A Pharmacist Explains How to Cope with Medication Side Effects

Medications can help you feel better when you are sick and help you manage chronic diseases, aches, and pains. Unfortunately, all medications have side effects, and some of them may make it difficult to take your medicine correctly. Knowing what to expect from your medicines is vital for helping you cope with your medication side effects.

What Is the Difference Between Allergic Reactions and Side Effects?

The first thing you need to understand is the difference between medication side effects and allergic reactions. You might believe that you are allergic to a medication if you experienced a side effect, perhaps a severe one, but one that may have been manageable. If you then classify that drug or drug class as one to which you are allergic based on that experience, it limits future therapy and may result in less than optimal treatment.

An allergic reaction is when your immune system reacts to a foreign substance, which often results in a rash or hives, itching and swelling, and, in severe cases, swelling of the throat, which can cause closing of your airway. Side effects generally do not involve an immune system reaction and, in the majority of cases, are not life-threatening. Some of the most common side effects include nausea, dry mouth, constipation, diarrhea, drowsiness, dizziness, cough, and confusion or difficulty concentrating.

Factors that Affect the Development of Side Effects

Although all drugs have a list of side effects, not everyone experiences the same side effects or at the same intensity. The following are factors that may make you more prone to developing some side effects:

• Age – Infants’ kidneys and livers are not fully developed, and this may affect the metabolism and clearance of some drugs. Additionally, it is easier for medications to cross into the brains of infants, which increases the risk of certain side effects. At the other end of the spectrum are older adults, who are more likely to take multiple medications that may interact, which increases the likelihood of side effects. Older adults may also have decreased ability to clear medications from the body, which contributes to drug side effects.
• Gender – Women generally have smaller bodies and organs and have more body fat in comparison to men. These differences can affect the way that drugs pass through your body.
• Kidney and liver function – People who have decreased kidney or liver function are more likely to have side effects from drugs that are cleared or metabolized through these organs.
• Fat distribution – People with excess body fat tend to accumulate fat-soluble drugs in fatty tissues for prolonged periods, even after the person has stopped taking the medication.
• Alcohol – Alcohol hinders the metabolism of some drugs, causing your body to accumulate the drug and increasing the possibility and intensity of side effects.
• Smoking – Tobacco, although not the nicotine in tobacco products, affects the metabolism of some medications and decreases their therapeutic effect.

Understanding the origin and the mechanism of your medication side effects can help you cope with and manage any unwanted symptoms.

Anticholinergic Side Effects

Anticholinergic side effects are a group of symptoms caused by anticholinergic drugs, which includes some psychiatric medicines, older antihistamines like Benadryl (diphenhydramine) and chlorpheniramine, medications for bladder spasms, and medications for overactive stomach. The following is a list of anticholinergic side effects:

• Dry mouth
• Blurred vision
• Dizziness
• Constipation
• Urinary retention
• Increased heart rate
• Confusion and inability to concentrate

If these anticholinergic side effects are bothersome or severe, you can talk to your doctor about decreasing the dose of your medication to reduce the side effects. You should avoid other prescription or over-the-counter medicines that have the same side effects. If you must take both medications, talk to your doctor about decreasing the dose of other drugs that cause these side effects.

Dry Mouth

Dry mouth, or xerostomia, is uncomfortable and can negatively affect your health and well-being. It can interfere with eating, causing dentures to rub on and irritate your gums, contribute to dental cavities, and can cause yeast infections in your mouth (thrush). Medications that can cause dry mouth include blood pressure medications, antidepressants, antihistamines, anxiety medications, and antipsychotics.

You can use different methods to manage dry mouth. Choose low-sugar and low-acid foods and avoid dry foods. Avoid mouthwash that contains alcohol. Use a room humidifier at night. Sip water or suck on ice chips during the day. Moisturize your lips to keep them from cracking, and talk to your doctor about using the lowest effective dose of your medication.

If dry mouth cannot be avoided, several saliva substitute products are available over-the-counter as mouth rinses, sprays, and chewing gum. Some examples are:

• MouthKote
• Oasis
• Biotene

Additionally, Salagen and Evoxac are prescription products available that stimulate saliva production.

Constipation

Several drugs, including anticholinergics, iron supplements, antacids containing aluminum, and some pain medications, can cause constipation. The following are some ways to relieve or prevent constipation:

• Increase your fluid intake, especially water.
• Increase your fiber intake.
• If possible, increase your exercise and mobility. Moving your body helps to move your digestive tract.
• Ask your pharmacist about over-the-counter laxatives and stool softeners.
• Ask your doctor about prescription products available to prevent constipation.

Diarrhea

Drugs that can cause diarrhea include chemotherapy medications, metformin, and antibiotics. Antibiotics are perhaps the most common drugs known to cause diarrhea. Diarrhea associated with antibiotics is due to the loss of the normal bacteria that live in your digestive tract. To preserve your natural bacteria and prevent or reduce diarrhea, always take your antibiotics with food. You can also eat yogurt that contains live cultures or take probiotics while you are taking antibiotics. Remember to separate the yogurt or probiotic from your antibiotic by a few hours to prevent the antibiotic from killing the live culture.

Nausea

Nausea is a common side effect present with many medications, but it is most prevalent with the following drugs:

• Chemotherapy drugs
• Opioids
• Antibiotics
• Anti-inflammatory drugs (NSAIDs)
• Antidepressants
• Digoxin

To prevent nausea, take your medicine with food unless it must be taken on an empty stomach. Ask your doctor or pharmacist if your medication can be taken at bedtime in order to have most of the nausea pass while you sleep. Sometimes, changing the formulation of your medication can alleviate side effects (for example, changing from tablet to liquid or vice versa). If this is not possible, talk to your doctor about switching to a different medication in the same class or changing to a different class of drugs.

If your medication cannot be changed, and your nausea persists, prescription options are available that help control nausea. Promethazine (Phenergan) and prochlorperazine (Compazine) are available for short-term treatment of nausea. If you need a medication to control nausea for longer, ondansetron (Zofran) can be used long-term.

Drowsiness or Dizziness

Medications that can cause drowsiness or dizziness include anxiety medications, older antihistamines such as Benadryl (diphenhydramine) and chlorpheniramine, opioids, some antidepressants, muscle relaxants, and some blood pressure medicines.

To manage drowsiness or dizziness, try taking your medication at night or ask your doctor about splitting up your dose throughout the day. Some medications can be slowly titrated up to your therapeutic dose to decrease sedation. Many blood pressure medications cause orthostatic hypotension, especially when you first start taking them. This is when you have a sudden decrease in blood pressure, causing dizziness, as you move from lying down to a sitting or standing position. To avoid this effect, be sure to get up slowly from your bed. First, sit up for a few minutes, then hold on to furniture around you as you stand up.

Cough

Some people may experience a dry cough while taking blood pressure medications known as ACE inhibitors. The cough will resolve after stopping the medication. If it is too bothersome, you can talk to your doctor about switching to another class of drugs.

The more you know about your medications and what you might experience, the easier it is to cope with side effects. Often, medications are essential to your health and your survival. Have a conversation with your pharmacist before you begin taking any new medication to learn the expected side effects and the best ways to manage them. You do not always have to just live with medication side effects, sometimes you can manage or even alleviate them.