The Heart Beat

People don’t tend to read the small print, except when it comes to medication side effects. After a doctor visit, diagnostic test and maybe even a procedure, there you are – overwhelmed with pharmacy paperwork that details every ache, gurgle and embarrassing eruption that you might expect after popping that little pill. You have inevitable questions for the pharmacist and your physician – and often leave frustrated and less confident about being able to stick with your medication regimen.

As a purveyor of cholesterol and blood pressure medications myself, I recognize that cardiologists rule the roost when it comes to potential medication side effects. And because so many of our therapies are preventive, we have the ability to make people feel potentially worse even as we lower their cardiovascular risk.

But “potential” is the operative word. It turns out that most people do not develop significant side effects to their meds, even if they take several of them. But as with many things in health care in practice, anecdotes trump evidence and the squeaky wheel is the one who usually gets the rash – or whatever the side effect may be…

But there are still some steps that you can take to reduce your risk of serious drug side effects. It starts with communication with your doctor and pharmacist.

• Make sure you know why you are taking all of your medications.  This way you can try to minimize redundancy.

• Ask your doctor for recommendations regarding when to take each medication – it might make sense to take your “water pill” earlier in the day so you aren’t woken up at night by the urge to go the bathroom.

• Ask you doctor if routine liver or kidney laboratory testing is appropriate.

• Bring your medication list with you to every doctor’s appointment or emergency room visit.  One of the biggest causes of medication errors or side effects is when doctors prescribe people medications that they don’t tolerate or when similar medications are already being prescribed.

• Remember that supplements can have side effects and may interact with your medications – know what you are taking and why you are taking it.

• When making changes in your medications, it’s best to make one change at a time – that way you can identify the likely cause if a side effect occurs.

• Take advantage of the pharmacist’s offer to counsel you regarding new medications.

One of the challenges many people face is how to approach a new medication that has a reputation for causing side effects. If your Uncle Arnold complains about muscle pain from his statin, should you still take it? How can you figure out your own risk, especially given that you might be on a fairly unique cocktail of multiple medications? Sifting through a half dozen pharmacy receipts doesn’t cut it. Good thing that there is now an app for that in the pipeline.

Meet Rxplore. Doctors and patients have waited impatiently for an easy, straightforward way to understand and predict side effects, and a new application from my friend Jon Duke, MD at the Regenstrief Institute at the Indiana University School of Medicine promises to do just that – by using a clever visualization tool to help doctors and patients “see” side effects rather than just read about them. Users enter medications into a list, and the program automatically estimates the likelihood of various side effects (by organ system) and the potential impact of various drug combinations. You can check out a cool demo of Rxplore.

It turns out that a picture is worth a thousand words.

- James Beckerman, MD, FACC

Do you do your homework before taking a new medication? Share your thoughts on the Heart Disease Exchange.