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In any discussion regarding the long-term effects of taking prescription medications versus a holistic approach geared toward lessening or even eliminating the use of prescription drugs, it is important to know the risks and adverse effects of any medications you are taking or which you are considering taking.
In this article I’ll continue my discussion of drugs and their side effects for stomach acid disorders, asthma, depression, mental disorders, pain and infections. You can read the first two articles in this series here:
Though the list of possible side effects looks long at first glance, only a few of the possible drug interactions are listed here.
Stomach acid disorders / GERD (gastro-esophageal reflux disease)
There are many causes of this disorder to consider, including other medications. For example, drugs that worsen GERD by weakening the lower esophageal sphincter muscle include: calcium channel blockers (blood pressure), theophylline (asthma), narcotics (pain), benzodiazepines (anxiety), and barbiturates (pain).
- H2 blockers – Pepcid, Tagamet, Zantac, Axid: Reduce the production of stomach acid and have an anesthetic effect. Side effects can be constipation, diarrhea, dizziness, headache, hives, nausea/vomiting and urinary problems.
- Proton Pump Inhibitors – Nexium ($6 billion U.S. sales in 2012), many others: These are linked to increased rates of pneumonia, GI infections, fractures (calcium absorption requires acid, calcium citrate best absorbed), Vitamin B12 absorption (get levels checked), gastric polyps (thus increased stomach cancer risk), and decreased effectiveness of the blood thinner Plavix. They also can cause rebound acid, so you must taper if you are going to discontinue it (more on this in the next article).
- Anti-emetic – Reglan: It increases risk of tardive dyskinesia the longer you take it.
Asthma / COPD (emphysema, chronic bronchitis)
- Short acting Beta agonists – albuterol (Ventolin), and others: These can cause fast heartbeat (means medicine is working); tremors, cramping, sweats, agitation, worsened asthma if overused in time, and can raise blood sugar,  lower blood potassium, and contribute to pulmonary hypertension, heart dysrhythmia and heart failure.
- Long acting Beta agonists – salmeterol (Serevent), and others: These have similar but less pronounced effects as short acting beta agonists and are shown in larger recent studies to worsen asthma if used alone.
- Leukotriene inhibitors – monteleukast (Singulair), and others: Can cause upper respiratory infection, sore throat, fever, headache, cough, abdominal pain, diarrhea, earache pain/infection.
- Inhaled corticosteroids – triamcinolone acetonide (Asthmacort), and others: These can impair growth in children, decrease bone mineral density, thin skin, increase risk of cataracts and act like oral corticosteroids. If you don’t use a spacer and rinse your mouth with antifungal wash, you will likely get thrush (mouth yeast).
- Anticholinergics – ipratroprium bromide (Atrovent): These can worsen narrow-angle glaucoma, cause cough, dry eyes/throat, urinary retention, constipation, tachycardia and allergic reactions (hives, bronchospasm).
- Anti-allergy – omalizumab (Xolair): This monoclonal antibody to IgE can be effective but is known for its own allergic reactions (hives, bronchospasm, angioedema); arm/leg/ear pain, dizziness, fatigue, skin rash, bone fractures. It can increase certain cancers and parasite infection if at risk for this.
Depression, anxiety, panic disorder
This category of medications is very problematic due to its high amount of drug-drug interactions. Also, they increase suicidal thinking in those under 24 years of age, although not suicides as per meta-analysis data. Only Prozac is considered safe in pregnancy.
- Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, etc.: More common side effects are nausea, headaches, anxiety, insomnia, drowsiness, weight gain, loss of appetite, sweating, blurred vision, sexual dysfunction. Can get heart rhythm dysfunction, increased bleeding, serotonin syndrome (described below). Discontinuation too quickly causes dizziness, confusion, nightmares.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – Effexor, Cymbalta, etc.: Side effects include nausea, dry mouth, constipation, fatigue, sleepiness, dizziness and sweating. Effexor can cause diastolic hypertension. Avoid Cymbalta with liver disease or alcohol overuse and with Prozac, Paxil and Luvox.
- Tricyclic antidepressants (TCIs) – amitriptyline, others: These cause side effects like drowsiness/dizziness, dry mouth, blurred vision, urinary retention, constipation, weight gain and increased blood pressure.
- Monoamine oxidase inhibitors (MAOIs) – phenelzine (Nardil), others: Much like those caused by SSRIs along with dry mouth, drowsiness and tingling skin sensation. Hypertensive crisis with tyramine ingestion.
Serotonin syndrome is a very dangerous condition of too much serotonin syndrome causing mental status changes (confusion to delirium), neuromuscular abnormalities (tremor to rigidity) and autonomic instability (fever, fast heart rate, etc.) leading to coma and death. All the medications for mood and mental disorders, plus opioids such as codeine, Ultram, methadone, fentanyl and the antibiotic Zyvox  can cause this.
Mental disorders (schizophrenia, bipolar)
These medications include the older and new antipsychotics, anticonvulsants, and combinations. There are many adverse drug effects from this category, so I’ll just describe the more significant ones:
- Neuroleptic malignant syndrome: This is a life-threatening neurological disorder caused from these drugs. It starts with muscle cramps and tremors, fever and can continue to autonomic instability and delirium.
- Tardive dyskinesia: irreversible involuntary movement disorder, especially of the lower face.
There is a long list of medications in this category. I’ll address the most common ones:
- Tylenol: Is harmless at usual doses, but can harm your liver at high sustained dosing over weeks. 
- Non-steroidal anti-inflammatory drugs (NSAIDs): These cause GI bleeding, kidney dysfunction and increased risk for stroke, heart attack and asthma. They are the 15th leading cause of reported deaths in the U.S., directly causing more than 16,000 deaths and 100,000 hospitalizations annually.  They are known to increase blood pressure like triptans (e.g. Imitrex for migraine).
- Opioid narcotic analgesics and tramadol (Ultram®): These all are centrally-acting so you can expect disturbances in sleep and mood (can elevate mood due to serotonin activity). Typical narcotics are very addicting and cause mental changes and constipation for nearly everyone. Withdrawal symptoms are the opposite of the drug effect. Risk for serotonin syndrome if taken with other drugs that can also cause it as described earlier.
Antibacterial medications have many common but self-limiting effects such as rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, and yeast infections. However, some of them have special concerns:
- Ampicillin: Pseudomembranous colitis.
- Gentamycin: Kidney toxicity and hearing loss.
- Antituberculosis agents: Hemolytic anemia, liver toxicity, headache, peripheral neuropathy (isoniazid); optic neuritis (ethambutol).
- Vancomycin: Hypotension, itching if given too fast; phlebitis.
- Erythromycin: Terrible GI side effects if you crush or chew pills.
- Septra: Stevens Johnson Syndrome, Toxic Epidermal Necrolysis.
- Doxycycline: Must protect from sunburns (photosensitivity).
- Cipro: Photosensitivity, tendon rupture if used with corticosteroids.
- Clindamycin: Pseudomembranous colitis (from C. dificile superinfection).
- Metronidazole: Headache, cramps, nausea/vomiting if used with alcohol.
Antifungals are quite safe when used as a cream (e.g. Nizoral, Lamisil, Sporanox). Orally, however, be aware of the following:
- Ketoconazole (Nizoral): Can cause severe liver injuries and adrenal gland problems. Serious heart dysrhythmias (QT prolongation on EKG) when combined with many heart medications.
- Terbinafine (Lamisil): Of the 10.5 percent who get side effects only a rare 0.04 percent will be serious. Therefore, Lamisil is the safest oral antifungal.
- Itraconazole (Sporanox): Elevated liver enzymes (4%), rarely liver failure; small but real risk of developing congestive heart failure.
Antivirals range from safe (acyclovir) to potentially dangerous (zidovudine). Therefore, this wide range means you will want to learn about each one individually as they may not have a class effect of safety. Here are some examples:
- Acyclovir: Pregnancy category B (no proven risk in humans) and even used safely in infants.
- Amantadine: Potentialyl teratogenic, embryotoxic, and carcinogenic. 
- Zidovudine: Anemia.
- Zalcitabine: Seizures, peripheral neuropathy.
In my next article I’ll address taking drugs along with herbs and supplements, safely getting off prescription drugs whenever possible, and safer alternatives for these same conditions.
To feeling good without prescription drugs whenever possible,
Michael Cutler, M.D.
Easy Health Options
 Robinson DS. Serotonin syndrome. Primary Psychiatry. 2006. 13(8):36-38.
 Ann Intern Med. 1977;87(3):299-301 found online at: http://annals.org/article.aspx?articleid=691409
 Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999 Jun 17;340(24):1888-99.