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Drug Overdosing: How to Avoid Medication
Side Effects
Updated: 7/08/2004
Drug side effects are the fourth leading cause of death in the United
States. According to an article published in the Journal of the American
Medical Association (JAMA) (Lazarou et al. 1998), about 106,000 Americans
die and 2,000,000 suffer from severe reactions every year from drugs prescribed
in hospitals. The information presented in this protocol was written to
enable you to reduce your risk of adverse drug reactions, while saving
significant dollars on the cost of your prescription medications. In addition,
it will provide you with a greater sense of control over your future good
health and help you to interact more confidently with your physician.
The statistics mentioned above understate the true magnitude of the problem,
since people often die from adverse drug reactions outside the hospital.
There are also many deaths that occur in hospitals caused by drugs prescribed
outside the hospital. For example, some prescription drugs deplete calcium
from bones, which causes elderly people to suffer fractures, which leads
to their hospitalization. In the hospital, these people often develop
pneumonia, vascular blood clots, sepsis, or some other illness that kills
them. The death certificate may list "pneumonia" as the cause
of death, but it was the inappropriate prescribing of the bone-depleting
drug in the first place that caused the fracture, which necessitated the
hospital confinement that led to pneumonia.
An examination of the data beyond that recorded on death certificates
reveals a shocking number of deaths related to inappropriate drug prescribing.
Even when a drug like Rezulin (Sparano et al. 1998) was withdrawn because
too many people were dying from liver failure (Watkins et al. 1998; Fukano
et al. 2000), it was estimated that only one out of ten deaths caused
by Rezulin was ever attributed to the drug (LA Times 2000).
WHAT MAKES PRESCRIPTION DRUGS SO DANGEROUS?
All drugs have the potential to cause side effects by themselves, or
through interaction with other drugs. This is one reason why more people
are turning to natural therapies that have proven track records of safety.
In order for pharmaceutical companies to earn a profit, they must develop
drugs that are potent enough to patent and can be approved by the FDA.
To gain FDA approval, these drugs must demonstrate an acceptable safety
profile. However, the safe dose of potent drugs can vary considerably
among individuals. What is safe for some people can be a lethal overdose
for others. Yet doctors and drug companies usually recommend the same
dose for everyone, even though lower doses of many prescription drugs
can achieve the same beneficial effects, while dramatically reducing side
effect risk and the cost of the medications.
Consider the cholesterol-lowering drug Zocor, for example. The recommended
starting dose is 20 mg, which has been shown to lower LDL cholesterol
by an average of 38%. Scientific studies show, however, that 5 to 10 mg
of Zocor works almost as well as 20 mg. This lower dose could reduce the
risk of side effects by as much as fourfold.
If your LDL-cholesterol level is 130 (mg/dL) and your objective is to
reduce it to under 100, just 5 mg a day of Zocor should accomplish this.
Yet, the typical starting dose of Zocor is 20 mg, and some doctors even
start as high as 40 mg. . . eight times higher than the dose needed by
many people!
New studies indicate that side effects (especially muscle aches) from
statin drugs such as Zocor are more common than originally thought. When
a person is prescribed 20 mg of Zocor, and encounters toxic side effects,
the patient often abandons the drug. Yet, if only 5 mg of Zocor were taken,
the odds of encountering side effects would be reduced and the therapeutic
target (LDL-cholesterol under 100) might be easily achieved.
It's not just Zocor that is often overdosed. The number one statin drug
sold in the United States is Lipitor, which is typically prescribed in
doses of 10 mg and higher. There are studies, however, showing that as
little as 2.5 mg a day is effective for many people.
If you are a statin drug user, have your blood tested to make sure your
total cholesterol is not below 180 mg/dL. Cholesterol levels below 180
(mg/dL) can increase your risk of cerebral hemorrhage and other lethal
diseases. Scientific studies show that the optimal total cholesterol range
is 180-220, while LDL-cholesterol should be under 100 and beneficial HDL-cholesterol
over 50. Some statin drug users drop their total cholesterol below 150.
If these people had taken a lower dose of the drug, they would probably
have adequately lowered their cholesterol levels, reduced their toxicity
risk, and saved a good deal of money. (See below on how to save money
on certain prescription medications.)
Too Much Prozac
Prozac has received considerable media attention for allegedly causing
serious psychological disturbances. Attorneys have blamed Prozac for all
kinds of criminal behaviors, and anecdotal reports abound about the adverse
effects some people experience on the standard (20 mg) daily dose of this
popular antidepressant.
When Prozac was introduced, it came only in 20-mg capsules, and all
patients were started at this dose. While Prozac helped most people, it
caused serious side effects in others. Among the side effects caused by
Prozac are headache, nausea, irritability, sexual dysfunction (impaired
orgasm, reduced libido), low energy, dry mouth, tremor, anxiety, and insomnia.
A study published before Prozac was approved showed that a daily dose
of 5 mg of Prozac helped 54% of patients, while 20 mg helped 64%. In other
words, administering four times the 5-mg dose only helped 10% more people!
Some doctors have found that lower doses of Prozac produce antidepressant
benefits without causing side effects, yet the Physician's Desk Reference
(PDR) and the drug's package insert still recommend 20 mg as a starting
dose.
While overdosing on Prozac can cause serious psychological side effects,
other antidepressants like Elavil can be lethal when taken in too high
doses. The PDR still advises an initial dose of 75 mg for Elavil (amitriptyline)
followed by gradually higher doses. Yet 10 to 25 mg of Elavil is enough
to treat mild depression or pain syndromes. Too much Elavil can cause
irreversible AV node block in the heart, leading to fatal arrhythmia.
Antidepressant drugs are often prescribed in higher-than-needed doses,
and the ensuing side effects cause many patients to abandon them altogether.
An Epidemic of Overdosing
Later in this chapter, you will see how drug companies, physicians, and
the FDA are all culpable in overdosing Americans with dangerous drugs.
The chapter also explains the toxic mechanisms involved when too much
of a drug is consumed, along with newly identified side effects of popular
drugs. Of practical value are charts showing lower doses of the most popular
prescription drugs, how to determine if you should start off at a lower
dose, and how to avoid lethal drug interactions.
This chapter exposes today's flawed system of drug regulation. Prominent
scientists accuse the FDA of failing to protect the American consumer
against the drug companies. The FDA claims it is protecting Americans
against dangerous drugs, yet the statistics show an epidemic of drug-induced
injury and death.
Too many consumers unknowingly overdose on their prescription drugs.
When unpleasant side effects develop, people often stop taking the drug
completely, even though a lower dose might be safe and effective.
More than 100,000 Americans die every year from prescription drug side
effects. In many cases, the drug-induced death could have been avoided
if a lower dose had been used.
SAVING LIVES
Chronic overdosing of prescription drugs is one of the greatest health
hazards Americans face. How can the medical establishment ignore something
so obvious? Unfortunately, obvious ways of improving patient care are
routinely overlooked by medical professionals. Today's leading causes
of disability and death are ignorance and apathy in applying proven scientific
methods of preventing and treating disease.
The information presented in this chapter will enable you to save hundreds
of dollars a year on prescription drugs, while reducing your risk of debilitating
or lethal side effects.
Save Money With Alternate Day Rather than Daily Dosing
Some drugs you are taking every day may work as well if you take them
every other day. In a study published in the American Heart Journal
(Matalka et al. 2002), a comparison was done using the cholesterol-lowering
drug Lipitor every day or every other (alternate) day. The findings showed
that alternate-day dosing was comparable to dosing every day.
The patients were started at 10 mg and their dose increased to 20 mg
if needed. The every day dosing schedule required a mean of 12 mg/day
of Lipitor to sufficiently lower cholesterol, whereas the alternate day
group only required a mean 9 mg/day to achieve similar effects. The doctors
concluded the study abstract by stating:
"these results suggest that the alternate-day administration
of atorvastatin (Lipitor) can produce a reduction in LDL-C comparable
to that of daily administration in patients with hypercholesterolemia,
and yet provide some cost savings."
What was not revealed in this study was the enormous amount of the cost
savings. Life Extension has calculated the exact amount one could save
by switching to alternate-day dosing. Here are the numbers:
- The cost of taking 10 mg of Lipitor every day is about $60.00 a month.
- The cost of taking 10 mg of Lipitor every other day is only $30.00
a month.
- If 20 mg of Lipitor is needed every other day, the cost of 15 20-mg
tablets comes out to about $44.00 a month.
Armed with this knowledge, the Lipitor consumer can save 50% ($30.00
each month) if they find they need only 10 mg of Lipitor every other day.
If 20 mg of Lipitor is needed every other day, the consumer saves 26%
($16.00 each month).
Anyone contemplating changing their dosing schedule of any drug should
notify their physician and verify that the changed dose is working. In
the case of Lipitor, one would want to check LDL, HDL, C-reactive protein
and total cholesterol blood levels within 45 days of changing the dose.
While "statin" drugs like Lipitor are taken primarily to lower
cholesterol, a side benefit is that they also lower the more dangerous
C-reactive protein. New studies confirm that C-reactive protein is a greater
risk factor for heart attack and stroke than is cholesterol.
Many drugs (such as anti-hypertensives) absolutely have to be taken
every day or even several times throughout the day. Alternate-day dosing
should not be attempted with any medication without physician approval.
Save Money By Dividing Doses
Many prescription drugs do not come in the lower doses that are optimal
for many patients. In these cases, the tablets have to be split or capsules
opened in order to obtain the desired dose. While this is somewhat inconvenient,
the cost savings can be substantial.
Zocor is one drug that comes in a wide range of doses. Here are the
typical prices in the United States for 100 tablets of each available
dose of Zocor:
- 5 mg $171.87
- 10 mg $221.78
- 20 mg $371.00
- 40 mg $390.00
- 80 mg $345.00
For the many Zocor users who need only 5 mg a day (instead of 20 mg),
the savings are 53% if one switches from the 20-mg dose to the 5-mg dose.
For those who use a pill-splitter to break 20-mg tablets into four doses,
the savings are 75%. Information about pill splitting devices appears
later in this chapter.
It is interesting to note that in today's upside-down drug pricing environment,
80-mg Zocor tablets sometimes cost less than 40-mg tablets. If you don't
want to pay artificially inflated prices for prescription drugs, you can
order from Internet pharmacies in Canada. A bottle of 100 20-mg Zocor
tablets that costs $371.00 in the United States costs only $192.12 in
Canada, a 48% savings. A bottle containing 100 5-mg tablets of Zocor costs
$171.87 in the United States, but only $119.00 in Canada, a 30% savings.
That means if you buy 20-mg Zocor tablets in Canada and split them into
four doses (5 mg each), you can save 86%. Not everyone can get by with
only 5 mg a day of Zocor, but as shown in this chapter, many individuals
are overdosing on statin and other drugs and can obtain better results
by reducing their daily dose.
MEDICATIONS SIDE EFFECTS: WHY THEY OCCUR AND HOW TO PREVENT THEM
by Jay Cohen, M.D.
MEDICATIONS SIDE EFFECTS
Prescription drugs help millions of people. Still, most people don't
like taking drugs, although many of us ultimately need to. This section
discusses how you can get the treatment you need while minimizing the
risks.
Mainstream medicine's record on preventing medication side effects is
poor. A 1998 article in the Journal of the American Medical Association
(JAMA) defined the scope of the problem: 106,000 deaths and 2,000,000
severe reactions from medications annually in U.S. hospitals, making side
effects the fourth leading cause of death in America (Lazarou et al. 1998).
These numbers aren't new. The side effect problem has continued for decades
and persists unrecognized by many doctors and authorities.
But patients understand. Patients' first concern about medications is
safety. They know intuitively that, as a leading drug reference states,
"Any drug, no matter how trivial its therapeutic actions, has the
potential to do harm" (Gilman et al. 1990).
How can you maximize safety while getting the treatment you need? There
are ways that are in accordance with scientific principles and proven
by medical studies, yet routinely ignored by drug companies, the FDA,
and doctors.
The First Key: Avoiding Side Effects
Side effects occur because most drugs aren't specific in their actions.
We may call a drug an "anti-inflammatory" or "antidepressant,"
but medications don't just go to the cells involved in these problems.
They go to most of the cells of our bodies, which can provoke undesirable
effects. Thus, an anti-inflammatory may reduce your joint pain, but it
may also cause stomach bleeding, kidney failure, or anxiety. An antidepressant
can improve mood but can also cause insomnia, nausea, weight gain, or
diminished sex drive.
Most of these unintended effects--side effects--are dose-related. You
see the same phenomenon every day with alcohol and coffee. In moderate
amounts, they cause few problems. But at excessive doses, coffee causes
edginess and insomnia, and alcohol impairs thinking and coordination.
The same is true with medications. Indeed, in the 1998 JAMA study cited
above, 76.2% of all side effects were dose-related. Melmon and Morrelli's
Clinical Pharmacology places the number at 75% to 85% (Melmon
et al. 1993). The number may be higher, because many drug interactions
are also dose-related. When people take multiple drugs, higher doses cause
more adverse interactions than lower doses. Whatever the actual number,
the first key to avoiding side effects is this: Most side effects are
dose-related. Hence, the problem isn't the drug itself, but a dose that's
too strong for you. Thus, the best way to avoid side effects is to use
the lowest dose that works. Excessive dosing merely increases risks.
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