The patient walked in to the casualty with her face drooping on the left side. Her appearance alarmed the medical officer who thought that it looked like she had suffered a Stroke, a medical emergency! The resident physician examined the patient and suspected that there could be something more to the story than meets the eye . He wasn’t convinced about it being a Stroke. He dug deeper into the history and to his relief , it wasn’t a Stroke. His clinical findings were consistent with the story narrated by the patient. A few days back, she had received an injection of Botox for reducing her wrinkles . The Physician concluded that her drooping face was an adverse effect of that injection. She was happy to know that it would get better over time. She wasn’t aware that there could be side effects of the Botox injection and neither did she regret having had it. Adverse effects of a desired treatment are often neglected!
In clinical practice, we come across many patients who get kidney diseases due to inappropriate intake of pain killers. Some get into trouble due to unsupervised treatment with medicines like steroids. Many adverse effects of medicines can be easily avoided. One just needs to remember that medicines have various effects on our bodies, many of which may not necessarily be desirable. If we know that there could be some undesirable effects then we can report them earlier, get them treated even change the medicine if necessary. Let’s discuss a few things about the good effects and adverse effects of medicines.
Whenever we take a medication, it causes some effect on our body. Rather, we choose active ingredients from substances which have effect on our body, as medicine. We can grossly differentiate such effects as expected and unexpected effects. Expected effects can be further classified as desirable and undesirable effects.
Most of the expected effects are desirable , which are beneficial for us; while some are unwanted or undesirable. The beneficial effects help us to get relief from our conditions while unwanted effects are known as side effects.These side effects could be benign or could be severe. Sometimes desired effect in excess can be troublesome and we may consider it as an adverse effect. Let’s see some examples. If someone takes a laxative for constipation, then he might get excessive loose motions. This effect is expected but would be unwanted . Another example would be weight gain with some of the anti-diabetic medicines. The weight gain is expected but unwanted. Such adverse effects are sometimes tolerable and doctors can involve the patient in deciding whether the medicine should be continued. Most of the medicines are used only when the possible benefits outweigh the risk of side effects.
On other hand, there is a range of adverse effects which are unexpected. These are the effects of medicine which might occur in a particular individual. This could be due to an allergic reaction to the medicine or due to idiosyncrasies. Such adverse reactions do not occur in everyone. They are person specific. We can not give the same medicine to that particular person as it can cause catastrophic reactions. In such cases, there should be a record of what kind of reaction occurred to what drug. This record should be with the patient during each consultation and hospital admission.
Some of the adverse effects occur in certain age groups. For example some medicines are safe in adults but can be harmful in young ones. Because of this, even if the child has similar symptoms to those of adults, we cannot give the same medicines to the child without confirming with the doctor. Medicines have different effects and adverse effects in the elderly. Many adverse effects are also more common in the older population. We also need to be more cautious about medication in pregnant and breast feeding ladies, as the medicines given to the mother can harm the baby. Some side effects can occur due to interaction between two different medicines.
Your doctor will usually look into all these aspects and then prescribe your medicines. The doctor may also warn you about the possible side effects and what to do if they occur. You should always ask about the side effects of the medicines prescribed by the doctor. You should also read the instructions on the medicines. If there is any doubt about the instructions, you should get it cleared. Many medicines have information leaflets which can be very useful.
Despite these precautionary measures, some patients may suffer from side effects. As we discussed earlier, the medicines are given only when the benefits outweigh the risks. For example, the antivenom treatment for a snake bite can cause a severe allergic reaction. But if it is not administered, then the snake venom can kill the person. So we have to accept the risk of adverse reaction in order to save life. However , if the situation is not life threatening, the patients can choose the treatment amongst the available options or can even refuse the treatment if the side effects are undesirable.
An irrational fear of the adverse effects is also as equally dangerous as ignorance of it. Some people reject essential and life saving medicines for fear of side effects, only to find out that not taking the medicine has harmed them more. Some people think that modern medicines (or Allopathy ) have very strong adverse effects and other medicines (like traditional medicine) are mild and have no side effects. Such thinking is simplistic and often wrong. In modern medicine, we have a system to keep a check on adverse events and to declare the medicine unsafe if necessary. So called “mild and safe” traditional /alternative medicines are not necessarily safe. One of my diabetic patients had an irrational fear of modern medicines in general. He started taking some alternative medicine which did not cause any side effect but at the same time had no effect on his diabetes. He had to be admitted with complications of uncontrolled diabetes and was in serious trouble. He was treated in an intensive care unit and thankfully his life was saved. He was later started on modern medicine which he tolerated very well. His diabetes is now well controlled.
People tend to think that medicines with doses like 1000mg or 500 mg are stronger and have more side effects than medicines with smaller doses in mg. This is not true either. Every medicine needs to be taken in a specific dose to have desired effect. For some medicines this dose could be in micrograms while for others it is in grams. A medicine with a dose in micrograms can cause adverse events while some might be extremely safe even when taken in doses of grams.
Our tendency to generalize about medicines and side effects takes us nowhere. Know more about your medicines and stay safe!
Dr Renuka and Dr Vinayak Hingane
