Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: Medications and side effects
We were talking a lot about medications and every medicine seems to have a benefit and a side effect or a risk factor that we have to pay attention to. And I find it useful in most of the patients I see to say “Yeah there’s going to be some side effects. Some are going to be tolerable and you’ll get used to them and they’ll go away. Some are going to be tolerable and they don’t go away.”
A good example is a new medication that is out there, Cymbalta. It’s good for many people. It helps some people. But I tell people that you’re going to hate it the first week. The first week on thirty milligrams makes you tired and blah and nauseous. And then the second week we go up to sixty milligrams and you’re going to be less tired and less blah but still nauseous. And by the end of the second week, you’re going to finally get used to those side effects and they are going to start going away and you can start making the decision “Is it going to help you?”
I call it like water skiing. It’s not fun while you’re getting up to the top level. Once you get on top, it starts to become more interesting.
When you are in that first two weeks of some of these medicines, who the heck would ever want to take this stuff but you’ve got to understand which ones are going to go away. Most every of those side effects I mentioned go away on that drug.
Tegretol, it’s going to cause you to be dizzy and a little loopy feeling and maybe cognitively you just don’t feel as sharp. In most cases, you start out slow and let it build up and you slowly increment the dose. You’ll tolerate it and get used to it. And it will gradually get to the point where you can tolerate them. Oftentimes people think they have gone away but when they actually do later on stop the medicine they go “you know what I still had that and until I stopped it, I didn’t know it was there.”
So these medicines are affecting nerves. The nerves are what make your brain work. And that nerve system is going to feel the presence of medications.
One of the things we see like in the use of Lyrica is a good example. I tell people straight up “It’s probably going to make you dizzy” or I call it the three beers woozy. It isn’t dizzy, rolling around vertigo, it’s just that little swimming headed or the floor is moving a little bit. If you know that that’s going to come on and it’s going to be there and go away over a period of a couple of weeks, I think it is a lot easier to handle. As opposed to letting somebody take the medication home and call you back a week later. I couldn’t take that because it made me too dizzy. If they know it’s going to happen and it should go away, they’ll often stick with it and then they’ll find the benefit.
And that’s probably the thing I would like most patients to hear. It’s really important to know what is a common side effect and what is going to go away and what’s not a common side effect and we need to think about.
We mentioned one medicine, Topamax. Unfortunately, one in a million people will have a really bad painful red eye out of Topamax. But guess what? If you’re that one person, you need to know because it’s going to be you stop the medicine today. Not to call the doctor and see.
So we tell people certain things that it is not likely to happen but you need to know. This is likely to happen and you need to know. I think that’s the hardest part of current medicine that we practice is having the opportunity to tell people this is what’s likely to happen. This is what you need to do about it. We just don’t quite have the time and the resources to really give that information that we would like to give.