The Simple Steps to Preventing Side Effects of Common Prescriptions

In 2009, side effects of prescription medications will account for an estimated 115 million doctor visits. These side effects will result in 8.5 million hospitalizations. As one of the leading causes of death, side effects from improperly prescribed prescription drugs will result in loss of life of over 100,000 people in the United States alone. And most of these deaths will have been preventable.

Side effects of prescription medications are almost always related to dosing. The larger the dose, the greater the risk of side effects. So it would seem to be a simple matter to reduce the risk of complications. Just lower the dosage!

But the problem is that most doctors do what they were taught to do in medical school, prescribing whatever dose is listed in the Physicians' Desk Reference (PDR), with a bias toward prescribing more drugs, not less. It's a rare doctor indeed who makes a serious effort to limit the amount of medication given to patients to manage their conditions. The problem doctors face is, the minimum effective dose for one patient may not be nearly enough for another.

The recommended dose of the anti-ulcer drug Prilosec (omeprazole), for instance, is 20 milligrams per day. This dosage can cause constipation, diarrhea, headaches, joint pain, and nausea. But clinical research has shown that 10 milligrams a day works for many people, and some seniors do well with just 5.

Prozac (fluoxetine) is prescribe for depression in a usually dosage of 20 milligrams per day. A study in the New England Journal of Medicine, however, found that a dose of 2.5 to 5 milligrams a day--one-fourth as much or less--often works better. The higher dose can cause a condition known as serotonin syndrome, when the brain kicks into overdrive in a kind of mild mania. The anxiety, attention deficit, mood swings, and headaches caused by a 20 milligram dose may not occur on 2.5 to 5.

The ACE inhibitor lisinopril is a relatively inexpensive generic drug for high blood pressure. The problem with all the ACE inhibitors for blood pressure (you can recognize their names by the ending -il) is that they can cause constant cough and dizziness.

The PDR recommends doctors start their patients on enalapril (Vasotec) in a dosage of 5 milligrams a day. The Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood pressure, however, suggests starting at 2.5 milligrams per day. And the difference in dosages is even more extreme in the case of Zocor (simvastatin) for high cholesterol. The starting dosage of Zocor is usually 10 milligrams a day, and some people taking it develop muscle pain and memory problems. What your doctor may not tell you is, many users of the drug achieve adequate cholesterol reduction with as little 2.5 milligrams a day.

So what do you do to make sure you don't become a statistic of prescription drug overdosing?

Encourage your doctor to start you with a low dose. Ask you doctor if he or she cannot prescribe the least effect dosage.

Try intermediate dosages. If the low dose doesn't work, don't go immediately to the highest dose. Ask your physician to prescribe an intermediate dose. This may require you or your pharmacist to use a pill splitter, but it may prevent side effects and save you money.

Ask you doctor about maintenance doses for diabetes and blood pressure. Sometimes as you get control over your health through other means, you can manage blood sugars and blood pressure with less medication. Just be sure you are making any changes in medication with your doctors, not independently of them.

And, if you have to take a higher dose, see if it can't be divided so you take a smaller dose 2 or 3 times a day. A single dose of a pill is convenient, but it may not be best for your health. Ask your doctor about dividing a pill into two or three doses a day.