You’re wise enough to take your doctor’s advice to eat right, watch your weight and get screened for cancer—but if you also take every medication he or she mentions without question, you may be too compliant. Sure, you need to trust your physician…but blind faith could leave you vulnerable to drug-related dangers.
The truth is that many medications are much riskier than people generally recognize. A recent article in Archives of Internal Medicine reported that 25% of people surveyed mistakenly believed that the FDA approves only drugs without serious side effects…39% wrongly believed that only “extremely effective” medications get FDA approval. Reality check: The FDA does require manufacturers to demonstrate that new medications are “safe” and “effective,” but those terms are far from precise. And in spite of “scientific testing,” the extent of risks for a given drug are generally not known until after the drug has been used by far more people and for longer periods of time.
What’s more, until about two decades ago, researchers routinely excluded women from clinical trials of drugs, fearing possible harm to women of childbearing age and assuming that what worked for men would work in the same way for women, too. What we know now: Women have a 50% to 70% greater risk of developing an adverse drug reaction than men, according to the Society for Women’s Health Research (SWHR).
Why are women are greater risk? Marianne Legato, MD, founder and director of The Partnership for Gender-Specific Medicine at Columbia University in New York City, explained that women and men often have disparate reactions to drugs due to differences in hormones, metabolism, biochemistry and anatomy—and even factors such as oral contraceptive use or where a woman is in her menstrual cycle can make a difference.
Unfortunately, some problems become evident only after a drug has been in use for a while. For instance, Dr. Legato pointed out that the antihistamine terfenadine (Seldane) was on the market for years before it was found to cause potentially fatal disruptions in cardiac rhythm, especially in women, and was banned by the FDA. This was not an isolated event. According to the SWHR, of the 10 prescription drugs withdrawn from the US market between 1997 and 2000, eight caused statistically greater health risks for women than men. What’s more, even when information is available on a drug’s dangers, you can’t assume that every doctor is aware of all potential side effects, especially the gender-specific ones.
More than half of all adverse drug reactions treated in hospitals and emergency facilities are preventable, according to the International Pharmaceutical Federation. Such prevention requires patients to be proactive in assessing the pros and cons before using a prescription or over-the-counter drug that is new to them. So when your doctor says, “Take this,” be sure to ask…
Why do I need to take this drug? Your doctor should be able to pinpoint your medical problem…describe what the medication is intended to do…clarify why this drug is better than any other…and explain why medication is more appropriate for you than any nondrug treatment available. A full explanation is particularly important if the drug is being prescribed “off-label”—meaning that it is being used in a way that has not been formally tested or approved by the FDA—as 21% of prescriptions written by US doctors are.
What are the possible side effects? There is no such thing as a drug with zero potential adverse effects, Dr. Legato noted. Your physician should review not only the most common side effects, but also the warning signs of a dangerous reaction (no matter how rare) and outline what to do (call the doctor, go to the emergency room) if problems arise.
Did the clinical trials for this drug include women? If the answer is yes, find out how well the drug worked for women specifically and whether females were more prone to problems. If the answer is no, ask what is known about how women react to this drug.
How long has this drug been on the market? Unless absolutely necessary, try to avoid taking a brand new medication until its full effects are better known.
What is your doctor’s own experience in prescribing this drug? For instance, has your doctor received any complaints about side effects from his other patients? It is best if your doctor has firsthand knowledge of the medication, rather than prescribing it based solely on its reputation.
Could this drug interact with other medications? The average American is prescribed medication 12.6 times per year, according to a recent report from the Kaiser Family Foundation. Women consume more medications than men, and the use of multiple medications is higher in women, the SWHR reports. Obviously, the more drugs you take, the higher the risk for potentially dangerous interactions. With your doctor, review all prescription and nonprescription drugs—as well as supplements—that you take regularly or even occasionally. If there is a potential for interaction, discuss alternatives to the new medication or needed alterations to your current regimen.
Once you get home, it’s prudent to do further research using a reliable Web site such as the National Library of Medicine Drug Information Portal (http://druginfo.nlm.nih.gov). Or try the new interactive online tool called the Question Builder (www.ahrq.gov) from the Agency for Healthcare Research and Quality, designed to help patients ask questions that will optimize their care, including safe and appropriate medication use. If you learn something about your new drug that concerns you, call your doctor to discuss it.
