The hidden costs of some drugs.
This has happened before.
A patient comes in with an array of disparate symptoms affecting several bodily systems. I am with students. When the patient is out of the room, we discuss differential diagnoses. Sarcoidosis is mentioned. Sjögrens is mentioned.
One of the students comments on the patient’s drug history which we have taken in detail. [Let’s face it, we took everything in detail – the intake form took 1.5 hours…]. It pays to be thorough though as one of the pharmaceutical drugs she is on seems to have some interesting side effects.
We go through her list of disparate symptoms and match it to some of the side effects of the drug, one by one. We look at each other and think the same thing; if she came off the drug, she wouldn’t feel so ill.
And that’s not all.
The maximum length of time anyone should be taking this drug is two years. She had been on it for over ten. Surely her GP should know?
One of the students reads out the possible side effects to the group:
Endocrine and Metabolic Dysregulation
- Chronic use can lead to adrenal insufficiency.
- Cushingoid Features: Weight gain, central adiposity, moon face.
- Glucose Dysregulation: Increased risk of insulin resistance and Type 2 diabetes.
- Dyslipidaemia and fluid retention.
2. Bone Health
- Osteoporosis: This drug is known to reduce bone mineral density especially with use >2 years.
- Pathological fractures are possible over long durations.
3. Neuropsychiatric Effects
- Mood Disorders: Depression, irritability, anxiety, suicidal ideation.
- Cognitive Changes: Brain fog, memory loss.
- Neurological Effects: Headaches, dizziness, tremor.
4. Reproductive System and Menstrual Disturbances
- Amenorrhoea is common, but long-term suppression can result in:
- Endometrial thinning
- Oestrogen deficiency symptoms (vaginal dryness, hot flushes)
5. Immune and Infection Risks
- Opportunistic infections due to immunosuppression.
- Latency reactivation e.g., TB recurrence
6. Skin and Musculoskeletal System
- Skin Atrophy, striae, acne, hirsutism.
- Myopathy, muscle weakness, and arthralgia.
7. Ocular and Auditory Effects
- Vision disturbances: blurred vision, glaucoma, cataracts.
- Tinnitus and vertigo.
And finally…..
MAY ALSO BE ASSOCIATED WITH AN INCREASED RISK OF BRAIN TUMOURS LIKE MENINGIOMAS.
We are a bit stumped as to what to say to the patient as she intimated that she wanted to keep taking it.
We decide to swerve the bullet for a time as there just isn’t time left to talk her through the implications with as much delicacy as is needed because she already has health anxiety.
So we give ourselves time and say nothing immediately, but notes are made for the next appointment to talk her through what might be happening to her body so she can make an informed decision as to what to do. Hopefully this will prompt a discussion with her GP, who may have been too busy to notice her situation.
One has to wonder; how many other people are struggling with symptoms caused by their prescribed medication, and they have no idea…
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