Sorting Out Side Effects | Consumer Health Information Corporation

Sorting Out Side Effects

Felicity L. Mitchell, Summer Student Intern 2002
Final Year Pharmacy Student,
University of Manchester

Recent news reports that a long-term form of hormone replacement therapy (HRT) might actually cause more harm than good have left many women confused about the safety of HRT.

Until now, doctors thought that taking HRT for many years could help keep women healthy by preventing diseases such as heart disease and osteoporosis. However, the study showed that long term use of a popular form of hormone therapy may not protect against heart disease, and appears to actually increase the chances of developing certain other serious conditions such as breast cancer and blood clots.

When frightening reports like these are published about HRT, or some other prescription medicine, patients may find it hard to understand what the complicated scientific terms and statistics mean for them. How can they tell what the side effects might be, if they will have them, and what they should do about them?

Almost everyone takes a prescription medicine at some point. Up to 80% of elderly people are taking at least one prescribed medication. These medicines prolong and improve the quality of our lives, and can even sometimes save them. But all medicines can cause side effects, and the risk of a side effect from a medicine can as much as triple as we get older.

A side effect is an unwanted reaction to a medicine. A mild side effect may be annoying, but the patient can usually keep taking the medicine. On the other hand, severe side effects can be life-threatening and require immediate medical attention.

Whether a side effect develops depends on the medicine being taken and the person taking it. Everybody is different and will respond differently to drugs. A person's age, weight, medical condition and other medications can all affect their chances of getting a side effect.

Some side effects may occur immediately. Others might take months to develop. Usually, though, side effects are seen when a person starts a new medicine or has a change in the dose of a current medicine.

By knowing what symptoms to expect and how to manage them, you can help make sure you get the most benefit from your treatment.

Here are some tips on how you can help manage the minor side effects of some common medicines.

Antibiotics
Antibiotics such as amoxicillin are prescribed to treat many different infections. They work by attacking bacteria that are in the body.

Antibiotics fight against harmful bacteria as well as bacteria that are needed by the body. Because they might remove the "good" bacteria that live in and protect the gut, antibiotics can cause diarrhoea and stomach upsets as a side effect.

TIP:

Eat bananas, rice and toast, and avoid acidic or spicy foods, to help manage mild diarrhoea. Drink clear fluids, and ask your doctor or pharmacist if eating yogurt will help. If the diarrhoea is severe, do not try to self-treat. Always call your doctor.

It is very important that you do not simply stop taking the medicine if you develop a mild side effect. Antibiotics kill the weak bacteria first and the stronger ones later. This is why it is important to take all the medicine to ensure all bacteria are killed and the infection does not come back. If you have any questions about side effects, or if they are too severe for you to finish the medicine, go back to your doctor.

Some people are allergic to some antibiotics. For example, if a person taking penicillin gets a rash or has trouble breathing, they may be allergic and should call the doctor straight away. Different types of antibiotics can be prescribed if you have an allergy.

Cholesterol-lowering drugs (Statins)
Statins such as simvastatin and atorvastatin are taken by people with high cholesterol to stop the body from making cholesterol. As a result, there is less cholesterol present in the blood and less chance that it can clog up the blood vessels.

Side effects from statin medicines are usually mild, and include muscle cramps, headaches, constipation, and abdominal pain. These side effects usually don't last long and calm down after a few weeks. So bear with it if you can. If the side effects interfere with your lifestyle, see if your GP can change you to a different type of medicine that suits you better.

However, if you ever experience muscle pain, tenderness or weakness that seems to happen for no reason, always check with your doctor straight away. This is because, in rare cases, statin medicines can cause muscle to break down, which can lead to serious kidney damage. The key is to talk with your doctor or pharmacist in advance so you can recognise the difference between a mild side effect and a serious reaction.

Antidepressants
Many different types of antidepressants are available. The most common are the SSRIs (Selective Serotonin Reuptake Inhibitors) such as fluoxetine (Prozac). These help "feel-good" hormones in the brain to lift your mood. These medicines may also be used to treat anxiety.

Side effects are less common with SSRIs than with older antidepressants, but may initially include an upset stomach or dry mouth.

TIP:

Treat a dry mouth by sucking on boiled sweets or drinking tart lemonade to produce more saliva. Brush your teeth and gums after to prevent tooth decay. Sip on ginger ale and only eat bland foods to help manage an upset stomach.

If you do experience side effects, it is important that you do not come off antidepressants without first talking to your doctor. The dose needs to be reduced gradually over a few weeks. This way your body can slowly readjust, without getting withdrawal symptoms such as headache and 'chills'.

Hormone Replacement Therapy (HRT)
The menopause causes symptoms such as hot flushes and night sweats, tiredness and mood swings. This is due to a lack of the hormone oestrogen in the body.

The absence of oestrogen over many years can also cause calcium to be lost from the bones - a condition called osteoporosis - so that they fracture easily. Fewer fractures are seen in women who take oestrogen as HRT.

There are some risks associated with hormone therapy. For example, women taking oestrogens are more likely to develop blood clots. These usually form in the veins of the calf, causing a red, swollen and often painful leg. If the clot travels to the lung it can block an artery there, causing breathlessness, sharp chest pains and fainting. If this happens you should contact your doctor at once.

Although HRT increases the likelihood of conditions such as blood clots, the overall risk of serious health problems is still very low. So for women with severe menopausal symptoms, the benefits of a few months - or even a few years - of HRT may make it worth the risk.

If you are currently on HRT and thinking of stopping, first talk to your doctor. It might be possible for you to change to a different therapy. For example, low doses of antidepressants such as Prozac may help with hot flushes as well as depression.

Remember that the symptoms of the menopause do eventually settle - sometimes this takes weeks, sometimes years.

HRT does not prevent heart disease. Lifestyle changes such as stopping smoking, losing weight or increasing physical activity are important for protecting your heart.

You can play an important part in making the most of your treatment. Ask your doctor or pharmacist from the very start about your medicine. Know the early warning signs of side effects and what to do if you develop such symptoms. Ask them to write it down if that will help you remember the facts. Help get the most benefit from your medicine by sorting out any side effects early on.