Drug dilemmas are among the oldest medical conundrums faced by doctors and patients. Especially when taken over a long period of time,medicines may end up being harbingers of new diseases. Therefore,the only antidotes are awareness,complete transparency between the patient and the physician and a consensus on how much is too much and for how long. Here is a look at the most common long-term medications and their side-effects.
Aspirin is inching towards the tag of panacea,or a cure for all ills. It has emerged as one of the most trusted friends of a hypertensive,thanks to its blood-thinning qualities,and has been found to have a role in preventing cancer metastatis. However,the drug is no knight in unalloyed shining armour. It is known to trigger gastrointestinal ulcers.
It is often prescribed with antacids but that is hardly a viable solution for long-term use. There have been reports of long-term aspirin use affecting renal function. Its most potent side effect could be its association with a potentially fatal condition called Reye Syndrome,when given to children with flu or chicken pox. Reye Syndrome is associated with liver and brain damage.
In January,English researchers in an article in the Archives of Internal Medicine concluded following an analysis of results of nine randomised trials that people with no previous history of heart attack or stroke were better off without aspirin than with it. These trials weighed the benefits and hazards of long-term aspirin use,which included a 30 per cent higher risk of serious gastrointestinal bleeding.
Another popular group of drugs are called statins. Counted among the best friends for those in the throes of metabolic syndrome,statins inhibit a particular enzyme in the body to reduce cholesterol formation in the liver. In conventional medical wisdom,the drug is to be continued for life. But its side-effects include muscle breakdown,neuropathy,sexual and hepatic dysfunction which has now necessitated a range of medical research to ascertain if statin use can be intermittent. Some years ago,the drug safety watchdog in UK revised the risk profile of statins to include memory loss,depression,sleep disturbance,sexual dysfunction and a rare lung disease.
Dr Sunil Jain,senior consultant medicine at Sir Ganga Ram Hospital,said,Statins are overprescribed because doctors have started treating reports,not patients. Statins have become a fad. The most important thing is not to use a drug till you have to and explain both the indications and contra-indications very clearly to the patient.
Giving the first sign that statin use may not have to be lifelong,a recent study in the New England Journal of Medicine concluded that the effect of statins can last for five to ten years after it has been stopped. This,doctors say,would have to be replicated for this finding to become the basis of future medical protocols.
Anti-hypertensives (beta-blockers) were once the first line of drugs for hypertensives. This class of drugs has recently begun to be relegated to the second or even the third
tier due to its association with diabetes,erectile dysfunction in men and higher triglyceride levels.
The trouble,says Dr Anoop Misra,director and head,department of diabetes and metabolic diseases,Fortis Hospital,is that the revision in norms is yet to sink in. Many physicians continue to use it as the first choice still,which is not advisable at all. The key for all such drugs where there is a dilemma as to whether the long term side-effects are well worth the risk is to take the patient into confidence,weigh pros and cons very carefully and decide on a course of action in consultation with patients, he says.
This group of compounds with a specific chemical structure like cholesterols are mainly used as very effective anti inflammatory agents and also as a powerful immuno-depressant. In auto immune diseases like SLE (systemic lupus erythromatosus) and myasthenia gravis,they can be life-saving. Small amounts are used in many skin creams and sprays.
The problem is that steroids are also molecules which can have devastating effects on almost all systems of the body. Their potency as an agent of massive physiological changes makes them a truant athletes best friend. Anabolic steroids can cause weight gain,brittle bones,diabetes,susceptibility to infections,diarrhoea,changes in secondary sexual features like facial hair growth etc.
There are conditions when steroids are life-saving and others where they can be extra damaging like in diabetics,people suffering from osteoporosis and infections. Patients is on steroids should be asked to report any minute events, Dr Jain says.
These may not seem as commonly used a drug as some of the others but that would have to do more with the stigma surrounding epilepsy rather than its actual incidence. Nevertheless anti-epileptics feature very high in the list of drugs which are sometimes life-saving,but also have side effects.
Old anti-epileptics like phenobarbitone – whose drug overdose killed Guru Dutt – can cause addiction. Some of the other side effects include osteoporosis and disruption of folate metabolism in the body. Doctors usually supplement these drugs with calcium and folic acid. They can also suppress sex hormones and cause hirsutism.
The most acute dilemma of anti-epileptics though is during pregnancy. Dr Anoop Kohli,consultant neurologist,Indraprastha Apollo Hospital,says,In theory no anti-epileptic is perfectly safe for pregnancy and sodium valproate is believed to be teratogenic (causing birth defects). But a seizure may also pose risks for the baby so it is better to be on drugs like carbamazepins,which are safer. It is important to tell your doctor about all other medications you may be taking and all details of your lifestyle including the frequency of alcohol intake.