From the Guidelines
To accurately determine the side effects of your medications, it is crucial to know the specific medications you are taking, as side effects can vary significantly between different drug classes and individual health factors. Side effects can include a wide range of symptoms such as nausea, dizziness, headache, fatigue, digestive issues, and skin reactions. For patients taking cardiovascular drugs, such as ACEIs/ARBs, alpha-adrenergic blockers, antiarrhythmic drugs, amiodarone, lidocaine, anticoagulants, DOACs, and heparins, the potential side effects can be more specific and sometimes severe, as outlined in a review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy 1.
For instance, ACEIs/ARBs can increase the risk of hyperkalaemia, hypotension, falls, dizziness, fatigue, acute kidney injury, and cough, with monitoring of renal function being recommended. Alpha-adrenergic blockers can cause postural hypotension, dizziness, somnolence, and dry mouth, with monitoring of blood pressure and caution against their use for hypertension treatment due to a less favorable risk/benefit ratio. Antiarrhythmic drugs can lead to a variety of side effects including bradycardia, AV block, intracardiac conduction block, heart failure, hypotension, anticholinergic effects, cognitive impairment, and even fatal hepatotoxicity, necessitating careful monitoring of the ECG and serum electrolytes.
Given the complexity and potential severity of these side effects, it is essential to consult the patient information leaflet provided with your prescription, discuss your medications with your pharmacist, or speak directly with your healthcare provider. They can offer personalized advice based on your complete medical history, current medication regimen, and any potential interactions between medications. If you are experiencing symptoms that you believe may be related to your medications, do not stop taking your medications without first consulting your healthcare provider, as this can lead to adverse health consequences. Instead, contact your healthcare provider promptly to discuss your concerns and determine the best course of action, as guided by the most recent and highest quality evidence available, such as the review provided by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy 1.
From the FDA Drug Label
NSAIDs can cause serious side effects, including: Increased risk of a heart attack or stroke that can lead to death Increased risk of bleeding, ulcers, and tears (perforation) of the esophagus (tube leading from the mouth to the stomach), stomach and intestines: Other side effects of NSAIDs include: stomach pain, constipation, diarrhea, gas, heartburn, nausea, vomiting and dizziness
The possible side effects of ibuprofen include:
- Serious side effects: increased risk of heart attack or stroke, bleeding, ulcers, and tears in the esophagus, stomach, and intestines
- Common side effects: stomach pain, constipation, diarrhea, gas, heartburn, nausea, vomiting, and dizziness
- Less common side effects:
- Dermatologic: rash, pruritus, vesiculobullous eruptions, urticaria, erythema multiforme, Stevens-Johnson syndrome, alopecia
- Special senses: tinnitus, hearing loss, amblyopia, conjunctivitis, diplopia, optic neuritis, cataracts
- Hematologic: neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia, eosinophilia
- Cardiovascular: edema, fluid retention, congestive heart failure, elevated blood pressure, palpitations, arrhythmias
- Allergic: syndrome of abdominal pain, fever, chills, nausea and vomiting, anaphylaxis, bronchospasm, serum sickness, lupus erythematosus syndrome, Henoch-Schonlein vasculitis, angioedema
- Renal: acute renal failure, decreased creatinine clearance, polyuria, azotemia, cystitis, hematuria, renal papillary necrosis
- Miscellaneous: dry eyes and mouth, gingival ulcer, rhinitis 2 2
From the Research
Side Effects of Medications
The side effects of medications, particularly those related to analgesics and anti-inflammatory agents, can be significant. Some of the key points to consider include:
- Nearly all analgesic and anti-inflammatory agents have the potential for hepatic injury 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce injury in an unpredictable fashion, while acetaminophen and aspirin are more predictable and produce injury in a dose-dependent manner 3
- Acetaminophen and aspirin can produce hepatotoxicity despite therapeutic intent 3
Hepatotoxicity of Specific Medications
Certain medications have been shown to have hepatotoxic effects, including:
- Aspirin, which can cause hepatotoxicity in patients with rheumatoid arthritis and other connective tissue disorders 4
- Acetaminophen, which is the leading cause of drug-induced acute liver failure in many developed countries 5, 6
- Mitochondrial oxidative stress is considered to be the predominant cellular event in acetaminophen-induced liver injury 5
Mechanisms of Hepatotoxicity
The mechanisms of hepatotoxicity are complex and involve multiple cellular processes, including:
- Mitochondrial oxidative stress 5
- Phase I/phase II metabolism 5
- Endoplasmic reticulum stress 5
- Autophagy 5
- Sterile inflammation 5, 6
- Microcirculatory dysfunction 5
- Liver regeneration 5
Patient Education
Patient education is critical in preventing hepatotoxicity, and written drug information can be an important source of knowledge for patients 7. However, this information is often inconsistent, incomplete, and difficult for patients to read and understand 7.