Treatment unwanted side effects might trigger a ‘prescription cascade’

Right this moment’s medication, as everyone knows, are very efficient, reliably lowering the varied medical circumstances for which they’re prescribed – heartburn, hypertension, insomnia and so forth ahead. That is all very effectively. However care should be taken that the signs handled with one drug will not be simply unwanted side effects.

That is the phenomenon of the “prescribing cascade” which was first recognized greater than 25 years in the past, when it was famous {that a} disproportionate variety of these began on blood strain reducing drugs had been taking anti-inflammatory arthritic medication (resembling ibuprofen). From this it could possibly be decided that these weren’t two impartial circumstances, however that the anti-inflammatories had been accountable for elevated blood strain.

Since then dozens of such “cascades” have been recognized – some very lengthy. For instance, amlodipine, which is usually prescribed for hypertension, could cause swollen ankles. This results in the prescription of a diuretic (water tablet) which, along with its different unwanted side effects, impacts diabetes, warranting extra treatment to decrease blood sugar – and so forth.

The strikes are virtually infinite. Pathologist Denis O’Mahoney lately reported that 4 sufferers with completely different circumstances – allergic rhinitis, hallucinations, low coronary heart price and incontinence – had been all taking the identical drug, donepezil, for extreme early thoughts. In each instances their signs had been misinterpreted as a brand new sickness, and pointless therapy was began, when stopping the donepezil would have been the right course.

There will be no prepared answer to such a ubiquitous phenomenon besides to all the time pay attention to the potential for a cascade as a attainable offender when analyzing a affected person.

Worsening angina

Transient throbbing pains transferring down each arms (just like “the squeeze” one experiences when taking blood strain), as talked about lately on this column, notes , notes household physician Robert Walker, of Prinzmetal’s angina. This differs from the frequent kind (which is because of coronary heart illness) in that it happens spontaneously at relaxation reasonably than being introduced on by exertion. In each, the blood movement to the center muscle will not be adequate for its necessities; however in Prinzmetal it is because of spasm of the coronary arteries reasonably than (as in coronary heart illness) being narrowed by atheroma. The trigger is treatable however, with the exercise of the center in any other case regular, his prognosis is uneven.

Relaxation after consuming

This week’s query comes courtesy of Miss SA from Southampton, who writes on behalf of an in depth pal in her fifties, “very energetic with a wiry physique”. That pal avoids consuming in the course of the day, however she is often very sleepy shortly after supper, to the purpose that she is barely conscious of what’s going on round her. This lasts for as much as three hours, throughout which she will solely be woke up with problem earlier than returning to her semi-comatose state.

This postprandial somnolence can observe any meal (so she will not eat till the night), dairy and candy meals being the obvious trigger. “In fact she would welcome any concepts concerning the trigger and therapy of this situation”, she writes.

Magnet remedy

Lastly, a number of readers have written to inform me of their nice shock – regardless of nice skepticism – concerning the effectiveness of magnetic units. “​​​​I believed it was a foul joke,” stated a gentleman, later when an acquaintance instructed shopping for a magnetic bracelet for his sore knee – solely to be “stunned” with the just about quick aid”.

Researchers on the Peninsula Faculty of Drugs on the College of Exeter had been additionally stunned, when a examine that was supposed to point out the doubtful credentials of magnetotherapy got here to a special conclusion. Evaluating the result in 200 sufferers with arthritis of the hips or knees, Dr. Tim Harlow and colleagues discovered a “clinically helpful profit” in these with a magnetic bracelet in comparison with a bracelet of metal washers. Admittedly, it’s troublesome to elucidate how a neighborhood magnetic area generated on the wrist ought to scale back painful signs in a distant a part of the physique (the hips and knees); however there may be a lot in drugs that we don’t actually perceive.

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