How to Think About Medication Side Effects and Adverse Reactions

Establishing causation between a side effect and a medication can be tricky for doctors and patients alike.

When a medical misadventure or new symptoms develop, physicians will often consider if the event is a side effect of a medication. This can be very difficult to establish. For example, if a patient is given medication to treat colitis and the diarrhea worsens, is this a side effect of the medicine or a worsening of the colitis?

Physicians face these dilemmas all the time. If a patient develops a symptom, and a side effect is being considered as an explanation, the doctor either knows or researches if there is medical evidence supporting that notion. If a patient develops headaches after a new medicine is prescribed, and this symptom has never been reported as a side effect of the medicine, then the drug is likely not the cause.

Of course, just because a side effect has not been reported does not guarantee that one has not occurred. As every doctor knows, patients often look up the side effect profiles of their drugs and decide that their nausea, fatigue, and GI symptoms must be drug-related if these symptoms are on the drug’s side effect list. Good luck finding a drug that doesn’t include nausea as a potential side effect!

It’s a wonder that patients who review the extremely long list of side effects of proposed drugs actually take them! We’ve all heard the ubiquitous TV drug ads that conclude with rapid-fire recitations of horrendous possible effects, often including fatalities. I’m a doctor, and I get spooked listening to these lists.

Even common aspirin can cause serious side effects.

Thankfully, most medicines cause either no side effects or only mild ones. Deciding if a side effect is even present can be challenging. Physicians may opt to discontinue a drug, not knowing for certain if the medicine is the culprit. This is not always a clean exercise, as some side effects can linger on for weeks or longer.

Here’s an effective strategy to minimize your risk of developing drug side effects. Advocate for yourself. Is the proposed medicine absolutely necessary? Is there a safer drug available? Are you prescribed the lowest dose necessary?

The rocket fuel for drug side effects is the disease of polypharmacy—in which patients simultaneously take at least five medications—a practice that is raging out of control.

How long is your medication list? Are several different physicians and medical professionals prescribing your drugs? Are all of them truly necessary? Is there a primary care physician to whom the consultants are accountable? Is there a medical professional assessing with some regularity the continued need for all of your medicinal potions?

These are all questions worth asking.