Health professionals often categorize drug side effects three ways. First come the common complications of medicines. If 20 to 30 percent of patients complain of headaches or diarrhea after taking a medicine, that is clearly common. Patients should be warned.
Next are the so-called minor drug side effects. These may not even be mentioned, especially if they occur less than 5 percent of the time. For example, insomnia or headache are often perceived as mild complications of some medications.
Then there are the serious or even life-threatening complications. Not infrequently, these adverse drug reactions are perceived as extremely rare. Many physicians and pharmacists may decide that they have no need to discuss such scary side effects with patients. They may assume that doing so would just worry people unnecessarily.
TV Commercials Must Spill the Beans:
If you ever watch television, you know that prescription drug ads have proliferated like dandelions after a spring rain. They often list a number of serious or even life-threatening side effects. This is an FDA requirement for airing drug ads.
But companies have figured out sophisticated strategies to distract viewers during the scary stuff. You often hear serious drug side effects recited while people on the screen are smiling and having fun.
Xeljanz XR (Tofacitinib) for RA:
The commercial for the rheumatoid arthritis drug Xeljanz XR cautions that it:
“…can lower your ability to fight infection, including tuberculosis. Serious, sometimes fatal infections, lymphoma and other cancers have happened…Tears in the stomach or intestines, low blood cell count and higher liver tests and higher cholesterol levels have happened…”
Vraylar (Cariprazine) to Treat Bipolar Disorder and Schizophrenia:
A medicine for bipolar disorder, Vraylar, warns of an increased risk of death or stroke in older people with dementia. Fever, stiff muscles or confusion could signal “a life-threatening reaction.” Uncontrollable muscle movements may be permanent. The announcer continues:
“High cholesterol and weight gain, high blood sugar which could lead to coma or death, decreased white blood cells, which can be fatal, dizziness upon standing, falls, seizures, impaired judgment, heat sensitivity and trouble swallowing may occur.”
Minor Drug Side Effects?
The adverse reactions listed during TV commercials are not the only problems patients may encounter with prescribed medications. Doctors and pharmacists might or might not mention adverse reactions such as lymphoma or seizures. Even though they are serious, some health professionals choose not to mention these scary side effects.
Many medicines also have the potential to cause less serious complications. Doctors and pharmacists refer to them as “minor drug side effects.” They include things like fatigue, cough, headache, heartburn, constipation, diarrhea, insomnia, weight gain, hair loss and blurred vision.
Such reactions may not be life threatening, but they can make people’s lives miserable. Often, people may not realize that a health problem is related to their medication. If a health professional doesn’t mention minor side effects, how would a patient figure out the connection?
The ACE Inhibitor Cough:
One of the most popular drugs in the pharmacy is lisinopril, prescribed to control blood pressure. Doctors who prescribe it may not mention that this ACE inhibitor can cause a chronic cough. It may seem like a trivial problem. One reader related this story:
“A month and a half ago, my doctor prescribed lisinopril for my hypertension. She never told me about any side effects. I had been taking it for about three weeks when I woke up one night with a horrible coughing spell. This went on for about a week. I was getting no sleep at all because of the coughing and the irritation in my throat.
“I went back to my doctor and she told me that I had allergies. She prescribed a steroid inhaler and told me to take Zyrtec once a day. Another week went by, and I still had a dry, hacking cough. It was getting so bad that I couldn’t go to work.
“I am an ex-smoker and I was imagining the worst: throat cancer, emphysema or the like. I searched online to see if anyone else was having the same problems and I found The People’s Pharmacy website. What a revelation that lisinopril was causing the problem all along!”
We have heard from hundreds of visitors about the problems they have encountered with ACE inhibitors like Lisinopril. Here is just one such article:
ACE Inhibitors and Angioedema:
Another problem with drugs like lisinopril is a strange reaction called angioedema. It can come on suddenly, with no warning. It can also strike after years of seemingly safe treatment. The tongue and throat can swell. Breathing can become impossible.
Cindy shares her story of gabapentin for nerve pain:
“I’ve been prescribed gabapentin for nerve pain in my lower legs. I have been taking it for three years. I have worse depression, severe blurred vision, dizziness, muscle twitching, sudden sweating. I’ve talked to my doctor about this and he didn’t seem to be very concerned.”
The official prescribing information for gabapentin includes this warning:
“Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.”
Worsening depression is not a minor side effect!
Hydrochlorothiazide and Skin Cancer:
A diuretic called hydrochlorothiazide (HCTZ or HCT for short) is one of the most popular drugs in the world. According to our calculations, 20 million Americans swallow a pill containing HCTZ every day. It is considered super safe by many health professionals. If side effects are mentioned, lower potassium levels would probably be the main issue.
This seemingly benign water pill has a slew of other side effects. It can lower other minerals besides potassium (sodium, magnesium, zinc). It can also raise blood sugar, uric acid and cholesterol. Dizziness, especially upon standing up, is a potentially serious side effect if it leads to a fall.
More information is found here:
We bet that there is one side effect that is rarely, if ever, mentioned. It is skin cancer (squamous cell carcinoma or SCC). Danish researchers have linked thiazide diuretics like HCTZ to this surprisingly common skin cancer (Journal of the American Academy of Dermatology, April, 2018).
Tee in Louisiana shares a story about SCC.
“I am completely devastated to find out about this medication. I have been on it since around 2007. In 2016 I was diagnosed with squamous cell carcinoma. I had to have 5 surgeries to have the left side of my nose removed and to rebuild what was taken. My septum collapsed during surgery. They had to remove cartilage from my ear to rebuild my septum.
“It was truly a nightmare and the most painful thing I have ever had to go through. Thank God I had wonderful doctors because it was very hard to deal with. I was scared to death. I was under the care of doctors from late 2016 to July 2017. It is truly devastating to find out this this medication might cause this type of skin cancer. I had no idea.”
While squamous cell carcinoma is much less dangerous than melanoma, Tee’s experience suggests that it can indeed be serious.
Antibiotics and the Nervous System:
People love antibiotics. There is no doubt that this class of medicines has saved millions of lives over the decades. Most people think that antibiotics are benign, with few drug side effects. Diarrhea is probably perceived as the most common problem.
Some antibiotics in the class called fluoroquinolones (FQ for short) can produce serious and lasting complications.
Sam in Melbourne, FL is having an ongoing reaction to levofloxacin:
“I had a very active life before taking Levaquin last year. As a result, I got chronic insomnia. It ruined my life along with ongoing digestive issues. I am not sure what else will come after these two issues. I am suffering.
“I am in my 30’s and lost control of my life and became isolated from all my friends due to mood issues, fatigue and sleep problems. I have not slept properly since July 2017 and have headaches all day since then. I try to exercise 3-4 times a week and eat healthy food but I am not sure what else I need to do in order to get my life back.”
Judy reports somewhat similar reactions to Cipro (ciprofloxacin):
‘Two doses of Cipro taken over one day in December, 2005, have taken away my life. I am still suffering (May, 2014) and it has been a horrible, painful journey. Issues have changed over time, but they re-cycle.
“To date, I have enormous burning pain over my entire body (some have likened it to chemo pain). I also have severe GI issues, vision issues (nearly blind) and have had at least 1 TIA (transient ischemic attack). I walk with a 4 pronged cane. I have had many CNS problems including sleep disturbances from insomnia to nearly constant sleep. I also have connective tissue/tendon/ligament/muscle issues, which range from pain to rupture.
“I have just had a ramp installed in my home as I will soon need a motorized scooter. I have not been able to walk stairs since the day I took the 2 pills. That was over eight years ago! I was FINE the day before I took the pills. Other than a suspected UTI, in fact I had just finished packing and moving the contents of a condo cross-country.
“Funny, it turned out I did not have a UTI after all, but the doctor was being cautious. I have since found out that Cipro is not to be given to those over 60. I was 62 when I was ‘floxed’.”
People’s Pharmacy Perspective:
We are tired of the term minor drug side effects. Many people have shared their distress with drug-induced hair loss, rash, headache, dry mouth or constipation. Such symptoms may not be as scary as cancer or liver damage, but they deserve serious attention. They can profoundly affect the quality of a person’s life. Sometimes a minor side effect, like dizziness, can be life threatening if it leads to a fall and a hip fracture.
Health professionals should write down common and serious drug side effects before letting a patient leave the office. Symptoms to look out for must be included in the list! That will allow patients to recognize and respond promptly to adverse drug reactions that could affect the quality of their lives.
To help with this discussion we offer our free Drug Safety Questionnaire and Medical History
You may also find our book, Top Screwups, of value. It too includes a Drug Safety Questionnaire along with guidelines to help prevent minor or major drug side effects. You will learn about the way to avoid the top 10 mistakes doctors make when prescribing.
Share your own experience with “minor” drug side effects in the comment section below.