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Beware of Unnecessary Medications!

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An elderly lady who had tolerated her mild symptoms of abdominal gas for decades, was suddenly metamorphosed to a vegetative state thanks to an unusual side effect of a newly launched drug for gaseousness!. The disturbing video of this lady, with shaking of hands and twitching of face, shown to a gathering of doctors in a meeting in Lucknow recently evoked a uniform surprise “Gosh, I did not know this could also happen!”. Dr Debnandan further shared information gathered from the net that several such instances of an ailment resembling Parkinson ’s disease have been reported with this agent, the disorder becoming permanent in many.
Adverse reactions to medicines do occur in a minority and every doctor faces them from time to time. What constitutes a tragedy is when the reaction is grave or life threatening while the indication for prescribing the medicine was mild.
Take for instance the side-effect of constipation that comes with many draugs such as pain-killers, anti-spasmodics or anti-depressants. It does not pose a danger to life, and if anticipated, can be prevented by co-prescribing a fibre laxative like Isabgol.
Liver damage can however be a fatal complication of some drugs, especially ones used for treating tuberculosis. I recall looking after an eminent scientist who developed jaundice due to anti-tubercular medicines for a mild chest infection. By the time he was brought to us he was deeply jaundiced, developed liver failure, went into liver coma and passed away despite all efforts. Very careful serial monitoring of liver functions is therefore mandated when drugs with potential to harm the liver are prescribed.
Another side-effect we dread is suppression of the bone marrow, a condition in which the white blood cells, platelets and red blood cell counts fall precipitously predisposing the patient to fulminant infections or bleeding. An antibiotic chloromycetin often prescribedfor typhoid fever, used to be the commonest culprit, It occurs nowadays with anti-cancer drugs, but may also occur with certain medications like azathioprine used for treating ulceartive colitis and auto-immune hepatitis.
In this case atleast, help has come from the laboratory. A blood test now helps recognize individuals prone to developing this complication, either based on their genetic make-up (genetic polymorphism in our jargon) or the level of enzymes that inactivate the drug (TPMT enzyme assay). Although somewhat expensive (around Rs 3000/-) getting it done before starting the azathioprine adds a dash of safety and is now internationally recommended.
Unfortunately such tests are very few while the list and inventory of drugs and the catalogue of their serious adverse reactions is sky-rocketing! What means do we then have to make our lives safer?
A useful dictum is to give home remedies a try first and resist the tempation of popping a pill for every minor discomfort. Doctors need to avoid prescribing more drugs than absolutely necessay and remember that old trusted medicines are often safer than the new ones touted as magic cures.
As published in HT City( Hindustan Times) dated 10 June, 2012.
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