Drugs approved by the FDA must pass rigorous tests demonstrating safety and efficacy. For a drug to be approved, the benefits associated with it should far outweigh the potential risks. However, many approved medications have adverse effects, ranging from minor issues like headaches to life-threating events such as heightened risk of heart attack and stroke. With such safety concerns, the question then becomes: Are the side effects worth the treatment? To paraphrase the Roman poet Virgil: Is the cure worse than the disease? To answer these questions, let’s take a closer look at some commonly prescribed medications with severe side effects. Oral terbinafine is a drug commonly used to treat mycotic infections, mainly of the skin and nails. More often than not, these types of infections are superficial and harmless. However, in some cases, these infections can cause thickened, hyperpigmented nails that may become painful and even separate from the nail bed, if left untreated. Unfortunately, patients treated with oral terbinafine are at risk of developing hepatotoxicity, which can lead to liver failure. Luckily, several alternative oral and topical treatments are available for onychomycosis, or fungal infection of the nail, from topical ciclopirox and clotrimazole treatment to low-level laser therapy. Amiodarone is a class III antiarrhythmic drug that is used to treat irregular heartbeat, such as atrial fibrillation, which can lead to stroke. Unfortunately, this drug, while useful, has a plethora of adverse effects such as ataxia, hyper- and hypothyroidism, congestive heart failure, heart block, bradycardia, hepatitis and cirrhosis, visual disturbances, optic neuropathy, and demyelinating polyneuropathy. In addition, psychiatric side effects, including hallucinations and delirium, have been reported. On the bright side, there are alternatives to amiodarone, one of which is dronedarone. In a clinical trial in patients with atrial fibrillation, dronedarone decreased the risk of cardiovascular complications or death by 24%. Methimazole is a thioamide-derived antithyroid drug used to treat hyperthyroidism, a condition that can lead to weight loss, heat intolerance, hypertension, heart palpitations, diaphoresis, anxiety, insomnia, and hyperhidrosis. Although not a definitive treatment, this drug is effective at controlling the symptoms caused by hyperthyroidism. While this is a useful remedy, it does not come without a price. lupus-like syndrome, hepatitis, agranulocytosis, nephritis, and rhabdomyolysis are all side effects that patients using this drug may encounter. One alternative to methimazole is propylthiouracil (PTU). Unlike methimazole, PTU is safe during the first trimester of pregnancy; however, it carries a risk for hepatotoxicity. A more aggressive treatment is radioactive iodine ablation of the thyroid gland. Gabapentin is an antiepileptic medication most commonly used for its off-label use for patients with various etiologies of neuropathic nerve pain. This type of pain can leave patients with a “pins and needles” or even a burning sensation in the extremities. Although gabapentin can reduce these symptoms, it comes with a hefty list of adverse effects including angioedema, somnolence, suicidal behavior, and even sudden and unexplained death in patients with epilepsy. The good news is that there are several alternative treatments to gabapentin, such as pregabalin, an anticonvulsant used off label to treat the same conditions as gabapentin. The only difference is that pregabalin has fewer of the serious side effects that accompany gabapentin. Lamotrigine is an anticonvulsant therapeutic used in the treatments of seizures. Seizures can cause sudden changes in the electrical impulses of the brain, which can trigger subtle and erratic changes in behavior. The treatment of such conditions, unfortunately, does not come without consequence. Some of the adverse effects associated with lamotrigine are multiorgan hypersensitivity reaction, organ failure, aseptic meningitis, status epilepticus, Stevens-Johnson syndrome, suicidal thoughts and actions, and sudden unexplained death in some epileptic patients. Luckily, patients who do not respond well to lamotrigine have other treatment options. One alternative is olanzapine, which has a lower rate of recurrence of depressive episodes compared with lamotrigine. Varenicline is a prescription medication used to treat nicotine addiction. Although smoking can have long-term adverse effects on patient health, such as increased risk for lung cancer, the use of varenicline to stop such a habit is not without risk. Patients using varenicline are at an increased risk of developing seizures, cardiovascular events, somnambulism, angioedema, as well as suicidal thoughts and actions. Fortunately, patients seeking treatment to support smoking cessation have multiple alternatives to varenicline, such as quitting cold turkey and over-the-counter nicotine patches, gum or spray, which (with the proper motivation) have the same end result as varenicline but without the potential consequences. So, the next time you pick up the prescription pad, think twice before signing your name at the bottom. Is the treatment worth the risk? Is there an alternative? Can the patient live a normal life without treatment? Source
