When most physicians prescribe medications, they may not realize they could be in danger of violating the Hippocratic principle to first do no harm. That’s because virtually every drug has the potential to cause adverse reactions for some patients. And sometimes drug side effects last a very long time.
The Benefit to Risk Ratio is Hard to Calculate:
Many prescribers believe that the benefits of any given medicine must outweigh the risks. Otherwise, they would not prescribe the drug. But it is hard to predict who will experience an adverse reaction and who won’t. Even when there are complications from the treatment, doctors expect symptoms to disappear after the drug is discontinued.
That’s not always the case. There are some medications that can cause irreversible harm. Patients must be warned of that possibility in advance, even if the likelihood is low. When drug side effects last a long time some physicians deny they could be caused by the medicine.
Tardive Dyskinesia is a Classic Complication:
One disturbing irreversible drug reaction is called tardive dyskinesia (TD). This uncontrollable movement disorder can result from treatment with antipsychotic medications such as chlorpromazine (Thorazine), haloperidol (Haldol) or thioridazine (Mellaril).
Even newer medicines such as risperidone (Risperdal) and aripiprazole (Abilify) can trigger this reaction. An old drug sometimes prescribed for digestive problems, metoclopramide (Reglan), is also capable of causing the disorder.
Physicians initially dismissed the facial, lip and tongue movements, torso jerks and finger taps of tardive dyskinesia as “inconsequential, not drug-related, and certainly rare” (Annual Review of Medicine, Feb. 1975). Now, no one doubts the connection with the medications, especially if they are administered for a long time or at high doses.
TD is hardly inconsequential from the patient’s point of view. One reader reported:
“I was diagnosed with bipolar disorder and placed on a mood stabilizer. The psychiatrist indicated that adding Abilify would be helpful.
“I began to pace and was unable to sit still. I literally walked the halls for three days straight. I was desperate for relief and…needed to be hospitalized.
“The symptoms persisted long after the medication was taken away. I also had uncontrollable movements with my tongue and slurred speech. None of these side effects were discussed with me [beforehand].”
Stopping antipsychotic drugs suddenly can sometimes set off an uncomfortable withdrawal syndrome, so coming off such medicines should be done only under medical supervision.
Statins and Muscle Damage:
Tardive dyskinesia is not the only potentially irreversible side effect that worries us. Cholesterol-lowering medicines such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) may sometimes lead to permanent muscle damage.
A study in the journal Current Opinion in Rheumatology (Nov., 2013) reports on an autoimmune condition called necrotizing myopathy. For susceptible individuals, taking a statin turns the immune system against muscle tissue, resulting in muscle destruction that may not be repairable.
Can Drug Side Effects Last from FQs?
Fluoroquinolone (FQ) antibiotics (ciprofloxacin, levofloxacin, etc) can cause tendon rupture and long-lasting nerve damage. It took decades before the FDA recognized that these drugs side effects last a long time. Sometimes they are permanent. Here is the official FDA announcement:
“The U.S. Food and Drug Administration is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolones should be reserved for those who do not have alternative treatment options.
“An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.”
Mary in Georgia reports that drug side effects last:
“Ciprofoxacin has devastated me. I was prescribed Cipro for a UTI in April of 2015. Seven days later my feet and ankles were swollen beyond belief. I went back to the same doctor and he gave me Lasix to get the fluid down. It did not help.
“I then started my journey to multiple doctors to try to find out what was wrong with me. I was fatigued beyond belief and could hardly walk My legs were swollen and my calves so tight. I kept trying to go to work.
“Six weeks later the first Achilles tendon tore and a week later the second one went. By this time I was about done in and had minimal mobility. My PCP sent me to a podiatrist. The MRI confirmed the tears and I went into boot casts at 65. I was not a candidate for surgery.
“I developed severe Colitis and diarrhea for four months. I was hospitalized three times. I was put on steroids to combat the Colitis. Steroids impede tendon healing and put me into adrenal insufficiency.
“Oh, the list goes on. I lost 35 lbs and ended up with malnutrition. The tendons finally healed and off I went to 8 months of PT. I still can’t walk right and my gait is totally off and always will be due to the fact that the tendons healed elongated. I still don’t feel right. I lost my job and more than a year out of my life.”
Sexual Side Effects That Last:
The prostate medicine finasteride sometimes used to treat male pattern baldness has been reported to cause long lasting sexual side effects (Journal of Sexual Medicine, Nov. 2012). Another drug prescribed for enlarged prostate problems is dutasteride (Avodart). Here are some stories from readers:
D. C. states:
“I took Avodart for about 15 months before stopping on my own because of the sexual side effects. Although, after a few months Avodart helped the trips to the bathroom at night, it caused my breasts to enlarge and literally destroyed everything related to my sex life.
“I thought I’d rather get up in the night than deal with the side effects. After 6 years of no Avodart my breasts are normal, but the same sexual side effects described in the article are still there [low libido, erectile problems, reduced penis size and reduced sensation or pleasure during orgasm]. Avodart is a very bad word in my vocabulary.”
Please Warn Patients If Drug Side Effects Last:
When drugs can cause such serious and persistent problems, patients must be informed in advance. If they know what symptoms to watch for, they may be able to stop the medication before lasting damage is done. Knowing about the possibility of persistent adverse drug reactions before starting a medication, some people may opt for a different treatment approach.