If your government allows it, your doctor prescribed it, and your pharmacist dispensed it, then it must be safe, right?
Not necessarily.
Make an informed choice so you can weigh the benefits of a prescription drug against potential harms. If you are already taking prescription drugs, be on the lookout for possible interactions and be aware of potential symptoms on stopping or changing your dosage.
Before even filling a prescription, ask your doctor:
1. How does this drug work, how much improvement can I expect, and how soon?
Your medication might be intended to treat your actual condition, or it might just reduce some of the symptoms. It’s important to know what benefit you will get from treatment and how soon you will see an improvement.
While it may take a while for the condition being treated to clear up, it’s important to understand that medications can produce effects almost straightaway. If you notice any significant problems within hours of taking a medication, you shouldn’t dismiss them just because you have been told the medication takes much longer to work.
2. If I don’t take this drug now, and instead wait for a while, what will happen?
Some conditions clear up whether treated or not. In those cases, it’s important to consider whether adding possible side effects and complications from treatment is worth it or not.
Even if your condition will not clear up on its own, lifestyle changes such as improving your diet and doing more exercise might improve your symptoms. For example, some people are able to control epileptic seizures without medication by adjusting their diet.
3. What are the most likely side effects?
You may have been told that the medication being offered is “a good treatment”, but treatments are neither good or bad – it depends on whether or not they suit the individual person. Find out what side effects you are likely to experience and decide whether these are acceptable to you.
4. Are there any rare serious side effects?
Find out about uncommon side effects that might be serious so you can watch out for them. For example, the antibiotic doxycycline can cause some people to become depressed and suicidal. Proton pump inhibitors (PPIs) to reduce stomach acid can cause anxiety. Montelukast used in the treatment of asthma can cause neuro-psychiatric side effects. The danger is that uncommon side effects such as these may be mistaken for another illness.
Medications can sometimes cause paradoxical effects. This means the drug produces the opposite effect to what is intended. For example, a drug to lower blood pressure can cause blood pressure to increase in a small number of people. A drug that is intended to make you relax can make you jittery and anxious.
5. Can this drug cause any permanent problems?
Taking and stopping a medication is not the same as never taking it. There can be permanent consequences of some commonly used medications. For example, some antidepressants (SSRIs and SNRIs), treatment for acne (isotretinoin), and treatment for hair loss (finasteride) can cause long-term sexual dysfunction after stopping the drug. Someone with severe acne may consider it an acceptable risk, while someone with relatively mild acne might decide otherwise.
6. If this is a new drug, why can’t I take an older drug?
Older drugs are usually no longer on patent, which means manufacturers receive less revenue. When new medications come onto the market, pharmaceutical company marketing encourages healthcare providers to abandon older drugs in favour of their new product. However, older drugs can sometimes be just as safe, just as effective, and much more is known about their adverse effects because they’ve been used in the general population for longer.
7. Can I try a lower dose?
Medications are sometimes overpowered for the condition being treated. It may make sense to start on a lower dose to see if it’s suitable for you. Starting on a lower dose can also help your body to get used to medication.
8. What date will we review my use/dose of this drug?
You should be monitored regularly when starting, stopping, or changing the dose of a medication.
9. Are there problems or any special considerations on stopping the drug?
Doctors are good at starting people on medications, but are not so good at helping them to stop. Medications can sometimes cause problems on stopping:
Rebound effect – This is where the original problem comes back more severely for a short period. For example, stopping a drug that lowers your blood pressure can cause a sudden increase in blood pressure for a short time after stopping.
Withdrawal effects – Some medications can cause dependence, even after a relatively short course. Withdrawal effects can be severe in some people, making it difficult or impossible to stop the drug. Even reducing the dose slowly over a long period of time may not be successful. Stopping some medications can result in protracted withdrawal which means that withdrawal symptoms continue indefinitely, sometimes for years or even decades.
The danger is that rebound and withdrawal effects are often misdiagnosed as the return or worsening of the original illness, and are treated with more drugs and higher doses.
10. Are there any potential interactions with food, my other medical conditions, or my current medications?
Some foods and dietary supplements can reduce or increase the effects of some medications. For example, foods that are high in vitamin K can stop some blood thinners from working properly. Also, some dietary supplements can have the same action as medications, meaning that if you take both, you will be getting too much of the effect.
Drinking alcohol while on some medications can make you more drunk than expected.
If you have another pre-existing condition, it is important to consider whether a medication may affect it. For example, if you suffer from obesity, taking a drug that can cause weight gain as a side effect might not be ideal.
Some medications can have potentially dangerous interactions if used together. For example, taking more than one drug that inhibits serotonin reuptake can increase the risk of a potentially life-threatening condition called serotonin syndrome.
11. Might this drug affect my weight/sleep/hair/skin/nails/mood/sex life/relationships – and if so, how?
When you hear the term “side effects”, you might think of upset stomach or headaches. However, medications can have side effects that you wouldn’t necessarily think about, but they can have significant implications for your quality of life. For example, they may cause excessive weight gain, sleep disturbance, alter the quality of your hair, change how you think and feel, change how you relate to your partner, etc. These are particularly important if you intend to take the medication long-term.
12. Do I need to stop this drug before I get pregnant?
Some medications can be harmful to an unborn baby and can also be present in breast milk. A further complication is that some medications may be difficult or impossible to stop due to withdrawal issues if you were to unexpectedly become pregnant.