Medication is given to patients to help them, not harm them, which is why it is so hard to comprehend that the side effects and interactions from medications cause more deaths annually than homicides, car accidents and airplane crashes combined. This means that, every year, approximately 100,000 deaths in the US are caused, in part, by dangerous drug reactions.
Some medication side effects are easy to recognize, such as an upset stomach after taking aspirin or confusion from sedatives. Other side effects—as well as drug interactions—may be unexpected and harder to recognize. For example…
Culprit: Levofloxacin (Levaquin), a broad-spectrum antibiotic given for infections. The fluoroquinolone class of antibiotics, which includes levofloxacin and ciprofloxacin (Cipro), has been linked to torsades de pointes, a rare but dangerous heart irregularity (arrhythmia) that can cause instant death in some cases.
Warning: Patients who take one of these antibiotics along with a thiazide diuretic, such as hydrochlorothiazide (Microzide), may have a higher risk for heart irregularities.
New development: A study published in The New England Journal of Medicine has found that azithromycin (Zithromax and others), an antibiotic used to treat bacterial infections, may increase risk for irregular heartbeat and sudden death in patients with, or at risk for, heart disease.
Solution: If you take any of these antibiotics and experience a change in your heart’s rhythm (a feeling of fluttering in the heart or a heart rate greater than 100 beats per minute), go to the emergency room. Episodes that last for more than about 10 seconds can cause a loss of consciousness and sometimes seizures.
Culprit: Sulfamethoxazole and trimethoprim (Bactrim), a sulfonamide antibiotic, used to treat intestinal and urinary tract infections and pneumonia. This class of antibiotics can lead to Stevens-Johnson syndrome (SJS), an immune reaction that causes flulike symptoms, including fever, followed by a painful, itchy rash that spreads, blisters and can become infected. Sores in the mouth and mucous membranes also are common.
SJS is rare, affecting one to three patients per 100,000, but it can be life-threatening. About 25% to 35% of patients who have an extensive rash (covering 30% or more of the body) die from it.
Solution: If you take sulfamethoxazole and trimethoprim or another sulfonamide antibiotic and experience any of the side effects described earlier, go to the emergency room. Patients with SJS are hospitalized and given the same treatments as burn victims.
Culprit: Warfarin (Coumadin), a “blood thinner” that inhibits blood clotting and often is prescribed to patients with heart disease or who have had a heart attack. Warfarin, as well as other anticlotting drugs, can make the blood so thin that bleeding occurs from the stomach, intestine or gums. And since bleeding can take longer to stop, blood can leak from a capillary and cause a bruise without an injury.
An article by Canadian researchers published in Annals of Internal Medicine in 2003, analyzing the results of 33 previous studies, found that patients taking warfarin had about a one in 39 chance of serious bleeding. About one in eight patients with major bleeding episodes died.
Solution: Warfarin can be a lifesaving drug if you need it, but you should work closely with your doctor to find the dosage that is best for you. Also, it’s crucial to be aware that other medications, supplements and even foods can thin your blood. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Motrin), and clopidogrel (Plavix), an antiplatelet drug—all of which have bleeding as a side effect. Before taking any other drug, let your doctor know that you’re also taking warfarin.
Caution: Many herbs and supplements, such as fish oil, licorice, ginseng and coenzyme Q10, can increase/worsen the effects of warfarin.
Also important: Foods that are high in vitamin K, such as spinach and kale, affect the rate at which your blood clots and could require a change in your dose of warfarin. If you take a blood thinner, speak to your doctor about the effects of other medications, supplements and foods on your blood.
Culprit: Alendronate (Fosamax), taken to prevent/treat osteoporosis. Alendronate is known to cause stomach ulcers in about 1% of patients and ulcers in the esophagus in up to 2%. These are small percentages, but the risk rises when patients also take an NSAID, such as ibuprofen or naproxen (Aleve).
Solution: If you need a drug such as alendronate to preserve bone strength, changing how you take the medication can reduce the side effects.
Examples: Take alendronate first thing in the morning when your stomach is empty, washing it down with six to eight ounces of plain water. Taking it with some beverages or foods, particularly orange juice or acidic foods, increases the risk for ulcers. Don’t lie down for 30 minutes after taking it—this can cause stomach acids to reach, and damage, the esophagus.
Also important: Avoid NSAIDs. Take acetaminophen (Tylenol), a non-NSAID painkiller.
Culprit: Gemfibrozil (Lopid), a fibrate medication that’s used to reduce triglycerides and increase HDL “good” cholesterol, taken with a statin drug.
Doctors routinely tell patients that cholesterol-lowering statins, such as atorvastatin (Lipitor) or simvastatin (Zocor), may cause muscle pain. But they often neglect to mention that other cholesterol medications can have the same effect. Up to 30% of patients who take a statin experience some degree of muscle pain. The risk is higher when patients also take gemfibrozil or another fibrate drug because this medication decreases levels of liver enzymes that are needed to break down statins. Result: Statin levels gradually rise in the body, which increases the risk for muscle pain.
Solution: If you’re taking both a fibrate and a statin, ask your doctor if the statin dose is low enough to prevent side effects.
Culprit: Metoclopramide (Reglan), a medication for heartburn, plus prochlorperazine (Compazine), a medication to relieve nausea.
Metoclopramide causes Tardive dyskinesia (uncontrolled muscle movements, especially in the face) in about 20% of patients who take it for three months or longer. It blocks the effects of dopamine, a brain chemical that plays a role in cognition and movement, the loss of which also occurs in Parkinson’s patients. Prochlorperazine also blocks the effects of dopamine. When these drugs are taken together, the risk for movement disorders is much higher.
Solution: Switch to a different heartburn drug—for example, an antacid or a medication such as cimetidine (Tagamet), an H2 blocker, that does not typically block dopamine. Important: Uncontrolled movements caused by medication may not appear for up to six months. If you are experiencing tremors or other movement disorders, ask your doctor to review all of your medications, not just the ones that you’ve recently started.
Speak to each of your physicians about all the medications you are taking. Alert your prescribing doctor if you experience any side effects when starting a new drug. Doctors often can find another medication that works for you.
Very important: It’s best to always use the same pharmacy or pharmacy chain. Every medication that you take, or have taken, is stored in the pharmacy’s computer, which identifies potential drug interactions. Ask the pharmacist to look up your record when you are picking up a prescription.
