Have You Consented to Drug Risks?

If you’ve ever had surgery you were given a form to read and sign first. Doctors are legally and ethically obligated to provide information about the benefits and risks of operations.
Patients are expected to provide informed consent after carefully weighing the pros and cons. Without such a signature, surgeons would be reluctant to operate.
The same process of informed consent should apply whenever a physician prescribes a medication.
Back in 1970 an editorial in the Journal of the American Medical Association (Jan. 26) reminded doctors that, “When a physician prescribes a drug, he has an obligation to warn the patient about the drug’s potential for causing adverse reactions, especially the more serious ones.”
Many doctors conscientiously communicate the most serious and most common complications associated with the pills they prescribe. They verify that the individual has really understood the benefits and risks and has provided informed consent before accepting any prescription.
Others, however, barely warn about potential problems. One reader shared this sad story:
“My husband is now legally blind in his right eye and has 30 percent sight loss in his left eye because of a medication called amiodarone. This medicine was given to him for atrial fibrillation (an irregular heart rhythm). We were never told that visual problems could be a side effect of this drug. His optic nerve was destroyed and he will never regain his eyesight.
“There were other options available to us, but the doctor insisted he take this medicine. My husband stopped taking amiodarone when he started to lose his sight. The doctor told him not to stop, but if he had not done so, he would have lost all vision in both eyes.”
Although damage to eyesight is a relatively rare side effect of amiodarone (Cordarone, Pacerone), it is so serious that patients should be warned about this and other serious adverse effects before they start taking the medicine. If any visual changes are noted, discontinuing the medicine might preserve vision.
Other side effects may be less serious, but if they are fairly common, patients should be informed. We have heard from many readers like this one whose doctors failed to mention–or perhaps even to recognize–cough as a side effect of ACE inhibitor blood pressure pills:
“I started taking lisinopril in December. Soon after, I developed a nagging dry cough that I couldn’t shake. I have thrown up because the coughing was so bad. I have had blood tests and chest x-rays that all came back negative.
“In desperation, I went to an ENT (Ear, Nose and Throat) specialist, who told me this kind of cough is common in people my age (50) due to post-nasal drip. He knew I was on lisinopril but he gave me an antihistamine and cough suppressant. Of course, they didn’t help.
“I learned on your Web site that lisinopril can cause a chronic cough. I am furious that none of the doctors I’ve seen suggested changing this medicine.”
Rather than rage at the doctor later, patients need to take responsibility for getting the facts before accepting a prescription. Our free Drug Safety Questionnaire (www.peoplespharmacy.com) may help by providing questions the doctor should address before a prescription is filled.