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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