The People's Perspective on Medicine

Why Do So Many Doctors Ignore Obvious Drug Side Effects?

Doctors are some of the most brilliant and well educated professionals in the world. How come so many can ignore one of the most common drug side effects?

Some adverse drug reactions are subtle and easy to overlook. For example, doctors could be forgiven for not catching a vitamin B12 deficiency associated with long-term prescriptions of popular acid-suppressing drugs like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec). This complication was not taught in medical school and requires some digging to figure out.

Symptoms of vitamin B12 deficiency are also subtle. They sneak up on people over months or years and can include memory problems, confusion, numbness, tingling or pain in toes, feet or fingers, difficulty walking or burning tongue. A standard serum B12 test may not reveal the problem. A doctor might also need to order a test of methylmalonic acid (MMA).

The point is, doctors can be excused if they don’t immediately recognize drug side effects like vitamin B12 deficiency. It’s just not that obvious.

ACE Inhibitor Cough is NOT Forgivable!

On the other hand, there are some drug side effects are so recognizable that they should never be overlooked! One symptom in particular is called an ACE (angiotensin converting enzyme) inhibitor cough. Keep in mind that this class of blood pressure medications is one of the most commonly prescribed medications for hypertension. Tens of millions of prescriptions are written for drugs like captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik).

Every medical student in the world is taught that an uncontrollable cough is a common side effect of this category of high blood pressure medicines. Depending upon the study, a disruptive cough occurs in anywhere from 5 to 35 percent of patients who take an ACE inhibitor. That means every patient who gets a prescription for one of these medications should be warned of this potential side effect and if it occurs should be switched to another drug.

What’s the Big Deal About a Cough?

You might be wondering why we would be making such a big deal about such a seemingly simple problem. First, this cough is NOT simple. It can disrupt your life. It cannot be controlled with cough medicine. This is the kind of cough that can keep you awake at night or make you pee in your pants. It can have a devastating effect upon your quality of life as you will shortly read in real-life stories from patients.

What really drives us wild is that far too many doctors seemingly do not recognize that this cough can be caused by the blood pressure medicine they have prescribed. Patients get sent to allergists, pulmonologists and other specialists to be worked up for all manner of other ailments. The cost of this unnecessary testing is outrageous, especially when the solution is as simple as changing the medicine.

Here are just a handful of the many stories we have received on this issue:

Emma relates an amazing tale of desperation:

“I am so disgusted by the side effect of severe coughing, for six months now, not to mention also throwing up at least a dozen times. I have been to my doctor several times for this cough.

“First I was given Benzonatate (a cough suppressant). No improvement.

“I went back to the doctor a few weeks later and was given a shot of steroid. No improvement.

“I went back a few weeks later and was given a chest X-ray. All clear, but no change in the cough. I was given hydrocodone cough medicine [a narcotic] which I took at night in an attempt to get some rest. I am surprised my husband still sleeps in the same room with me. I wake him up all night randomly having coughing attacks.

“I am a Realtor and this has caused my business to come to a halt. I can’t talk for 5 minutes without having hacking attacks. My dear mother even suggested I get tested for TB.

“I’ve lost my voice, I can’t even stand to sing alone. My voice now sounds like some heavy smoker (I am not a smoker and never even get around second hand smoke).

“This all came on real fast after starting lisinopril for high blood pressure. It has cost me time, money, joy and basically I stay more to myself.

“I work out several times a week at a gym, but now try to go on off hours so as not to scare people. How long can you tell family, friends, and even strangers not to worry, that your cough is not contagious? This is awful.

“Thankfully the nurse noticed the fact I kept coming back because the cough was not going away. She asked if I happened to be on lisinopril and then suggested to my doctor that he change my prescription. Okay, well, it’s been several months now, and it has not let up.”

Donna shares a similar story:

“Lisinopril…it’s a nightmare. I had the flu three months ago and around the same time had to start blood pressure meds. One week into my flu I developed a horrible cough. Well I just thought it was the flu. Another week passed. I developed laryngitis from the cough.

“It’s been three months of coughing now. I have had two ER visits and three doctor visits. Today at 4:30 am, when I finally said I can’t sleep anymore, I made another trip to the ER.

“The doctor put me on yet another round of steroids and another antibiotic. I finally asked, “could this be my blood pressure meds doing this to me?” He said, “better talk to your doctor because it may be.”

“I called her and said, “How many ER visits, how many doctor visits, how many meds did I have to go through? I had to figure out it’s my blood pressure pills on my own!”

“Now that my family hates me for the months of annoying coughing and I can barely work because I’m in retail and have to talk. They want to put me on another ACE inhibitor! I flat out refused to take one. I have been miserable. I hope my Dr can find another solution because I’m done with doctor visits and pills.”

This from Lyn:

“I was prescribed ramipril about 8 months ago for high blood pressure. Since then I have had a terrible debilitating cough that kept me and everyone else awake most of the night. I have terrible bouts of coughing at work where it is impossible for me to go to meetings as I cough so violently that I gag and throw up.

“I even threw up while driving as I did not have time to pull over before throwing up. I am too embarrassed to go to the hair dressers, dentist or out for a meal due to the terrible bouts of coughing.

“I have been back to the doctors twice and been prescribed a nasal spray and montelukast asthma tablets. They did not work.

“I stopped taking the ramipril 2 days ago and the cough is subsiding quite rapidly. I no longer vomit or gag or cough as violently or anywhere near as frequently.”

The stories come in like the tide. One man passed out and hit his head while coughing because of lisinopril. A woman took an ACE inhibitor for years while complaining bitterly to her doctor about the nagging cough. He responded by prescribing cough medicine. She went on to tell us, “When the coughing got so bad that I wet myself, he prescribed a pill for incontinence!” Eventually a new doctor prescribed a different blood pressure medicine and the cough “went away in less than a week.”

What is the Point of This Tirade?

The point, dear reader, is that if so many physicians can misdiagnose an ACE inhibitor cough and prescribe heavy duty cough medicine, allergy medicine, asthma medicine and corticosteroids, something is very wrong with medicine today.

First, these doctors did not warn about the cough when they wrote the prescription. Second, they did not diagnose the problem promptly as caused by their prescription and third, they did not withdraw the offending drug promptly. Remember, this is such a common complication that every medical student must learn about this side effect. It is clearly described in the official prescribing information.

If the ACE inhibitor cough can be missed, then goodness knows what other drug-induced side effects go undetected or mistreated. Yes, we know that doctors are way too busy these days, but this is too important to overlook. Each year hundreds of thousands of people die because of medical mistakes: misdiagnosis, deadly drug reactions or interactions, hospital acquired infections and other avoidable mishaps.

To find out how to protect yourself or someone you love from such disasters, we suggest our book, Top Screwups Doctors Make and How to Avoid Them. You will learn ways to avoid being misdiagnosed and which drugs people over 65 should avoid like the plague. Warning: they are some of the most popular drugs in the pharmacy. Learn more here. Share your own story below in the comment section and please vote on this article at the top of the page.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Lisinopril does cause a cough – in my case, it has caused a nearly continual urge to clear my throat. I can no longer sing. My friend takes it and has a cough from it, and her singing voice is affected, too.

Your “tirade” is understandable, but it would have been very helpful if you had included links to articles that have suggestions about how to deal with this. Of course, I guess my friend and I will go to an ENT doctor, but in the meantime…

…the only things I have found so far on the internet that suggest remedies are ridiculous ideas such as homeopathic stuff (a drop of a disease in tons of water does nothing, and along with making absolutely no sense there is NO science to back up that claim), acupuncture (same deal), “natural/quack so-called cures”, and just discontinuing the medication (sorry, I don’t want to stroke out).

Would have been helpful to at least have a few medically sound links.

The cough from lisinopril is inextricably bound to its effects. So someone who is suffering from the cough needs a different category of blood pressure medication. Sometimes the doctor will choose an ARB such as telmisartan. Here’s a link:
http://www.ncbi.nlm.nih.gov/pubmed/22272064
Here is an article in which various blood pressure drugs are compared: http://www.ncbi.nlm.nih.gov/pubmed/14685749

The second part of my story is unbeknown to me. I
thought the lymphoma is what did him in until I read the death certificate that my husband was suffering from coronary artery disease for the last five years and all of a sudden it finally was easy to see he was failing. The rheumatologist aparantly was negligent in noticing anything wrong and the cardiologist who you assume would have made a much bigger effort to help my husband but I saw nothing more than the usual treatment he was getting for years. As a patient of this cardiologist myself, this doctor never ever took anytime to speak to me about my husband. I had no idea anything was really wrong. If I had known you bet I wouldn’t have just sat by, I would have looked fully into the matter. I’m not the doctor here but when I read what can be done I say to myself where was this doctor and why he did nothing. Not one doctor said a thing to me until it was too late and at that point I still was unaware of what was going on.

My story is about a rheumatologist who was treating my husband with Remicade, a drug used for rheumatoid arthritis. It’s a fact that Remicade can and does cause lymphoma, which is exactly what happened. The doctor took no precautions to monitor my husband for any serious side effects relating to the start of lymphoma (fungus) during the period he was on Remicade. Needless to say and it’s no surprise to me that this doctor denied any wrong doing. In other words it’s still a “mystery” but I know what happened and I’m out to prove it.

I think you’re being way too kind, by letting doctors off the hook, for prescribing acid blockers, without those prescribing doctors knowing that acid blockers cause a Vitamin B 12 deficiency (by acid blockers preventing the stomach from making “intrinsic factor” molecules”, resulting in mal-absorption of Vitamin B 12 in the ileum of the small intestine), and then the Vitamin B 12 deficiency results in peripheral neuropathy nerve damage, etc.!

There should be a rule, that if a doctor wants to prescribe a medication, that the doctor should first learn about potential and actual adverse side effects, and then decide if s/he really wants to prescribe those meds!

How did I find out about this problem of acid blockers causing peripheral neuropathy nerve damage? I found it out, when I myself got a peripheral neuropathy, not because I was on acid blockers (I’ve never taken an acid blocker in my life), but because my stomach was obviously not producing enough HCl (Hydrochloric acid), due to my not being a youngster!

Now, I use some apple cider vinegar, and, sub-lingual “Methyl” cobal amin type of Vitamin B 12–which helps to reverse that peripheral neuropathy.

If I could figure this out, and I’m not a doctor (just a retired nurse, and someone who questions authority from time to time, and who appreciates your writings!), then doctors should be able to figure this out, too–so don’t give them so much of a pass!

I’m a type one Diabteic and i recently discovered I have neuropathy in my eyes. I’m on a mission to hault my complications and attempting to reverse them. I’m currently on dr Bernsteins diet plan and I’m taking apple cider vinegar. I was wondering where I can find that form of b12. I have b complex supplements but I wasn’t sure if that’s the same so I was hoping you could give me examples and tell me where to find them! Thank you!

It took several years and a life of basically staying home and close to the bathroom before a doc recognized that my husband was taking Metformin, causing his uncontrollable diarrhea.

Unfortunately, this really hit home with me in 2007. I was hospitalized because of a chronic cough and given steroids along with Avelox IV, and found out I did not even have an infection to warrant being given a Fluoroquinolone Antibiotic. My cough was due to the ACE inhibitor Lisinopril. The doctors treating me at the hospital for 3 days should have known that. A week later I could not walk. Had many adverse reactions from Avelox but 7 yrs. later I am still suffering crippling pain and weakness in legs. Muscle biopsy shows damage done, and I am afraid the damage is permanent. Please take heed if your Dr. prescribes a Fluoroquinolone please ask if a safer antibiotic can take its place. These Fluoroquinolone antibiotics are so toxic not work the risk of playing Russian Roulette with your life.

I have wondered if many physicians are reluctant to admit that a drug they ordered might harm a patient even when a clearly stated side effect is involved?

You have probably heard of defensive driving?

How about defensive patienting – check for yourself on possible side effects if you experience anything suspicious.

What about Macrodantin? Does it have an effect on the lungs? Can it cause pulmonary fibrosis? Is there a warning on Macrodantin prescriptions?

I have had three UTI’s in the last six months that were resistant to most antibiotics. My urologist prescribed Cipro each time and my side effects have become more severe and longer lasting each time. He “threatened” to put me on IV antibiotics and have already told him that I wil not take Cipro again and if necessary prefer the IV antibiotics.

let us not forget that besides the lowered quality of life associated with this type of cough, a history of ace inhibitor induced cough is associated with a 9-fold risk of angioedema (swelling of the face, tongue, and possibly gut).
Source:
j eval clin practice 2004;4:449-509

the Fluroquinilones (Levaquin, Cipro, Avalox, Floxin) are prescribed for minor ailments; they should be used only for like threatening situations when nothing else will work.

The FDA has a Black Box warning for these drugs, re nerve damage, tendon rupture and a huge list of possible side effects. The patient is not warned and sometimes suffers permanent damage. Many side effects are delayed and the patient never connects their problems with the medication.

Nothing like clueless doctors and pharmacists handing out Fluoroquinolone antibiotics (and worse sometimes also giving contraindicated corticosteroids with them) to ruin a life. These are used for non life threatening or worse unconfirmed infections. It’s down right criminal. Lives are being ruined over sinus infections.

I did some genealogy dna testing and in the informative literature I found out that some people’s dna determines that they cannot tolerate many medications. My mother could not tolerate most blood pressure meds. I cannot tolerate BP meds. My cousin on mother’s side cannot tolerate BP meds. The doctor blames ME and says “And you won’t take your medications.” I’ve tried half dozen BP meds and get horrid face swelling, coughing, neuropathy in my feet, or bright red skin. One doctor wanted to put me on a 2nd med to counter act the first, and a 3rd med to counteract the 2nd med, all at the same time. No way. Absolutely no way. Halving or quartering sometimes helps in other meds, but didn’t help in the bp meds.

I really like the forum as I have been fighting intense reactions To IV’s of Levaquin… through diligence of a faithful nutritionist, for month, I have been able to turn around most of the damage.

I look forward to being a subscriber

thank you

I began reading The People’s Pharmacy in a newspaper once a week.

After reading a lot of INTERESTING AND most INFORMATIVE information, I discovered they had a book to buy.
That book is my first go-to source for information on a new medical problem. It might not always have an answer, but it is usually a place to start to get a question answered.

Now I get the newsletters and am learning more.
Thank you Dr. Graedons for helping enlighten people about health problems.

I took methotrexate for 5 years. The side effects were horrendous. I gave myself a weekly injection along with a zofran tablet to prevent the nausea. I lost 40 pounds (20 would have been ok). I also took prednisone along with pepcid to prevent the stomach problems caused by the prednisone. Pepcid caused me to not be able to absorb nutrients (b12 and folic acid were the most noticeable and showed up in blood tests).
I had to have B12 injections weekly and increased my folic acid to 5 mg weekly. Prescription folic acid was too expensive and I ended up ordering huge bottles online. It was a horrible merry go round of feeling so tired I could not get out of bed most days. By the time I could get up for a little while it was injection day again and I had to start all over again. I complained to my doctors about the side effects and they ignored me. Finally, I had enough and took myself off of it last October, 2014. I am just starting to get my appetite back. I am no longer stuck in bed but my energy level is lagging. A word of advice. If the side effects are too much to bear then just stop taking the medicine and find another doctor (like finding good doctors is easy these days). Methotrexate is poison and was used as chemo for breast cancer in the past. Sometimes the side effects are worse than the disease the medications are supposed to be treating. I don’t think I will ever be the same. There are lots of immunosuppressants out there with some very nasty irreversable side effects. I went in knowing what the side effects could be yet my doctors had me believe that this was my only hope. It was not worth it to me. I

As my name says……my life has been ruined by Levaquin……..if anyone doubts the dangers of Fluoroquinolone Toxicity JUST please google it, and do not become a VICTIM, there is no treatment or cure………just a ruined life…….

Besides the meds you wrote about, there is a group of antibiotics known as fluoroquinolones. A few of the “popular” ones are, Cipro, Avelox, Levaquin, Floxin in ALL forms, IV, pills and topicals such as ear and eye drops. These drugs can have very troublesome side effects, long term and delayed, that 99% of drs disregard! We will also go from dr to dr, test after test not connecting the dots that an antibiotic could be the culprit.

I know you have written about this group before and we in the “floxed” community appreciate it. In the past several months there has been an onslaught of evening news reports all over the country warning people of the perils of these drugs. The only problem about these reports is the reporter’s end remarks. ” Ask your Dr about the side effects before taking them”. Unfortunately, your Dr either doesn’t know or won’t admit they aren’t as rare as the insert states. Big Pharmas win again.

Sir/Ma’m
I am feeling nubness/tingling in my hand/leg/other parts of body on adulteration of Jalra M 50/500.Is it also due to side effect of Vit. B-12 Deficiency?.
If it is so which medicine should i use to control diabetes without side effect?

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