Medication explained
First and foremost, the best medication is no medication. Anytime one takes a medication, the risks of taking the medication have to be outweighed by the benefits of taking medication. When I prescribe medications, it is because I believe that the problem being treated can be helped by the medication and that the risks of the medication are less than the benefits.
All medications have side effects. Unfortunately, recent trends in advertising such as on television and the fact that pharmacies hand out long lists of side effects with every medication or that patients go to the Internet to look up their medications, makes some people be afraid of medications or stop medications that might otherwise help them. For example, cholesterol-lowering medications have all sorts of warnings related to muscle aching and liver problems. While these problems are real, in most patients, the risks are much less than the benefits of having a lower cholesterol. Also, we can monitor for the side effects. When pharmacies or the Internet list side effects, they often list all the side effects that have been reported but not just the most common. This tends to confuse patients because they look up a given medication and see that it can cause a given symptom and then blame the medication even though the side effect may be extremely rare or perhaps occur almost never.
Another trend is that some patients always tend to blame medications for anything that is new in their life or any symptom that they may be feeling. This is why, when we do research, the use of a control group who receives a placebo is important. Experience has taught us that often it is the placebo group who has as many or more "side effects" than the treated group. The only way we can tell whether a drug is actually causing a side effect is whether the drug has significantly more side effects than placebo. It is human nature to blame any new medication for any new change that occurs within the first month that the medicine was started.
Having said all this, if you do experience new problems after you've started a medication, it is important for you to tell me about it. I don't want you to wait until it becomes a crisis if you are really convinced that the drug is causing a side effect. Similarly, you need not way to your next visit to report that a problem has been occurring for the last weeks or months. However, please never stop a medication that I gave you without talking to me first. Some medications – such as beta-blockers - can be distinctly dangerous it stopped abruptly.
Drug interactions are also a very big problem. When we test new drugs in research, we test them one at a time and we avoid using them in patients who are on numerous other drugs. When someone is on multiple drugs, the chance of one drug inactivating, competing with, interacting with or in some way changing the level -- either up or down -- of another drug goes way up. Thus, I try to keep patients on as few medications as possible. Anytime someone is on more than five medications I am unhappy. For example, the addition of an antibiotic to the blood thinner (anticoagulant) Coumadin can increase the Coumadin levels to dangerous levels. I should be made aware of drugs from other doctors or changes in doses.
Finally, over-the-counter medications including herbals, vitamins, combination medications etc. all count as medications. Herbals and other medications found in health food stores or pharmacies without prescription can be very deleterious and can interact with other medications. Also, while a multivitamin pill is usually benign, Vitamin E has been shown to worsen cardiovascular outcomes. While I am not completely anti-herbal or anti-vitamin or anti-food supplement, many of these preparations contain many different herbs and are not regulated for purity or even for containing the medication they claim to have in them. I find it very unusual that some patients come in with a huge list of herbals or vitamins and then tell me that they ‘don't want to take prescription medications.” The irony lies in the fact that any side effects from FDA-regulated medications are probably much more predictable than herbals or vitamins- which are not regulated for purity or composition or side effects. Again, there are some herbals and vitamins that I use in my practice such as saw palmetto for prostate, glucosamine for arthritis, etc. I do urge patients to use only those products made by reliable companies such as Nature’s Made. Please make sure that I'm aware of any over-the-counter medications you are taking and that they are on your medication list.