Drug side effect

Dr. Dini Sri Damayanti,MKes

Introduction
Whether synthetic or natural (herbal), drugs are intended to act on the body. There always is a chance that they will produce effects that we do not want. Also, if two or more drugs are taken at the same time, there is a chance that one drug will interact with another drug in either a positive or negative way. This does not imply that the drugs are bad, but rather that they should be used carefully in order to reap the greatest benefit while minimizing unwanted side effects.

How does the drug work?

Knowing how the drug works provides the rationale for its use in the treatment of a particular disease.

Why People Take Drugs

The drugs would make them feel good or that they'd have a better time if they took them. Some teens believe drugs will help them think better, be more popular, stay more active, or become better athletes. they're depressed or think drugs will help them escape their problems. The truth is, drugs don't solve problems they simply hide feelings and problems. When a drug wears off, the feelings and problems remain, or become worse.

How should the drug be taken?

The optimal dose and timing of ingestion of a drug is determined by scientific studies. Drugs provide their greatest benefit when they are taken as prescribed. Deviating from the prescribed dose often leads to failure of the therapy or to side effects. However, in some circumstances (for example, when severe side effects occur), changes in dose may be appropriate

What are the drug's side effects?

Since drugs provide a benefit by modifying processes in the body, it is not surprising that they also have side effects. Successful drug therapy produces the desired beneficial effect without side effects. Therefore, it is important to know what a drug's side effects are so that they can be recognized, prevented, and acted upon appropriately when they occur.

 Side effects: Problems that occur when treatment goes beyond the desired effect. Or problems that occur in addition to the desired therapeutic effect. Example -- A hemorrhage from the use of too much anticoagulant (such as heparin) is a side effect caused by treatment going beyond the desired effect. Example -- The common side effects of cancer treatment including fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores are instances of side effects that occur in addition to the desired therapeutic effect.

What substances interact with the drug?

Interactions with drugs are common and they can cause side effects or reduce the beneficial effect of the drug. Sometimes, the interaction may promote a beneficial effect. Knowing which interacting agents to avoid while taking a drug (for example, food and herbal drugs) will prevent failure of therapy and side effects.

Herbal remidies: advantage and side effect

Herbal products are not tested with the scientific rigor required of conventional drugs, and they are not subject to the approval process of the U.S. Food and Drug Administration (FDA). Herbal products therefore cannot be marketed for the diagnosis, treatment, cure or prevention of disease.

 Unlike conventional drugs, herbal products are not regulated for purity and potency.2 Thus, some of the adverse effects and drug interactions reported for herbal products could be caused by impurities (e.g., allergens, pollen and spores)

Ginko biloba
Ginkgo biloba has potential interactions with garlic, vitamin E and medications with antiplatelet or anticoagulant properties.

TABLE 1 Side Effects of Select Herbal Products

Herbal product Ginkgo biloba St. John's wort

Side effects Bleeding Gastrointestinal disturbances, allergic reactions, fatigue, dizziness, confusion, dry mouth, photosensitivity

Ephedra (ma huang)

Hypertension, insomnia, arrhythmia, nervousness, tremor, headache,

seizure, cerebrovascular event, myocardial infarction, kidney stones

Kava

Sedation, oral and lingual dyskinesia, torticollis, oculogyric crisis, exacerbation of Parkinson's disease, painful twisting movements of the trunk, rash

TABLE 2 Drug Interactions with Herbal Products

Herbal product Ginkgo biloba

Interacting drugs Aspirin, warfarin (Coumadin), ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine)

St. John's wort Ephedra Ginseng Kava

Antidepressants Caffeine, decongestants, stimulants Warfarin Sedatives, sleeping pills, antipsychotics, alcohol

Ephedra
Ephedrine and related alkaloids are the pharmacologically active moieties of the extract of Ephedra (a genus of shrubs).19 Ephedrine constitutes 30 to 90 percent of the alkaloids of Ephedra species. The extract of some species also contains pseudoephedrine. Patients should be advised not to use ephedrinecontaining supplements if they have cardiovascular disease, hyperthyroidism, diabetes mellitus, benign prostatic hypertrophy or glaucoma.

Ginseng
Little scientific evidence shows that ginseng is effective for any purpose to strengthen normal body functions, increase resistance to stress and improve sexual function

Questions to Ask Patients Who May Be Taking Herbal Products

Are you taking an herbal product, herbal supplement or other "natural remedy?" If so, are you taking any prescription or nonprescription medications for the same purpose as the herbal product? Have you used this herbal product before? Are you allergic to any plant products? Are you pregnant or breast-feeding?

Guiding Principles of Pharmacotherapy

There should be justifiable and documented indication for every medication that is used. A medication should be used at the lowest dosage and for the shortest duration that is likely to achieve the desired outcome. When a patient is adequately treated with a single drug, monotherapy is preferred. Newly approved medications should be used only if there are clear advantages over older medications. Whenever possible, the selection of a medication regimen should be based upon evidence obtained from controlled clinical trials.

 The timing of drug administration should be considered as possible influence on drug efficacy, adverse effects, and interactions with other drugs and food. A medication regimen should be simplified as much as possible to enhance patient adherence. A patients perception of illness or the risks and benefits of therapy may affect adherence and treatment outcomes. Careful observation of a patients response to treatment is necessary to confirm efficacy, prevent, detect, or manage adverse effects, assess compliance, and determine the need for dosage adjustment or discontinuation of drug therapy. A medication should not be given by injection when giving it by mouth would be just as effective and safe.

 Before medications are used, lifestyle modifications should be made, when indicated, to obviate the need for drug therapy or to enhance pharmacotherapy outcomes. Initiation of a drug regimen should be done with full recognition that a medication may cause a disease, sign, symptom, syndrome, or abnormal laboratory test. When a variety of drugs are equally efficacious and equally safe, the drug that results in the lowest health care cost or is most convenient for the patient should be chosen. When making a decision about drug therapy for individual patients, society effects should be considered. The possible reasons for failure of medication regimens include inappropriate drug selection, poor adherence, improper drug dose or interval, misdiagnosis, concurrent illness, interactions with foods or drugs, environmental factors, or genetic factors.