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Health Zone: Keep taking the medicine..; We all swallow tablets without a second thought. But how much do we really know about the side-effects?

Byline: ANASTASIA STEPHENS and SALLY JANES

WHEN did you last take medication? Chances are you've recently glugged down a cold remedy to help you struggle into work. Or perhaps you keep painkillers in your handbag for tension headaches or monthly cramps.

We may watch what we eat and drink, count calories and quit smoking, but we're more blase when it comes to medication. Now experts are telling us to be more aware of potential side-effects. And a number of high-profile cases have thrown the issue into the spotlight. More than 60 Britons who say they became hooked on Seroxat are threatening legal action against pharmaceutical giant GlaxoSmithKline over side effects of the anti-depressant.

Earlier this year the medical world was shocked by the death of 21-year-old air stewardess Kerry Weston, a fortnight after she was prescribed anti-smoking drug Zyban. An inquest ruled that her death was by natural causes, but the coroner warned about the dangers of taking Zyban with other medicines.

Thirty-seven deaths have so far been reported in the UK in people taking Zyban. Evidence has not conclusively pointed to the effects of Zyban as the cause, but in June the Committee on Safety of Medicines (CSM) ordered the drug to be controlled more strictly. Despite the scare stories most of us are unquestioning when it comes to taking medication. Half of all patients on regular treatment will suffer a side-effect. Yet few people read the information leaflet, which lists side-effects, or ask about any negative effects.

We're just as unquestioning about over-the-counter medications. Did you know that sleeping pills can cause nervousness and aspirin can trigger asthma attacks?

GP and lecturer at Newcastle Medical School Dr Anand urges caution with all medication. "First of all ask, is it really necessary? While some very sick people need medication, pharmaceutical drugs generally offer a quick-fix to illness without addressing the causes.

"When needed medication can be very effective and for serious illnesses it can be lifesaving. However, you shouldn't take it unthinkingly and above all always research the side-effects."

Drugs are developed and scrutinised in decade-long trials, but only tested on 2,000-3,000 people in the final stages. So some side effects can be missed. That's why new drugs are marked in doctors' man uals with a black triangle - the doctor can report any adverse reactions. So if you are concerned, ask your GP if your drug has a black triangle.

Withdrawing from medication without medical supervision can also cause problems. This is one issue covered by the TV drama Swallow, which is about the devastating side-effects of an anti- depressant. The main character Lorraine Landry battles with depression and attempts suicide when she comes off the drug.

One viewer, Anita Walsh, found the drama especially unnerving as she too suffers from depression, and earlier this year stopped taking the anti-depressant Seroxat. Within days Anita was terribly depressed.

She says: "When I came off Seroxat I was depressed, short-tempered and emotional. After a few weeks I went back to my psychiatrist who told me to start taking it immediately."

Anita was diagnosed with clinical depression in her early 20s. She's tried five or six different anti-depressants in a bid to find the one with the least side effects. Now aged 34 Anita has finally found the right medication and works at an employment service and is proud mum to three-year-old Harry.

Prozac was the first drug she was prescribed and she thought it would be a miracle cure. She didn't ask about side effects but within a fortnight she'd turned into a "zombie".

"Prozac was by far the worst for me," she says. "It had some horrible side- effects and I got more depressed. I was a zombie, totally emotionless.

"I had awful retching and wasn't bringing anything up so it burnt my chest and throat. I wouldn't go out, diddn't work and I couldn't even even be bothered to reply when my family spoke to me. On top of it all I couldn't sleep because I'd be itching all night.

"After a couple of months I went back to the psychiatrist and was put on to a different anti-depressant. I now take Seroxat with Largactil which stabilises me. It means I can get on with my life."

It must be remembered that Prozac works for a lot of people - different people react in different ways. But Anita found out the hard way about the possible side effects of her medication. Are you aware about yours?

I was hit by a wave of depression and anxiety

SOPHIE Biro, 28, a financial researcher in a London bank took the anti-smoking Zyban, four months ago. Within a few days she was depressed and anxious.

SOPHIE says: "On the second day of taking the drug I began feeling a strange, toxic unnatural feeling in my body.

"I was feeling depressed, restless and began arguing with my boyfriend over the smallest things. It was really disturbing. I didn't stop taking Zyban because it was helping me give up a life-threatening habit. I cut my dose. Instead of taking two tablets daily for eight weeks, I took one tablet for a month. I still felt anxious and agitated. I still argued with my boyfriend a lot.

"The side-effects disappeared after about a week but at least I've given up smoking."Follow our side-effects guide...

Cold remedies

THE worst thing you can do is mix cold remedies containing painkillers. Without knowing it you could overdose. In just 72 hours this can lead to liver toxicity which can be fatal.

Never take more than one cold or flu remedy (containing painkillers) at the same time.

Cough suppressants (Pholcodine Linctus or Benylin Dry Cough) This contains pholcodine which can sometimes cause constipation.

Decongestants (Lemsip, Night Nurse, Boots Cold & Flu Relief, Nurofen Cold & Flu, Benylin Day & Night)

Decongestants can increase blood pressure or hyperactivity so should not be taken if you have high blood pressure or heart disease.

Anything with an anti-histamine (eg Night Nurse) can cause drowsiness so don't drink alcohol.

Painkillers

Aspirin

Don't take aspirin on an empty stomach as it can irritate and damage the stomach lining. Aspirin can interfere with anti-coagulants and anti-inflammatory drugs so inform your pharmacist of medication you are taking. It can also trigger allergic or asthmatic reactions. Aspirin should never be taken by children under 12 as research has shown it may lead to a rare condition called Reyes Syndrome, a disorder that affects the liver and brain. For this reason don't take aspirin if you're breastfeeding - it could be transferred via the breast milk.

Ibuprofen

Always make sure you eat before taking ibuprofen as diarrhoea is common if you take it on an empty stomach.

Paracetamol

Overdosing on paracetamol is very dangerous and can cause liver toxicity which can kill. Don't drink - alcohol stops medication working properly and strains the liver.

Sleeping pills

Nytol or diphenhydramine, Sominex which is promethazine

If taken short term, sleeping pills are unlikely to cause problems. However, some people may experience a dry mouth, nausea and even nervousness within four to six hours.

If you take sleeping pills long term there may be an underlying reason why you're not sleeping, so go to see your GP.

Sleeping pills can interact with anti-depressants, making them stronger.

Anti-histamines

Non-drowsy anti-histamines (Boots Hayfever and Clarityn)

These contain a non-sedating anti-histamine called loratidine. Very rarely this can cause dry mouth, blurring of vision, constipation and impotence. Non-sedating anti-histamines shouldn't be taken with some anti-fungal medication and certain antibiotics as they could stop these drugs working properly.

Indigestion remedies

H2antaganists (Zantac or Pepsid)

These prevent the release of acid into the stomach but they can affect the absorption of other medication and minerals. They decrease the absorption of iron and vitamin supplements. Antacids (Rennies, Boots Indigestion Tablets, or Gaviscon. contain aluminium hydroxide, calcium carbonate, magnesium salts or sodium) - to nuetralise the stomach acid.

These neutralise stomach acid, but some contain calcium carbonates which can cause constipation. And magnesium salts sometimes give you diarrhoea.

Stomach ulcer medication

Prescription: Losec (omeprazole), Protium (pantoprazole), Zoton (lansoprazole).

These may cause diarrhoea, rashes and headaches. The main thing to remember is don't take with Valium (diazepam), epileptic and heart drugs, warfarin and the antibiotic ketoconazole. They can either stop these drugs working or increase their strength. GP Dr Tanvir Jamil, of Burnham, Berkshire, says: "These drugs have changed people's lives and if you can tolerate them it will make a real difference. If you get headaches within two or three days go back to your GP. It's just a question of finding one that's right for you."

Cholesterol lowering drugs

Zocor (simvastatin), Lipitor (atorvastatin), Lipobay (cerivastatin), Lescol (fluvastatin), Lipostat (pravastatin)

Side effects can take weeks and include constipation, flatulence, headache, nausea, indigestion, abdominal pain, diarrhoea, insomnia, rash, light sensitivity, dizziness, muscle cramps, nerve pains and anaemia. Dr Jamil says: "Many side effects occur for a few weeks and calm down. If you can bear with it, give it a few weeks and see how it goes. If the side effects interfere with your lifestyle go back to your GP. Sometimes you have to try a few different types before you get one that suits you."

Anti-depressants

Seroxat (paroxetine), Prozac (fluoxetine),Lustral (sertraline), Edronax (reboxetine), Efexor (Venlafaxine)

If you experience side-effects, don't come off the medication without medical advice. Dr Jamil says: "If you've been taking anti-depressants for longer than a month you may have withdrawal symptoms if you come off them. Talk it through with your GP."

Anti-depressants can cause stomach-ache and nausea within 24 hours but it may take two to three weeks for other side-effects to develop. These include sweating, tremors, dry mouth, insomnia, lower sex drive and fever.

Bronchodilators for asthma

Serevent Inhalor (salmeterol), Bambec (bambuterol), Foradil (eformoterol).

Any side-effects will come on within 24 hours. You may suffer tremors, palpitations, headaches, tremors and skin problems. Rarely they can cause muscle cramps, spasms of the bronchial tubes in the lungs and low potassium levels. If they are mild see how you feel for a few days and if the problem resolves itself. If they are severe call your doctor immediately.

Blood pressure pills

Istin (amlodipine), Plendil (felodipine), Adalat La (nifedipine), Syscor MR (nisoldipine)

These widen blood vessels, increasing blood flow to the heart. Any side-effects will usually come on within a couple of days and you may find you get headaches, rash, fatigue, nausea and dizziness. Rare side-effects include: abdominal pain, indigestion, muscle cramps, mood changes, impotence and visual disturbances. Dr Jamil says: "Occasionally your doctor will switch you from amlodipine to adalat. They are similar drugs but if you change types you may see side effects reduce. Often it's a question of getting used to it."

Penicillin Antibiotics

Amoram or Augmentin (amoxycillin), Pondocillin (pivamipicillin)

It's possible you'll have a tummy upset if you're on antibiotics as the medication kills friendly bacteria in the gut. This will happen within a few days. Long term use makes people prone to fungal infections. Some evidence suggests that killing friendly gut bacteria may weaken immunity.

Dr Jamil says: "There's a great deal of choice when it comes to antibiotics. You can always find the right one that won't give you side-effects. If you have a rash contact your doctor as this could be an allergy. Your GP will usually switch you to another type."

Non-steriodal anti- inflammatories (NSAIDS)

Brufen Retard (Ibuprofen 800mg), Fenopron (fenoprofen), Ponstan (mefenamic acid) and Nurofen (Ibuprofen)

If you have side-effects it will usually happen in a couple of days. Dr Jamil says: "The first sign is upper abdominal pain. You'll have bad stomach ache and black stools which is digested blood. If this happens come off the medication straight away and see your GP as this indicates internal bleeding."

Prolonged use of NSAIDS can cause stomach ulcers. If you develop a skin rash, tell your doctor. They may also cause impaired kidney function, drowsiness, constipation, dizziness and nausea.

There are new drugs out now called selective COX II inhibitors which cause very little stomach bleeding and are suitable for people who have had ulcers in the past or who have acidity. Dr Jamil recommends asking your doctor if these are appropriate for you. Don't take NSIDS if you have a stomach or abdominal ulcers, impaired kidney function. Avoid if you take aspirin or suffer an anti-inflammatory induced allergy such as asthma or skin rashes. Interacts with blood-thinning drugs, diuretics and quinolones.

Blood thinners

Caprin and Disprin (prescription strength aspirin), Monoparin (heparin), Multiparin, Calciparine (heparin), Marevan (warfarin).

Aspirin and warfarin drugs can cause gastric irritation, internal bleeding as well as asthmatic and allergic reactions. Warfarin (which is rat poison!) is a blood thinning agent. It can cause diarrhoea, hair loss and skin rashes. These side effects can happen in a few days. If they do contact your doctor.

Dr Jamil says: "Take care shaving if you are on blood thinners. If you do it could take five to 10 minutes to stop bleeding." Do not take if you have haemophilia, liver or kidney impairment, stomach ulcers, within 24 hours of surgery, while pregnant or breastfeeding because of the risk of haemorrhage. Warfarin or heparin drugs shouldn't be taken with certain anti-inflammatories, antibiotics, steroids and drugs affecting liver enzymes.

Contraceptive Pill

Cilest (ethinyloestradiol;norethisterone), Eugynon 30 (ethinyloestradoil, norgestimate) Femodene (ethinyloestradoil, gestodene).

Progesterone only contraceptives include Femulen (ethynodiol), Micronor (norethisterone) Microval (levonorgestrel).

Dr Jamil says: "Different pills suit different women, that's why there's so many available. Side-effects of the pill will take a few weeks as each pill is low dose. Don't stop taking the pill immediately as you may get pregnant. Have a chat with your doctor. There are lots of pills you can try."

Side-effects include breast enlargement, fluid retention, cramps, depression, loss of libido, headaches and nausea. You must remember to use additional contraceptive precautions while you are taking antibiotics and for a full week after. If you're not absorbing the pill you could get pregnant.

Pills containing gestodene or desogestrel are not advised for women with increased risk of blood clots such as those with varicose veins or angina.

Tell your doctor if you have hypertension, diabetes, asthma, depression, kidney disease, multiple sclerosis or you smoke. Progesterone-only pills can occasionally cause acne and ovarian cysts.

Acne drugs

Antibiotics HAntibiotics (Erythrocin (erythromycin), doxycycline, Aknemin (tetracycline) Metrogel (metronidazole)

A three-month course of oral antibiotics is needed. However irritation of the gut lining, diarrhoea and stomach ulcers are a risk factor. They may also cause skin irritation or allergies. Dr Jamil says: "Tummy upsets will come on within 24 hours and you may feel the other side-effects in a few days.

Some are easier on the stomach than others but as it varies from person to person - you may just have to try different types. Luckily there are lots of antibiotics for acne." Vitamin A. Roaccutane, a strong vitamin-A based treatment is very effective for severe acne which is unresponsive to antibiotics.

You may experience skin dryness, nausea, headaches, drowsiness, sweating, menstrual irregularities and seizures, depression and mood swings.

The above is an abbreviated guide listing the most common side effects. Always consult your doctor or pharmacist before taking medication.

For further information speak to your pharmacist or visitwww.patient.co.uk, www.drugdigest.org, www.healthsquare.com, www.rxlist.comor contact the MentalHealth Foundation on 020 7535 7400 orvisit www.mentalhealth.org.uk

SO WHAT SHOULD YOU DO?

YOU may not make the connection between medication and your symptoms as some take months to develop and others strike immediately.

If you notice any unusual symptoms your first port of call should be your pharmacist or GP.

Remember to tell your doctor if you are taking other medication or herbal remedies.

Our response to drugs differs depending on physiology and immune system. What suits one person won't be right for everyone.

You may be advised to change to another drug in the same family.

Boots pharmacist Sarah Pattison says always ask about potential side-effects before taking any drug.

She says: "If a drug is necessary for treating an illness, you may need to live with the side-effects.

"If a side-effect is severe, you may be told to come off the drug. It's a question of balancing the importance of the drug in treating your condition and the severity of the side- effect."

If your drug is newly licensed, the side effects may be unknown.

Sarah Pattison adds: "Encourage your GP to notify the Committee on Safety of Medicines, who will store the information on a database so other doctors can warn patients."
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Article Details
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Title Annotation:Features
Publication:The Mirror (London, England)
Date:Dec 13, 2001
Words:2761
Previous Article:Justice With Jacobs: Cardholder repayment protection.
Next Article:Health Zone: Nutrition - It bites; PARTY FOOD makeover Week 29 NIBBLES THAT WON'T NOBBLE YOUR FIGURE.


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