Medications: Read This Before You Take Them

Information for patients at The Spine Surgery London

Introduction

We will often prescribe drugs. Most drugs in most people cause some side effects. These are actions beyond those the drug is being taken for. Commonly these additional, unwanted effects are minor such as slight drowsiness, a funny taste or mild indigestion. The drugs we use for injections and those we might suggest you take by mouth are usually quite standard and will therefore very often have some mild side effects. The side effects along with the desired effects will usually stop after the drug is discontinued. Occasionally the same drugs can cause serious and permanent side effects. All the drugs doctors use have killed people as have those you can buy over the counter. This is of course very rare.

Always read the packet

Before you take any tablets, including those we prescribe, make sure you have read the information leaflet that comes with them i.e., ensure the pharmacist gives it to you with the tablets. We will cover the issues which seem relevant during your consultation, and in some of the written information we give out, but this is not a substitute for you reading the information sheets provided by the manufacturer inside the box.

Side effects

In broad terms there are five groups of side effect.

• Commonly side effects are predictable, occur in proportion to the amount used (eg. the more you take the more drowsy it makes you) and go away when you stop taking it.
• The more dangerous type, are unpredictable, can occur suddenly and after you have taken a drug without trouble for months. These may be fatal or irreversible and usually consist of catastrophic effects on the liver, blood, skin or kidneys. These are very rare.
• There are those that relate to specific pre-existing conditions such as diabetes when steroids may cause disruption of insulin requirements. It is important that we are aware of any medical condition you might have besides the one we are treating. Likewise you must ensure any other doctor you are seeing is aware of what we are prescribing.
• Over dosage is another group. This most often occurs because patients fail to realise that two tablets are in the same family. We not infrequently get a history of patients “taking the Voltarol my doctor gave me but also Nurofen when it doesn’t work”. Both drugs are anti-inflamatories and carry a risk of causing stomach ulcers. The individual doses may be fine but when added to each other may not be.
• Finally, there is the potential “cocktail” effect of taking multiple drugs which is more likely the greater the number you take. If you are on warfarin or drugs to control epilepsy the blood levels are often upset by other drugs such as antibiotics. Be careful.

What you should know before you take a medication

This includes at least the following:-

• Does it make you drowsy – can I drive, climb a ladder, operate machinery, work when taking it?
• What are the usual or common side effects?
• What are the possible serious side effects?
• When, how often and for how long should I take it?
• Can I stop it straight away if I need to?
• If not what do I do in the event of side effects?
• Is it safe with my other tablets and my other medical problems?

Supplements

These are often used and may claim to be “natural” products. Naturally we tend to think they will be harmless – they may not be.

Recently Glucosamine has become very popular with arthritis sufferers. There is reasonable evidence that it helps by restoring the cartilage on joint surfaces. It may, as a result, help back and neck pain. Many patients tell me of its benefits. It is a principal component of cartilage and was originally harvested from cow joints. It is now manufactured or obtained from crab shells. The dose required is thought to be 500mg three times per day. This is the equivalent of eating the surface off several large cow joints each meal. It may be a natural substance but these are very unnatural amounts. Because it is not considered a “drug” but a food supplement it does not go through any rigorous safety surveys. Having said that half of England seems to eating it at present - so far so good!

If in doubt, talk to a doctor either on my team or elsewhere.

* All copyright reserved for Mr P J Hamlyn. The information sheets provided by Mr Hamlyn are intended for use by his patients and need to be read in conjunction with the conversations they have with him and members of his team. It is not advised that they are used outside of this context.