently taking Remeron, but she is tired and dizzy all of the time. She also has gained weight.
All of these medications can cause a host of side effects when not prescribed properly. Treatment must be individualized. The dose must be matched to the patient's tolerance. Clearly, this woman's doctor did not do so.
Another problem is multi-pharmacy. Many people, especially seniors, take five or ten or more medications every day, yet doctors and pharmacists often do not act to avoid dangerous drug interactions. The risk of serious side effects increases with the number of drugs you take. Computer technology allows Dr. Cohen to check for potential drug interactions, but he is dismayed about how few doctors actually do so with their patients.
Dr. Cohen's Guiding Principle
The highest ethic of the medical profession is: Do No Harm. For Dr. Cohen, preventing side effects is a top priority. Dr. Cohen's first principle of safe medication treatment is:
The best dose of any medication is the least amount that works.
Careful assessment of each person, condition, the treatment choices, and possible multi-drug interactions, allows Dr. Cohen to provide information and direction for any person encountering medication side effects or seeking to prevent them.
Newsweek. One-Size-Fits-All Medications Do Not Fit All: Doctors and Patients Need to look beyond cookbook guidelines from the drug industry. Dec. 6, 1999, page 92.
Life Extension Magazine. Medication Side Effects: Why They Occur and How You Can Prevent Them. March 2003;9(3):46-68.
Bottom Line Health and Bottom Line Personal Newsletters. Multiple articles and interviews on preventing medication side effects. 2002 through present.
Special from Bottom Line's Daily Health News. Four More Drugs with Serious Health Risks. February 28, 2005.
Life Extension Magazine. Tylenol: More Risky Than You Realize.
JAMWA (The Journal of the American Medical Women's Association). Do Standard Doses of Frequently Prescribed Drugs Cause Preventable Adverse Effects in Women? 2002;57:105-110. The first in-depth article to examine why women sustain more side effects than men.
Medscape. Preventing Adverse Drug Reactions Before They Occur. Expert Pharmacology Column. Dec. 1999: www.Medscape.com.
Postgraduate Medicine. Ways To Minimize Adverse Drug Reactions: Individualized Doses and Common Sense Are Key. Sept. 1999;106:163-72.
NOTE TO READERS: The purpose of this E-Letter is solely informational and educational. The information herein should not be considered to be a substitute for the direct medical advice of your doctor, nor is it meant to encourage the diagnosis or treatment of any illness, disease, or other medical problem by laypersons. If you are under a physician's care for any condition, he or she can advise you whether the information in this E-Letter is suitable for you. Readers should not make any changes in drugs, doses, or any other aspects of their medical treatment unless specifically directed to do so by their own doctors.
If you have questions about your medications or medical care, Dr. Cohen is available for consultation at his office or by telephone.
If you find this article informative, please tell your friends, family members, colleagues, and doctors about www.MedicationSense.com and the free MedicationSense E-Newsletter.