Don’t wait to call your doc
By: Altaf Patel
Always take the advice of your physician before self medicating so that you are warned about adverse effects of certain drugs.
Doctors prescribe medicine, of which they know little, to patients of which they know less. This has been a wellknown statement. It should be rephrased to “doctors prescribe medicine, of which medical science knows little to patients of which medical science knows even less”.
A neurologist opined that the medication prescribed for the urinary infection – a quinolone —caused the fit. This was construed by the patient and his relatives as inappropriate medication and I was called in to evaluate him. When I explained that quinolone was an appropriate medication, but he was unfortunately suffering from a rare side-effect, the patient party calmed down.
This gentleman had only functionally impaired his spinal chord and therefore I suggested that recovery would be complete.
An excellent antibiotic for typhoid is chloramphenicol. But sometimes it causes aplastic anemia. Most people are frightened to use this medication and I only advise it if all other medications fail. I had once known a nurse who died after taking a single tablet of analgin for headache. Analgin is an over-the-counter medication for headache and pain.
In the United States, the Food and Drug Administration regulates OTC medication. It has a category of restricted OTC substances as well. Such drugs are sold only in stores which are registered by the state.
One such drug is pseudo ephedrine. It is used as a cold medication. It increases the heart rate and blood pressure and may be hazardous for heart and blood pressure patients. Though an extremely efficient remedy for a running nose, it can be problematic. The state of Mississippi in 2010 passed a bill to put this under prescription and I would like to see more states do this. The other closely related drug is phenylpropanolamine available in nasal decongestants. In Europe it is available as an OTC. Because of the risk of hemorrhagic stroke in young women at a study done by Yale University and cases of psychiatric disturbances of acute mania, organic psychosis and even paranoid schizophrenia, the US FDA issued a public health advisory in 2000 against the use of this drug.
In January, 2011, drugs containing PPA were banned in India but the Madras High Court revoked a ban on the manufacture of PPA on September 13, 2011.
Painkillers like refecoxib were discontinued in the US markets in 2004. It has been estimated that 60,000 people lost their lives due to this medication. This drug suppresses the prostaglandins that cause pain and inflammation. In the process it also suppresses the good prostaglandins that dilate blood vessels promoting blood flow.
A study done in 2012 shows that the pain killers (NSAIDs or Non Steroidal Anti Inflammatory Drugs) were associated with 59% increased death rate after 1 year and 63% increased death rate after 5 years usage in patients who have a history of heart attacks.
Similar studies in the British Medical Journal found that many NSAIDs had a two to four fold increase in heart attack, stroke or cardiovascular death.
The American Heart Association suggested a stepped care approach in patients with preexisting heart disease. It suggested the use of safer medication like aspirin in the beginning. Head to head studies of various pain killers suggest that naproxen is safer than celecoxib and in ascending order, ibuprofen, rofecoxib and diclofenac. It also makes sense that one uses these medications if you must under physician supervision, in the smallest effective dose, for the least possible time.
In addition there may be added risk of kidney dysfunction and asthma. In most ideal circumstances, it is wise that the prescription be supervised by a pharmacist.
However, I see a strange system in this city where the chemist plays the role of a surrogate doctor and advises patients on which drug to take. In this situation, I often see dangerous pain killers being prescribed, presumably with the notion that it would cure rapidly. Worse still, I see patients who come back to see me with my own prescription because the chemist thinks the medication is inappropriate for the situation. This practice should be greatly discouraged.
Another practice in the city is substitution of a prescription medication for a pharmacological equivalent drug by the chemist without informing the physician. In all fairness, most chemists ring the physician if they are unable to fill the prescription and ask the physician’s permission for an equivalent. Physicians usually prescribe medications in which they have faith.
Though the arguments are that they are all the same, one must understand that the bioavailability of the active pharmacological ingredient in the blood stream must be good. Amongst the reasons cited for poor bioavailability is poor formulation of the medications.
Another problem of OTC or self medication is the risk of not knowing about drug interaction. In conclusion, pill popping with the concept of instant cure is to be discouraged. If you self medicate, do it carefully, preferably under your physician’s advice and be warned about adverse effects of drugs over which there is little predictability.
Always take the advice of your physician before self medicating so that you are warned about adverse effects of certain drugs.
Doctors prescribe medicine, of which they know little, to patients of which they know less. This has been a wellknown statement. It should be rephrased to “doctors prescribe medicine, of which medical science knows little to patients of which medical science knows even less”.
The database of evidence changes from time to time and what we might have prescribed yesterday may be considered disastrous today. I remember a colleague had gone to see a patient who had a urinary infection. This man also had a neck and spinal surgery done for early compression of his cervical spine. During the course of his therapy for urine infection, he developed fits and became incontinent.
A neurologist opined that the medication prescribed for the urinary infection – a quinolone —caused the fit. This was construed by the patient and his relatives as inappropriate medication and I was called in to evaluate him. When I explained that quinolone was an appropriate medication, but he was unfortunately suffering from a rare side-effect, the patient party calmed down.
This gentleman had only functionally impaired his spinal chord and therefore I suggested that recovery would be complete.
An excellent antibiotic for typhoid is chloramphenicol. But sometimes it causes aplastic anemia. Most people are frightened to use this medication and I only advise it if all other medications fail. I had once known a nurse who died after taking a single tablet of analgin for headache. Analgin is an over-the-counter medication for headache and pain.
In the United States, the Food and Drug Administration regulates OTC medication. It has a category of restricted OTC substances as well. Such drugs are sold only in stores which are registered by the state.
One such drug is pseudo ephedrine. It is used as a cold medication. It increases the heart rate and blood pressure and may be hazardous for heart and blood pressure patients. Though an extremely efficient remedy for a running nose, it can be problematic. The state of Mississippi in 2010 passed a bill to put this under prescription and I would like to see more states do this. The other closely related drug is phenylpropanolamine available in nasal decongestants. In Europe it is available as an OTC. Because of the risk of hemorrhagic stroke in young women at a study done by Yale University and cases of psychiatric disturbances of acute mania, organic psychosis and even paranoid schizophrenia, the US FDA issued a public health advisory in 2000 against the use of this drug.
In January, 2011, drugs containing PPA were banned in India but the Madras High Court revoked a ban on the manufacture of PPA on September 13, 2011.
Painkillers like refecoxib were discontinued in the US markets in 2004. It has been estimated that 60,000 people lost their lives due to this medication. This drug suppresses the prostaglandins that cause pain and inflammation. In the process it also suppresses the good prostaglandins that dilate blood vessels promoting blood flow.
A study done in 2012 shows that the pain killers (NSAIDs or Non Steroidal Anti Inflammatory Drugs) were associated with 59% increased death rate after 1 year and 63% increased death rate after 5 years usage in patients who have a history of heart attacks.
Similar studies in the British Medical Journal found that many NSAIDs had a two to four fold increase in heart attack, stroke or cardiovascular death.
The American Heart Association suggested a stepped care approach in patients with preexisting heart disease. It suggested the use of safer medication like aspirin in the beginning. Head to head studies of various pain killers suggest that naproxen is safer than celecoxib and in ascending order, ibuprofen, rofecoxib and diclofenac. It also makes sense that one uses these medications if you must under physician supervision, in the smallest effective dose, for the least possible time.
In addition there may be added risk of kidney dysfunction and asthma. In most ideal circumstances, it is wise that the prescription be supervised by a pharmacist.
However, I see a strange system in this city where the chemist plays the role of a surrogate doctor and advises patients on which drug to take. In this situation, I often see dangerous pain killers being prescribed, presumably with the notion that it would cure rapidly. Worse still, I see patients who come back to see me with my own prescription because the chemist thinks the medication is inappropriate for the situation. This practice should be greatly discouraged.
Another practice in the city is substitution of a prescription medication for a pharmacological equivalent drug by the chemist without informing the physician. In all fairness, most chemists ring the physician if they are unable to fill the prescription and ask the physician’s permission for an equivalent. Physicians usually prescribe medications in which they have faith.
Though the arguments are that they are all the same, one must understand that the bioavailability of the active pharmacological ingredient in the blood stream must be good. Amongst the reasons cited for poor bioavailability is poor formulation of the medications.
Another problem of OTC or self medication is the risk of not knowing about drug interaction. In conclusion, pill popping with the concept of instant cure is to be discouraged. If you self medicate, do it carefully, preferably under your physician’s advice and be warned about adverse effects of drugs over which there is little predictability.
Disclaimer: The views expressed here are the author's own. The opinions and facts expressed here do not reflect the views of Mirror and Mirror does not assume any responsibility or liability for the same.
