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$Title{Coping with Side Effects}
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Side Effects Table*0180301.tab}

Copyright (C) 1991 Publications International, Ltd.


Coping with Side Effects
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     Drugs have certain desirable effects--that's why they are taken.  The
desirable effects of a drug are known as the drug's activity or therapeutic
effects.  Drugs, however, have undesirable effects as well.  Undesirable
effects are called side effects, adverse reactions, or, in some cases, lethal
effects.  An adverse reaction is any undesirable effect of a drug.  It can
range from minor to toxic or lethal.
     Even if you experience minor side effects, it is very important that you
take your medication exactly as it was prescribed.  You should take the full
dose at the appropriate times throughout the day for the length of time
prescribed by your doctor.  Taking a lesser amount of medication to avoid side
effects or because your condition appears to be improving is NOT appropriate.
A smaller dose may not provide any benefit whatsoever; that is, half of the
dose may not provide half of the therapeutic effects.
   Some side effects are expected and unavoidable, but others may
surprise the doctor as well as the patient.  Unexpected reactions
may be due to a person's individual response to the drug.
     Side effects generally fall into one of two major groups--those that are
obvious and those that cannot be detected without laboratory testing.
Discussion between you and your doctor about your medication should not be
restricted to easily recognized side effects; other, less obvious side effects
may also be harmful.
     If you know a particular side effect is expected from a particular drug,
you can relax a little.  Most expected side effects are temporary and need not
cause alarm.  You'll merely experience discomfort or inconvenience for a short
time.  For example, you may become drowsy after taking an antihistamine or
develop a stuffy nose after taking reserpine or certain other drugs that lower
blood pressure.  Of course, if you find minor side effects especially
bothersome, you should discuss them with your doctor, who may be able to
prescribe another drug or at least assure you that the benefits of the drug
far outweigh its side effects.  Sometimes, side effects can be minimized or
eliminated by changing your dosage schedule or taking the drug with meals.  Be
sure, however, to consult your doctor or pharmacist before making such a
change.
     Many side effects, however, signal a serious, perhaps dangerous, problem.
If these side effects appear, you should consult your doctor immediately.  The
following discussion should help you determine whether your side effects
require attention from your physician.

OBVIOUS SIDE EFFECTS

     Some side effects are obvious to the patient; others can be discerned
only through laboratory testing.  We have divided our discussion according to
the body parts affected by the side effects.

     Ears

     Although a few drugs may cause loss of hearing if taken in large
quantities, hearing loss is uncommon.  Drugs that are used to treat problems
of the ear may cause dizziness, and many drugs produce tinnitus (a sensation
of ringing, buzzing, thumping, or hollowness in the ears).  Discuss with your
doctor any persistent problem with your hearing or your ears.

     Eyes

     Blurred vision is a common side effect of many drugs.  Medications such
as digoxin may cause you to see a halo around a lighted object (a television
screen or a traffic light), and other drugs may cause night blindness.
Chlordiazepoxide and clidinium combination makes it difficult to judge
distance accurately while driving and also makes the eyes sensitive to
sunlight.  While the effects on the eyes caused by digoxin are danger signs of
toxicity, the effects caused by chlordiazepoxide and clidinium combination are
to be expected.  In any case, if any eye-related problems occur while you are
taking medication, contact your physician.

     Gastrointestinal System

     The gastrointestinal system includes the mouth, esophagus, stomach, small
and large intestines, and rectum.  A side effect that affects the
gastrointestinal system can be expected from almost any drug.  Many drugs
produce dry mouth, mouth sores, difficulty in swallowing, heartburn, nausea,
vomiting, diarrhea, constipation, loss of appetite, or abnormal cramping.
Other drugs cause bloating and gas, and some cause rectal itching.
     Diarrhea can be expected after taking many drugs.  Diarrhea caused by
most drugs is temporary and self-limiting; that is, it should stop within
three days.  During this time, do not take any diarrhea remedy; drink liquids
to replace the fluid you are losing.  If the diarrhea lasts more than three
days or is accompanied by fever, call your doctor.
     Diarrhea sometimes signals a problem.  For example, some antibiotics can
cause severe diarrhea.  When diarrhea is severe, the intestine may become
ulcerated and begin to bleed.  If you have severe diarrhea (diarrhea that
lasts for several days, or stools that contain blood, pus, or mucus) while
taking antibiotics, contact your doctor.
     As a side effect of drug use, constipation is less serious and more
common than diarrhea.  It occurs when a drug slows down the activity of the
bowel.  Medications such as chlorpromazine and amitriptyline slow bowel
activity.  Constipation also occurs when drugs cause moisture to be absorbed
from the bowel, resulting in a more solid stool.  It may also occur if a drug
acts on the nervous system to decrease nerve impulses to the intestine--an
effect produced, for example, by methyldopa.  Constipation produced by a drug
can last several days.  You may help relieve it by drinking eight to ten
glasses of water a day, including more fiber in your diet, and getting plenty
of exercise (unless your doctor directs you to do otherwise).  Do not take
laxatives unless your doctor directs you to do so.  If constipation continues
for more than three days, call your doctor.

     Circulatory System

     Drugs may speed up or slow down the heartbeat.  If a drug slows the
heartbeat, you may feel drowsy and tired or even dizzy.  If a drug accelerates
the heartbeat, you probably will experience palpitations (thumping in the
chest).  You may feel as though your heart is skipping a beat occasionally.
For most people, none of these symptoms indicates a serious problem.  However,
if they occur frequently, consult your doctor, who may adjust your drug dosage
or prescribe other medication.
     Some drugs cause edema (fluid retention)--fluid from the blood collects
outside the blood vessels.  Ordinarily, edema is not serious.  But if you are
steadily gaining weight or have gained more than three pounds within a week,
talk to your doctor.
     Drugs may increase or decrease blood pressure.  When blood pressure
decreases, you may feel drowsy or tired; you may become dizzy, or even faint,
especially when you rise suddenly from a sitting or reclining position.  If a
drug makes you dizzy or light-headed, sit or lie down for a while.  To avoid
light-headedness when you stand, contract and relax the muscles of your legs
for a few moments before rising.  Push one foot against the floor while
raising the other foot slightly, alternating feet so that you are "pumping"
your legs in a pedaling motion.  Get up slowly, and be especially careful on
stairs.  When blood pressure increases, you may feel dizzy, have a headache or
blurred vision, hear a ringing or buzzing in your ears, or experience frequent
nosebleeds.  If these symptoms occur, call your doctor.

     Nervous System

     Drugs that act on the nervous system may cause drowsiness or stimulation.
If a drug causes drowsiness, you may become dizzy or your coordination may
become impaired.  If a drug causes stimulation, you may become nervous or have
insomnia or tremors.  Neither drowsiness nor stimulation is cause for concern
for most people.  When you are drowsy, however, you should be careful around
machinery and should avoid driving.  Some drugs cause throbbing headaches, and
others produce tingling in the fingers or toes.  If these symptoms don't
disappear in a few days to a week, call your doctor.

     Respiratory System

     Side effects common to the respiratory system include stuffy nose, dry
throat, shortness of breath, and slowed breathing.  A stuffy nose and dry
throat usually disappear several days after starting a medication.  If these
side effects are bothersome, you may use nose drops (consult your doctor
first) or throat lozenges, or you may gargle with warm salt water to relieve
them.  Shortness of breath is a characteristic side effect of some drugs (for
example, propranolol).  If shortness of breath occurs frequently, check with
your doctor.  It may be a sign of a serious side effect, or you may simply be
overexercising.

     Skin

     Skin reactions include rash, swelling, itching, and sweating.  Itching,
swelling, and rash frequently indicate a drug allergy.  You should NOT
continue to take a drug if you develop an allergy to it, but consult your
doctor before stopping the drug.
     Some drugs increase sweating; others decrease it.  Drugs that decrease
sweating may cause problems during exercise or hot weather when your body
needs to sweat to reduce body temperature.
     If you have a minor skin reaction not diagnosed as an allergy, ask your
pharmacist for a soothing cream.  Your pharmacist may also suggest that you
take frequent baths or dust the sensitive area with a suitable powder.
     Another type of skin reaction is photosensitivity (also called
phototoxicity or sun toxicity)--that is, unusual sensitivity to the sun.
Tetracyclines can cause photosensitivity.  If, while taking such a drug, you
are exposed to the sun for even a brief period of time (10 or 15 minutes), you
may experience a severe sunburn.  You do not have to stay indoors while taking
these drugs, but you should be fully clothed while outside, and you should not
remain in the sun too long.  Furthermore, you should use a protective
sunscreen while in the sun--ask your pharmacist to help you choose one.  Since
medications may remain in your bloodstream after you stop taking them, you
should continue to follow these precautions for two days after treatment with
these drugs has been completed.

SUBTLE SIDE EFFECTS

     Some side effects are difficult to detect.  You may not notice any
symptoms at all, or you may notice only slight ones.  Therefore, your doctor
may want you to have periodic blood tests or eye examinations to ensure that
no subtle damage is occurring to any of your organ systems while you are on
certain medications.

     Kidneys

     If one of the side effects of a drug is to reduce the kidneys' ability to
remove chemicals and other substances from the blood, these substances begin
to accumulate in body tissues.  Over a period of time, this accumulation may
cause vague symptoms, such as swelling, fluid retention, nausea, headache, or
weakness.  Obvious symptoms, especially pain, are rare.

     Liver

     Drug-induced liver damage may result in fat accumulation within the
liver.  Since the liver is responsible for converting many drugs and body
chemicals into compounds that can be eliminated by other organs of the body
(kidneys, lungs, gastrointestinal tract), drug-induced liver damage can result
in a buildup of these substances.  Because liver damage may be quite advanced
before it produces any symptoms, periodic blood tests of liver function are
recommended during therapy with certain drugs.

     Blood

     A great many drugs affect the blood and the circulatory system but do not
produce noticeable symptoms for some time.  Some drugs decrease the number of
red blood cells--the cells responsible for carrying oxygen and nutrients
throughout the body.  If you have too few red blood cells, you become anemic;
you appear pale and feel tired, weak, dizzy, and perhaps hungry.  Other drugs
decrease the number of white blood cells--the cells responsible for combating
infection.  Having too few white blood cells increases susceptibility to
infection and may prolong illness.  If a sore throat or a fever begins after
you start taking a drug and continues for a few days, you may have an
infection and too few white blood cells to fight it.  Call your doctor.

DRUG USE DURING PREGNANCY AND BREAST-FEEDING

     Before taking ANY medication, it is very important to tell your doctor if
you are pregnant (or planning to become pregnant) or are breast-feeding an
infant.  For most drugs, complete information on safety during pregnancy and
while breast-feeding is lacking.  This is not due to negligence or lack of
concern on the part of regulatory agencies, but to the fact that it would be
unethical to conduct drug experiments on pregnant and nursing women.  With
this in mind, you should discuss with your doctor the risks versus the
benefits of taking any medications during pregnancy or while nursing an
infant.

MANAGEMENT OF SIDE EFFECTS

     Consult the drug profiles to determine whether the side effects you are
experiencing are minor (relatively common and usually not serious) or major
(symptoms that you should consult your doctor about).  If your side effects
are minor, you may be able to compensate for them (see the following table
["Side Effects Table"] for suggestions).  However, consult your doctor if you
find minor side effects persistent or particularly bothersome.
     If you experience any major side effects, contact your doctor
immediately.  Your dosage may need adjustment, or you may have developed a
sensitivity to the drug.  Your doctor may want you to switch to an alternative
medication to treat your disorder.  Never stop taking a prescribed medication
unless you first discuss it with your doctor.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
