Why does medicine cause side effects?

The recent Vioxx recall underscores the importance of carefully considering your health conditions and potential side effects before taking any medication.

“Wellness” is the balance among thousands of highly structured networks of chemical reactions in your body.  Changing one reaction with medication can affect several others, often unintentionally and undesirably.  These are side effects. 

For example, the NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, relieve arthritis pain by blocking the biochemical reaction that causes inflammation.  However, the sequence of events that ends as inflammation also includes some reactions responsible for keeping your body healthy.  There are steps that eventually maintain kidney function and blood pressure, preserve the stomach’s lining and regulate blood clotting.  This is the reason you might have an upset stomach or high blood pressure after taking ibuprofen. 

When treating your arthritis with NSAIDs, our challenge is to block the pathways that cause inflammation, but not the ones responsible for normal housekeeping.  Remember our “lock and key” metaphor that explains how medicines work.  The individual drugs within this class differ slightly in their chemical structure, or the shape of their “key.”  They are effective medicines because they concentrate on the “lock” that leads to inflammation, and are less apt to affect the others.   

There are usually several drugs available that work in similar ways; why can’t there be only one?  Well, what works in the test tube does not transfer neatly to the body!  All NSAIDs are supposed to block inflammation (and they do, when studied across thousands of patients!)  However, some might work better for your pain than others.  Likewise, NSAIDs aren’t supposed to cause side effects that render them unbearable (and they generally don’t, or they wouldn’t have hit the market!)  But, you may have experienced intolerable side effects from some NSAIDs, less so from others. 

Some drugs mimic other drugs at certain points in their digestion, processing, and transportation through your bloodstream.  This works according to a similar lock and key system we discussed above:  their “keys” fit the same lock.  Two or more drugs might cancel each other out, or amplify each other’s effects.  These drug interactions can be very dangerous.  All the more reason to understand what medications you take, and why!

Your pharmacist is a valuable consultant who can advise you about getting the greatest benefit from your medicines.  You spend a lot of money trying to feel better—don’t waste it!  Appreciate how interrelated all of your organs and systems are.  Do everything you can to sustain your body’s vigor, balance and wellness in order to ward off anything that threatens it with disease (or side effects)!

Comments

[Yvonne DiVita]

What a great idea -- examining our 'fractured' health system. I'm looking forward to more posts. Can't wait to tell everyone I know about this new blog...thanks, Dr. Siegrist!

[Stephanie]

Your welcome, Yvonne! My goal here is to connect patients with the information they need to make their best health-management decisions.

Now that "managed care" has officially been declared a dismal failure (leaving skyrocketing costs, limited access and a violated doctor-patient relationship in its wake), the new buzz is "consumer-driven healthcare." People deserve accurate, personalized guidance to learn what's right for themselves now and in the future.

I welcome comments from people out there about their success and disappointments seeking/receiving medical services. What do you wish you knew? What would help you?