Watch Out for Problem Pills

When Michael Jackson’s doctor, Conrad Murray, was found guilty of involuntary manslaughter, many people might have concluded that propofol is an especially dangerous drug. This is the medication that Dr. Murray injected to try to put Michael to sleep when sleeping pills failed.
Patients might be unjustifiably scared of propofol if they need anesthesia for an operation. In truth, propofol is an excellent medicine when used as intended.
We worry far more about other common drugs taken by millions of people every day without sufficient appreciation of their potential problems.
In our new book, Top Screwups Doctors Make and How to Avoid Them, we discuss the “Top 10 List of Potentially Problematic Pills.” Some of these drugs may be crucial, even life-saving, but their potential for harmful side effects means they require extra caution.
One example is warfarin (Coumadin) and other anticoagulants. Such drugs are used to prevent blood clots that might cause a heart attack or stroke, but they also make people more susceptible to dangerous bleeding.
Walking the tightrope between hemorrhage and clotting can be challenging. Veering too far in either direction could be lethal, so finding the correct dose is critical. Interactions complicate this task. Warfarin interacts with many foods as well as scores of other medicines, so patients as well as physicians and pharmacists need to pay close attention.
Another life-saving medication that has many potentially serious interactions is digoxin (Digitek, Lanoxin, Lanoxicaps). Getting the dose right for this heart medicine can be tricky. When it is too high, patients may suffer loss of appetite, nausea, vomiting, stomach pain, diarrhea, weakness, depression, apathy or a greenish or yellowish tint to vision with a halo around lights. Close monitoring is essential with this drug.
Other drug dangers may be a surprise because some are available without a prescription. Thus they may be taken for granted.
More than 20 million Americans take a nonsteroidal anti-inflammatory drug (NSAID) daily. Medicines such as celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin, etc.) and naproxen (Aleve, Naprosyn) can damage the digestive tract to cause bleeding ulcers. Such drugs can raise blood pressure and increase the risk of heart rhythm irregularities, heart attacks or strokes as well as other adverse effects.
Some people aware of these possible hazards may choose acetaminophen (Tylenol) to ease their pain instead. Most patients think of it as one of the safest pills in the pharmacy. As a result of that belief, they may let down their guard. Unintentional acetaminophen overdose is a leading cause of liver failure in this country.
Other drugs that concern us include corticosteroids such as prednisone, anti-arrhythmic medications such as amiodarone (Cordarone, Pacerone) and dronedarone (Multaq) and third-generation anti-psychotic agents such as aripiprazole (Abilify), olanzapine (Zyprexa) and quetiapine (Seroquel).
All these medications are beneficial when used appropriately. We urge everyone, patients, pharmacists and physicians, to use these medicines with great care and awareness of the risks they entail. More details are available in our new book.