By: Dr. Alan Christianson
It’s no surprise medications can cause side effects. Commercials have made us numb to them. Still, we rarely hear how dangerous common medications can be, even for those who carefully follow the directions.
RETHINK YOUR MEDS
I’ve been blessed to have a patient population I enjoy spending my time with. Doug was no exception. I had cared for him, his wife, and their adult daughter for over a decade. One day, Doug came to see me because his back hurt. I noticed he was also retaining fluid; his face was puffy. The pain didn’t seem to feel worse when he bent or moved—it just always hurt. I had a small suspicion his kidneys were a culprit, so I did a simple urine test. I had examined Doug and done blood tests just over a year prior, and he had no signs of kidney problems.
The urine test showed his kidneys were not filtering protein at all. A few more tests confirmed Doug was in late-stage kidney failure. He spent four months on dialysis in hopes of receiving a kidney transplant. It never came, and he died just before his 51st birthday.
The nephrologist who treated Doug attributed his death to ibuprofen use.
Doug didn’t mention it to me, but he’d developed tendonitis and was regularly taking ibuprofen for several months. He never exceeded the recommended dosages. The first sign of there being a problem was his fluid retention. By then, it was too late. Kidneys can lose 80% of their working cells, called glomeruli, before there is any symptom or measurable change in function.
In the last decade, the rate of death from prescription medications has gone up 2.8 times.
Both prescription and over-the-counter medications have become a leading cause of early mortality, and the trend is only worsening.
Below is a quick list of the top offenders. If you see any of these names in your medicine chest, please work hard to explore your options.
Over-the-Counter Medications
NSAIDS
Generic Brand Name(s)Ibuprofen Advil, Motrin
Naproxen sodium Aleve
Aspirin Ascriptin, Bayer, Ecotrin
Acetaminophen
Generic Brand Name(s)Acetaminophen Tylenol
Antihistamine/Sedatives
Generic Brand Name(s)Diphenhydramine Benadryl, Tylenol PM, Advil PM
Prescription Medications
Sleep Aids
Generic Brand Name(s)Zolpidem Ambien, Intermezzo
Eszopiclone Lunesta
Ramelteon Rozerem
Zaleplon Sonata
Doxepin Silenor
Benzodiazepines (see below)
Opioid Narcotics
Generic Brand Name(s)Hydrocodone Vicodin, Lortab
Oxycodone OxyContin, Percocet
Morphine Kadian, Avinza
Benzodiazepines
Generic Brand Name(s)Alprazolam Xanax, Restyl
Clonazepam Klonopin, Paxam
Diazepam Valium
Lorazepam Ativan
Temazepam Restoril
Triazolam Halcion
Let’s go a little deeper into each of these categories.
NSAIDS
These are nonsteroidal anti-inflammatory drugs. The best known are Advil and Aleve. There are also many prescription NSAIDS. Some are the same medicines as the nonprescription ones (but in higher potencies), and others are different medicines. In terms of dangers, the differences between nonprescription and prescription are only related to the dosage used.
Bleeding Ulcers
Nearly 40% of the American population take ibuprofen or aspirin on a regular basis to help with aches and pains.[1] Each year, 1-2% of those who take NSAIDS have side effects bad enough to warrant hospitalization, mostly related to bleeding ulcers. In 2000, this was 103,000 people with 16,500 of them dying from taking these medicines responsibly.[2]
This does not take into account harm from intentional overdoses, from those who take NSAIDS with incompatible medications, or in cases of the recommended dosages being exceeded.[3]
Stroke
NSAIDs also raise the risk for heart attack, heart failure, and stroke. This risk begins as early as two weeks of starting regular use. The longer you take them and the more you take, the more these risks increase.[4]
Weight Gain
Is it hard to get to your favorite weight? Ibuprofen may be to blame. Studies show it can mimic the effects of diabetes and cause a higher amount of insulin to be released.[5]
Liver Failure
Liver damage with acute liver failure is the most common complication with acetaminophen (Tylenol). These risks are higher for those who use alcohol.[6] One estimate is that of the 2000 Americans who have liver failure each year, 38% of the cases are caused by acetaminophen with 28% of the cases resulting in fatality.[7]
A special concern with acetaminophen is that it is a secondary ingredient in many over-the-counter and prescription medications. This raises the potential for unintentional overdose for those who take it by itself while unknowingly taking it in other products as a secondary ingredient.
Pediatric Dangers
Children may especially be at risk. Those under the age of six have been shown to have non-fatal liver injuries even when taking doses deemed safe.[8]
Opioid Narcotics Fatalities
In 2014 alone, over 47,000 people died from prescribed opioid narcotics. This represents 61% of all drug overdose deaths, both prescription and illicit. This rate has more than tripled since the year 2000.[9]
Safer and More Effective Options for Chronic Pain:
- Cognitive behavioral therapy
- Targeted amino acid therapy
- Mindfulness meditation
- Acupuncture
- Cryotherapy
- Massage therapy
- Curcumin alkaloids such as Inflama-Rest
- Mind body therapies such as John Sarno’s approaches
- Prolotherapy and PRP therapy
- Chiropractic and physical therapy
These are medications given for anxiety and sleep. Despite the fact that many people are on these for years, the prescribing labels and practice guidelines recommend them only for short-term use.[11]
The most common brands used are Ativan, Xanax, and Klonopin. The death rate from these medicines has gone up five times in roughly the last decade.
As of 2013, Medicare started to pay for benzodiazepines like Xanax and Ativan. Since then, they have been prescribed an extra 40 million times.[12]
Dementia
These medications may cause premature dementia,[13] leading to impaired short-term memory, confusion, poor word recall, and lack of mental focus. Similarly, they can raise the risk of developing Alzheimer’s disease with as little as 1-2 months of regular use. Each dose after this showed a higher and higher risk of Alzheimer’s.[14]
Addictive
They are also known to be highly addictive and difficult or impossible to stop after months of regular use.[15]
Long-Term Effects
Some of the long-term effects of benzodiazepines are:[16]
- Memory loss
- Confusion and difficulty thinking clearly
- Lethargy and lack of motivation
- Fatigue
- Headaches
- Drowsiness and sleepiness
- Difficulty sleeping and disturbing dreams
- Nausea
- Personality change and changes in emotional responses
- Anxiety
- Irritability, paranoia and aggression
- Depression
- Lack of motivation
- Weakness
- Fatigue
- Skin rashes
- Weight gain
Medicines like Ambien and Lunesta are used by 60 million Americans each year. Large studies have shown they don’t work, as they provide only 14-15 minutes of additional sleep.
Death and Cancer
Several studies have shown these medicines are deadly. As few as 19 doses per year can raise the risk of death by nine-fold in those who are obese and 4.5 times in those who are lean.[17] They have also been shown to raise the risks of many types of cancer.[18,19]
Diphenhydramine (Antihistamine)
Diphenhydramine (Benadryl) is commonly used both as a sleep aid and for allergy symptoms. Histamine can be the chemical trigger of allergy symptoms, yet it is also a brain chemical that causes alertness and mental focus. When it is blocked, many feel groggy and sleepy. Diphenhydramine is the active ingredient in many over-the-counter sleep aids such as Tylenol PM and Advil PM.
Dementia
A large study showed that diphenhydramine can cause dementia. A team of researchers tracked 3500 adults, ages 65 and over, for seven years. During that time, those who used medications like diphenhydramine had a 54% higher risk of developing dementia than those who didn’t use the medicine or who used it for under three months.
Weight Gain
Diphenhydramine has been shown to cause dramatic weight gain and insulin resistance with regular use in both genders. Research has shown men who use it regularly are over 19 pounds heavier than similar men who do not. For women, the difference can be over nine pounds.[20]
Safer and More Effective Options for Anxiety and Insomnia:
- Cognitive behavioral therapy
- Targeted amino acid therapy
- Mindfulness meditation
- Theanine
- Fish oil
- Acupuncture
- Kava extracts
[1] Kaufman DW, Kelly JP, Rosenberg L, et al, “Recent patterns of medication use in the ambulatory adult population of the United States: The Slone Survey,” JAMA 2002;287:337-344.
[2] Ofman JJ, Maclean CH, Straus WL, et al, “A metaanalysis of severe upper gastrointestinal complications of nonsteroidal anti-inflammatory drugs,” The Journal of Rheumatology, 2002;29(4):804-812.
[3] Singh G, “Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-inflammatory drugs: A view from the ARAMIS database,” American Journal of Therapeutics, 2000;7:115-121.
[4] Mangoni AA, Woodman RJ, Gilbert AL, Knights KM, “Use of non-steroidal anti-inflammatory drugs and risk of ischemic and hemorrhagic stroke in the Australian veteran community,” Pharmacoepidemiol and Drug Safety, 2010 May;19(5):490-8. doi: 10.1002/pds.1945.
[5] Li J, Zhang N, Ye B, Ju W, Orser B, Fox JE, Wheeler MB, Wang Q, Lu WY, “Non-steroidal anti-inflammatory drugs increase insulin release from beta cells by inhibiting ATP-sensitive potassium channels,” British Journal of Pharmacology, 2007 Jun;151(4):483-93. Epub 2007 Apr 16.
[6] Sinclair J, Jeffery E, Wrighton S, Kostrubsky V, Szakacs J, Wood S, Sinclair P, “Alcohol-mediated increases in acetaminophen hepatotoxicity: role of CYP2E and CYP3A,” Biochemical Pharmacology, 1998 May 15;55(10):1557-65.
[7] Larson AM, Ostapowicz G, Fontana RJ, et al, “Outcome of acetaminophen-induced liver failure in the USA in suicidal vs accidental overdose: Preliminary results of a prospective multi-center trial,” Hepatology 2000;32(4 pt 2):396A.
[8] Heard K, Bui A, Mlynarchek SL, Green JL, Bond GR, Clark RF, Kozer E, Koff RS, Dart RC, “Toxicity from repeated doses of acetaminophen in children: assessment of causality and dose in reported cases,” American Journal of Therapeutics, 2014 May-Jun;21(3):174-83. doi: 10.1097/MJT.0b013e3182459c53.
[9] Mancano MA, “Risk Factors for Androgen Deficiency with Daily Opioid Use; Co-trimoxazole and Sudden Cardiac Death in Patients Receiving ACE Inhibitors; Clindamycin-Induced Myelosuppression; Apixaban-Induced Diffuse Alveolar Hemorrhage; DRESS Syndrome Induced by Allopurinol,” Hospital Pharmacy, 2015 Mar;50(3):189-93. doi: 10.1310/hpj5003-189.
[10] Giron SE, Griffis CA, Burkard JF, “Chronic Pain and Decreased Opioid Efficacy: An Inflammatory Link,” Pain Management Nursing, 2015 Oct;16(5):819-31. doi: 10.1016/j.pmn.2015.04.001. Epub 2015 May 9.
[11] “Short- and Long-Term Use of Benzodiazepines in Patients with Generalized Anxiety Disorder: A Review of Guidelines,” [Internet] Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2014 Jul 28
[12] “One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013,” June 10, 2015, https://www.propublica.org/article/medicare-paid-for-nearly-40-million-tranquilizer-prescriptions-in-2013.
[13] Barbui C, Gastaldon C, Cipriani A, “Benzodiazepines and risk of dementia: true association or reverse causation?” Epidemiology and Psychiatric Sciences, 2013 Dec;22(4):307-8. doi: 10.1017/S2045796013000358. Epub 2013 Jul 3.
[14] Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Bégaud B, “Benzodiazepine use and risk of Alzheimer's disease: case-control study,” BMJ, 2014 Sep 9;349:g5205. doi: 10.1136/bmj.g5205.
[15] Tan KR, Rudolph U, Lüscher C, “Hooked on benzodiazepines: GABAA receptor subtypes and addiction,” Trends in Neurosciences, 2011 Apr;34(4):188-97. doi: 10.1016/j.tins.2011.01.004. Epub 2011 Feb 25.
[16] “Benzodiazepine Facts,” http://www.druginfo.adf.org.au/drug-facts/benzodiazepines (accessed Jan 2013).
[17] Lan TY, Zeng YF, Tang GJ, Kao HC, Chiu HJ, Lan TH, Ho HF, “The Use of Hypnotics and Mortality - A Population-Based Retrospective Cohort Study,” PLoS One, 2015 Dec 28;10(12):e0145271. doi: 10.1371/journal.pone.0145271. eCollection 2015.
[18] Kripke DF, Langer RD, Kline LE, “Hypnotics' association with mortality or cancer: a matched cohort study,” BMJ Open, 2012 Feb 27;2(1):e000850. doi: 10.1136/bmjopen-2012-000850. Print 2012.
[19] Kripke DF, “Possibility that certain hypnotics might cause cancer in skin,” Journal of Sleep Research, 2008 Sep;17(3):245-50. doi: 10.1111/j.1365-2869.2008.00685.x.
[20] Ratliff J, Barber J, Palmese L, Reutenauer E, Tek C, “Association of prescription H1 antihistamine use with obesity: Results from the National Health and Nutrition Examination Survey,” Obesity (Silver Spring), 2010;18(12):2398-2400. doi:10.1038/oby.2010.176.
(c) 2015- Integrative Health Care, PCWould you like to use this article? You may as long as you use the following information along with the article:
Dr. Alan Christianson is an Arizona-based Naturopathic Physician who helps
people overcome adrenal and thyroid disorders and achieve lasting fat loss. He
authored the New York Times' bestselling Adrenal Reset Diet, and The Complete Idiot’s Guide to Thyroid Disease. Dr. Christianson is the founding physician
behind Integrative Health.
Dr. Christianson can be reached at www.MyIntegrativeHealth.com, www.DrChristianson.com and 480-657-0003.
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