Do the benefits of taking prescription drugs outweigh the risks of not taking them?

In 2008 Medco Health Solutions conducted a study ^[1] and found that more than 51 percent of Americans where taking at least one prescription drug for a chronic condition. This was an upward trend from 47 percent in 2001.

The company examined prescription records from 2.5 million customers of all ages from 2001 to 2007. Most notably were those 65 and older: Three out of four were taking at least one medication while 22 percent of men and 28 percent of women were taking five or more medicines regularly. Those numbers are even higher today.

On average, individuals aged 65-69 take nearly 14 prescriptions per year, according to the American Society of Consultant Pharmacists. Those aged 80-84 take an average of 18 prescriptions each year.

In this article I’ll look at why prescription medication use is rising, which illnesses and their drugs are most common, and the adverse effects you will want to be aware of from these drugs. In a subsequent article I’ll look at safer alternatives to prescription drugs for these conditions.

The good and bad in increased prescription drug use

By the time your illness becomes advanced or chronic you have a much greater need to be treated with a prescription drug.

One important piece of good news is that researchers and drug companies have made it possible to treat what used to be fatal diseases such as AIDS, some cancers, hemophilia, sickle-cell disease, many heart conditions, etc. Moreover, prescription drugs can be relatively effective and safe for common illnesses,. According to the 2008 AHA (American Heart Association) president, Daniel W. Jones, M.D, “More people are now taking blood pressure and cholesterol-lowering medicines because they need them”.

From a holistic perspective, however, increased drug use represents worsening public health, less focus on reversing the underlying causes of disease, and more interest in a quick fix by patients and doctors. But it doesn’t have to be that way, even if we do have better medicines for chronic conditions. The same Dr. Jones previously mentioned was quoted as saying, “Unless we do things to change the way we’re managing health in this country … things will get worse instead of getting better.” ^[2]

The Medco study revealed that approximately 1.2 million American children take pills for diabetes, sleeping difficulties and gastrointestinal problems like heartburn. And there are newer drugs doctors can recommend for conditions such as depression, asthma, attention-deficit disorder and seizures. As you know, there are many alternatives to these drugs, but it would take proper education and motivation—a completely different approach to health care than our current system.

What are the most common illnesses and their drug treatments?

Since more than half of Americans take a chronic medication, we should look at the illnesses most commonly being treated. According to the Express Scripts 2013 Drugs Trend Report, ^[3] the following (in descending order) are the top illness categories for which medications are used: diabetes, high cholesterol, high blood pressure, stomach acid, asthma, depression, mental and neurological disorders, pain control, infections and “other.”

Benefits of taking any prescription drug must outweigh the risks of not taking it. Remember that some side effects can just be bothersome, while others can be dangerous. In either case, if you are the one taking the drug then it is you who must be informed and vigilant. Remember also that you increase your drug-drug interactions the more drugs you are taking concurrently. With that in mind, I’ll go through a partial list of medications used for these common conditions and their side effects.

Diabetes Mellitus

• Insulin – short, medium, long acting: This hormone allows blood sugar to go into the cells of your organ tissues, a requirement to live. Side effects from too much range from mood changes, nausea or dizziness to seizures and comatose state.
• Sulfonylureas – glipizide (Glucotrol), glyburide (Diabeta), glymepiride (Amaryl): These increase pancreatic insulin secretion. Side effects include low blood sugar, upset stomach, skin rash or itching, and weight gain (like insulin). They can cause birth defects. Don’t use as monotherapy for diabetes.
• Biguanides – metformin (Glucophage): This decreases liver sugar secretion and increases insulin sensitivity. Side effects are upset stomach, headache, fatigue, dizziness and metal taste. It can cause lactic acidosis if used with alcohol consumption, resulting in breathing difficulties, heart arrhythmias or vomiting.
• Alpha-glucosidase inhibitors – acarbose (Precose), miglitol (Glyset): These prevent carbohydrate digestion. Side effects include gas, abdominal pain and diarrhea.
• Thiazolidinediones – pioglitazone (Actos): This decreases liver sugar secretion and increase insulin sensitivity. Side effects are weight gain, fluid retention, risk of liver disease, anemia, and it worsens moderate to severe heart failure.
• Glinides (Prandin, Starlix): These increase (pro)insulin. Side effects are weight gain and low blood sugar.
• Incretin mimetics – exenatide (Byetta): Is thought to enhance insulin secretion and slow gastric emptying. Side effects include decreased appetite and weight loss.
• DPP-4 inhibitors – sitagliptin (Januvia): These block glucagon and lower blood sugar. Side effects include nausea/vomiting. Doses must be adjusted for kidney impairment.
• Amylin analogue – pramlintide (Symlin): This decreases stomach emptying and food intake. Side effects are nausea/vomiting, poor appetite and headache.

Cholesterol and heart disease risk reduction drugs

• Statins (Lipitor, Zocor, etc.): HMG-CoA reductase inhibitors lower bad (LDL) cholesterol, raise good (HDL) cholesterol, and lower triglycerides. More importantly, they have an anti-inflammatory effect to lower heart attack risk. Side effects are increased risk for liver damage, “statin myopathy” muscle pain or serious rhabdomyolysis, worsening of type 2 diabetics and cognitive impairments.
• Bile acid binding resins – Colestid, Questran, Welchol: These decrease bad cholesterol. Side effects include constipation, nausea and gas, and may increase triglyceride levels.
• Cholesterol absorption inhibitor – ezetimibe (Zetia): Has effects on cholesterol similar to statins. Side effects are stomach pain, fatigue and muscle soreness.
• Fibrates – gemfibrozil (Lopid), fenofibrate (Tricor): These decrease triglycerides and increase good cholesterol. Side effects include nausea, stomach pain and gallstones.
• Niacin (prescription) – Niaspan: This increases good cholesterol. Side effects are face/neck flushing, nausea and raised blood sugar. It also increases risk of bleeding, infection, liver damage and stroke.

High blood pressure and heart disease risk reduction

• Thiazide diuretics – hydrochlorothiazide (Esidrix): Side effects are increased blood sugar (diabetes); increased cholesterol; lowered potassium, sodium and magnesium, with increased calcium blood levels; increased uric acid (gout); weight gain, headache, nausea, photosensitivity and pancreatitis.
• Loop diuretics – furosemide (Lasix): Side effects include significant loss of electrolytes potassium, sodium and magnesium dehydration and gout. Less commonly seen are increased cholesterol, increased serum creatinine (kidney function) and kidney failure if also taking NSAIDs (i.e. Motrin) and an ACE inhibitor (i.e. Lisinopril).
• Potassium-sparing diuretics – spironolactone (Aldactone): Side effects: dangerously elevated blood potassium. Also, drowsiness, dry skin, rashes. In males it can cause enlarged tender breasts and even feminization.
• Angiotensin-converting enzyme (ACE) inhibitors – lisinopril (Prinivil, Zestril), etc. and Angiotensin-receptor blockers (ARB) – candesartan (Atacand) etc.: Side effects are chronic cough, increased blood potassium, dizziness, headache, metallic taste, rash, birth defects, worsened kidney function in renal artery stenosis, angioedema and increased lithium drug levels.
• Calcium channel blockers – amlodipine (Norvasc) and others: Side effects are lightheadedness, a slowed heart rate, drowsiness, constipation, leg/feet swelling, increased appetite and reflux (GERD).
• Beta blockers – metoprolol (Lopressor), propranolol (Inderal LA), and others: Side effects are worsened asthma; it masks hypoglycemia in diabetics and causes depression, impotence, insomnia, decreased HDL cholesterol and reduced exercise strength.
• Alpha-1 blockers – doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin) and Centrally acting agents – clonidine (Catapress), methyldopa (Aldomet): Side effects are dry mouth, orthostatic hypotension (blood pressure drops upon standing up), weakness, heart palpitations, nasal congestion and headaches.
• Centrally acting agents – clonidine (Catapress), methyldopa (Aldomet): Side effects are like alpha-1 blockers, plus sedation, erectile dysfunction and dizziness.
• Direct-acting vasodilators – Hydralazine (Apresoline), Minoxidil (Loniten): Hydralazine side effects include  headache, heart racing, weakness, flushing and nausea. Minoxidil side effects are hair growth, fluid retention and elevated blood sugar.

Next week I’ll address medications prescribed for stomach acid/GERD, asthma/COPD, depression, mental disorders, pain control and infections.

To feeling good without prescription drugs,

Michael Cutler, M.D.

Easy Health Options

[1] http://usatoday30.usatoday.com/news/health/2008-05-14-medication-nation_N.htm

[2] http://usatoday30.usatoday.com/news/health/2008-05-14-medication-nation_N.htm

[3] http://lab.express-scripts.com/drug-trend-report