The Side Effects of Side Effects

We have all seen the TV ads for popular prescription drugs. One shows a young woman running through a field with butterflies all around her. Another familiar ad zooms in from the back to capture an attractive older couple sitting in adjacent bath tubs on the beach (who lugs two bathtubs to the beach, anyway?).

Just as these bucolic scenes penetrate the brain, we hear a calm authoritative voice go through a long list of potential side effects of these miracle drugs, anything from a mild upset stomach to blood pressure fluctuations to death.

But why do drugs have to have these dreadful side effects? There are many reasons, but the most straightforward is that it is difficult to get a drug to interact with only one part of a body. Drugs have an effect on the whole body and while you might be prescribed a drug for one symptom, that medicine will interact with all of your body’s systems, creating more symptoms.

The Codeine Example

For example, codeine is generally prescribed for moderate pain. It’s an opiate and works by blocking the pain receptors in your brain and slows your body’s systems. Codeine is also used in some prescription cough syrups because it calms the spasms of a cough. Because codeine (and all opiates) slow down all the systems in your body, it can cause constipation — it will relax the “ripples of muscle contractions and relaxations that move food along the digestive tract,” as the New York Times put it in a recent Q&A.

Here’s another thing about medicines and side effects — one drug leads to another. Because constipation can be a serious health condition, doctors may offer a second prescription, naloxone, which counters the effects of opioids on digestive receptors. How so? Naloxone unblocks the pain receptors that the codeine blocked, so you feel the pain for which you were given the codeine that led to the constipation.

Lactulose is an over-the-counter constipation remedy. It’s less strong and seems as if it should be safe because it is a synthetic sugar. When it gets to your colon, it will pull liquid out of the walls of the colon, easing constipation. However, because of its method of action in your body, it can cause stomach pain and cramping, gas, nausea, vomiting and diarrhea. You get the idea!

The Medicine ROI

When you go to the doctor for a pain medication and the doctor offers a prescription, whether for codeine or any other medicine, consider this: How long will the pain last if unmedicated? Can you tolerate the pain? What are the side effects of the medicine? Are the side effects worth the relief? Will the side effects of this prescription cause you to seek another drug? Are there alternative drugs or physical therapy and lifestyle changes that would help mitigate your pain?

Is my doctor’s advice the right medical decision for me? Or do I need to do my own research and conduct a risk/benefit analysis? We are all consumers and advocates, and if there is one product category that requires a pro/con analysis, it’s prescription drugs.


Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.


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