The fear of medication side effects is one of the reasons many people do not start or discontinue taking their prescriptions. While many side effects are mild and temporary, others can have a serious negative effect on quality of life. That is why the adage “forewarned is forearmed” is so important when talking with patients about taking their medication.
Striking the delicate balance between giving patients useful, actionable information on the possibility of common but innocuous side effects and the rare but dangerous/potentially dangerous side effects is critical to establishing trust with your patients. Mimicking TV commercials and listing every side effect is not helpful, and neither is avoiding a discussion of clinically minor but perpetually annoying reactions. In addition, providing patients with practical information on what they can do about troublesome side effects is the other half of the equation to help your patients properly take their medication to receive the most benefit.
Side effects are more likely to occur the older a patient is, the more infirm they are, and the more medications they take. It makes sense that if a patient takes three medications that cause nausea, the likelihood that they will experience nausea will increase. Many drugs are metabolized by either the liver or kidney and patients with conditions affecting these organs may have more issues with side effects.
If patients are experiencing side effects, one of the first avenues to explore is whether the patient understands the purpose of the drug, the expected action of the drug, and is taking the drug as prescribed. For example, patients taking antibiotics may stop taking a prescription when symptoms clear, setting themselves up for a rebound. Skipping doses, taking the drugs with/without food, or drinking alcohol when contraindicated are also an invitation for side effects.
Here are some general guidelines for helping patients with side effects.
- Have patients call 911 or their health care provider for any allergic reaction (trouble breathing, airway swelling) or dangerous side effects.
- Have patients report uncomfortable or bothersome side effects to their health care provider.
- Maintain healthy eating, exercise, and sleep habits. For patients with chronic conditions, improving overall health can often reduce the number or dose of drugs taken, thereby improving any side effects and their overall quality of life.
- Maintain hydration status. Many drugs are cleared through the kidneys, and dehydration may induce dangerous side effects. This is particularly true for those taking diuretics.
- Alcohol can potentiate the effect of many drugs causing unwanted side effects. Patients should be realistically informed about alcohol and the difference between those drugs in which alcohol is counter-indicated and those for whom small amounts of alcohol are acceptable.
Guidance for Specific Categories of Side Effects
Gastrointestinal issues – Problems including nausea, vomiting, heartburn, and diarrhea apply to a substantial portion of side effects that people experience. Suggestions for managing diarrhea include drinking fluids, eating a lower fiber, bland diet until the issue is resolved, and discussing the use of an antidiarrheal with the patient’s health care provider.
Constipation can be ameliorated with gradually increasing fiber and fluids with a goal of getting 14 grams of fiber per every 1000 calories the patient requires.
For nausea, eating bland, low-odor foods, snacking on crackers, and slowly getting up from lying positions are helpful. Ginger in the form of capsules, tea, and tinctures up to 1000 mg/day has been effectively used for nausea. For heartburn, eating small meals, quitting smoking, not lying down after eating, and reducing alcohol, fatty foods, caffeine, and carbonated beverages, can be suggested.
Headaches– If headaches are not debilitating, patients can try either warm or cold compresses and lie down in a quiet, dark room. The use of analgesics should be discussed with their health care providers as excessive use can lead to rebound headaches.
Drowsiness or “brain fog” – Suggest the patient talk with their health care provider about the timing and dose of medication. Encourage adequate sleep and hydration and avoidance of alcohol. Caution the patient about driving and the use of machinery.
Weight Gain- Focus on eating a healthy diet and maintaining a regular exercise program.
If side effects do not resolve with simple home remedies, a discussion with the patients’ health care provider about a change in medication or dose would be in order.
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