Banish those side effects

Although many AIDS patients suffer side effects from their medications, not all do, and many side effects can be managed. Many patients suffer needless pain because physicians are reluctant to prescribe potentially addictive drugs. Patients may find relaxation techniques helpful in managing nausea, and should vary the use of their drugs to avoid developing an aversion to its taste. Patients should also ask for medications that can alleviate the side effects associated with some drugs.     

Hematologic side effects of drugs

Bone marrow and peripheral blood cells may be adversely affected by drugs. Although the risk from most drugs is very small, many cases are reported because of the millions of doses of drugs taken each year by the population. Neutropenia, thrombocytopenia, hemolytic anemia, aplastic anemia, and macrocytic anemia are the commonest effects, in that order. Aplastic anemia is rare, but very serious when it does occur. Adverse effects may be produced by a direct toxic action of the drug or its metabolites on the bone marrow or, less often, on circulating cells. Antineoplastic drugs and chloramphenicol are examples. Most drugs produce their adverse effects through an immunological mechanism. The drug may act as a hapten or may affect the immune system leading to the production of antidrug antibodies and sometimes autoantibodies. Hemolytic anemia may result. Penicillins may behave in this manner. Some drugs act on erythrocytes with enzyme defects, e.g. glucose-6-phosphate dehydrogenase (G-6-PD) abnormalities, to produce hemolysis. In many cases, the mechanism underlying the adverse effect is unknown. The paper lists the drugs reported to have caused some hematological adverse effect and describes the mechanisms in those cases where they are known.     

Evaluation of the prevalence of side effects of phenobarbital in patients in the Champagne-Ardenne region]

Side effects were compared in 454 patients under phenobarbital and in 133 patients under other antiepileptic agents. Prevalence of adverse effects was 12% and 4% in these two groups, respectively. The fairly low prevalence of untoward reactions to phenobarbital in this study as compared with previously published reports is due to the methodology used. Despite unquestionable drawbacks, especially in patients above 50 years of age at first use, phenobarbital is a valuable therapeutic alternative in some cases.     

Psychiatric side effects of steroid therapy

Many psychiatric side effects have been noted with steroid administration. Occurring in about 6% of all patients on steroids, they are not uncommon. The English-language literature from 1951 to the present reveals numerous case reports and reviews but few prospective, controlled studies exploring this issue. This paper reviews the various psychiatric presentations and the relationship to patient profile, steroid type, dosage, and therapy duration. In 90% of cases, symptoms are reversible with steroid termination; some patients require psychopharmacologic treatment. Prophylaxis with lithium carbonate has met with good response in a few anecdotal reports and one prospective study.     

Hematologic side effects of psychotropics.

Psychiatrists are often unaware of the potential hematologic complications of the psychotropics they prescribe. Although this review is not a hematologic text reference, relevant hematologic syndromes are described so that the consultation-liaison psychiatrist will be familiar with the usual signs, symptoms, and treatments of these syndromes. This article reviews the hematologic side effects of the commonly prescribed psychotropics, including antipsychotics, antidepressants, benzodiazepines, lithium, mood stabilizers (including some of the anticonvulsants), and the acetylcholinesterase inhibitors. Clinical signs and symptoms that should alert the physician to obtain a complete blood count are described.     

Informing patients about drug side effects

Two hundred forty-nine newly diagnosed hypertensive patients prescribed thiazide medication were recruited for study. Two-thirds were given a leaflet or patient package insert (PPI) that described the drug and its possible side effects, and one-third were not. At a revisit about 1 month later, patients were asked whether they had experienced any of 17 different “health problems.” For each problem that they experienced, they were asked whether they thought the problem was related to the medicine they were taking. Ten of the health problems were taken verbatim from the PPI's list of possible drug side effects. Patients who received the PPI reported experiencing about the same number of side effects as the non-PPI subjects. However, those who recieved the PPI were more likely to attribute experienced reactions to the drug. This was true both for reactions specifically listed in the PPI and for similar reactions not listed. Results support the notion of an “attribution-labeling” process rather than a “suggestion” effect.     

Mesna side effects which imitate vasculitis

Summary Mesna (sodium-2-mercaptoethansulfonate) is used in the prophylaxis of cyclophosphamide (CYC)-induced hemorrhagic cystitis. Four patients being treated with low dose CYC and prednisone for vasculitis developed severe side effects to Mesna. Fever, arthralgia, myalgia, tachycardia, electrocardiogram changes consistent with perimyocarditis, erythroderma, bullous skin and mucous membrane lesions, and abdominal complaints with profuse diarrhea were noted approximately 3 weeks after the initiation of therapy for CYC-induced leukopenia and a conservatively reduced prednisone dosage. Positive reexposure tests confirmed the association to Mesna use, and hypersensitivity skin tests demonstrated a delayed hypersensitivity reaction.Abbreviations CYC cyclophosphamide - WBC white blood count - ANA antinuclear antibodies - AP alkaline phosphatase - SGPT serum glutamic pyruvic transaminase - SGOT serum glutamic oxaloacetic transaminase - SGGT serum -glutamyl transaminase - ECG electrocardiography - ANCA antineutrophil cytoplasmic antibodies - cANCA cytoplasmic fluorescence pattern - pANCA perinuclear fluorescence pattern - PR3 proteinase-3-antibodies - WG Wegener's granulomatosis     

Treatment of the side effects of antiviral therapy

The adverse effects of antiviral drugs are dose dependent and often reversible. The major side effects include influenza-like symptoms, hematologic abnormalities and neuropsychiatric symptoms. The influenza-like syndrome can be prevented by paracetamol taken at the time of the injection. Psychiatric adverse effects range from irritability to a severe depressive syndrome. Antidepressants, such as selective serotonin reuptake inhibitors, may be useful in the management. Adverse hematologic effects can occur very early during treatment. The platelet count often stabilizes rapidly, but neutropenia can deteriorate throughout treatment. In selected patients treatment with hematopoietic growth factor (filgrastim) may be useful. Ribavirin therapy may result in a dose-dependent reversible intravascular hemolytic anemia in 10% of patients. Adjunctive therapy with erythropoietin for ribavirin-induced anemia is currently under evaluation. Interferons and ribavirin are contraindicated in pregnancy. Contraception must be continued for 4 months (women) and 7 months (men) after ribavirin cessation. Lactic acidosis may be a rare complication of combination therapy in patients undergoing therapy for HIV and HCV. Any sign of mitochondrial DNA depletion syndrome calls for blood lactate measurement and, possibly, a modification of antiretroviral treatment. Lamivudine is well tolerated but the emergence of lamivudine-resistant (YMDD) HBV mutants is associated with the loss of clinical response. Adefovir dipivoxil effectively suppresses lamivudine-resistant HBV in chronic hepatitis B.