Dealing with drug side effects – Part 1

August 31, 2008 · Filed Under Side Effect Facts · Comment

The key to coping with your side effects

The key to coping with side effects is knowing what to watch out for and having a plan in place to respond if problems occur. If a drug you are taking or are planning to take has a side effect that may be life-threatening, it’s important to know what early symptoms of that effect are and to monitor for them. It is also possible to prevent or reduce the seriousness of some side effects by taking certain preventive therapies a few days before or at the same time as starting a new regimen.

Before starting any therapy, talk to your doctor about the risk of side effects from various drugs. This information usually comes from studies conducted on the drug. Ask how often side effects were reported.

What to look for; what to do?

Many people experience an adjustment period when starting a new therapy. This period usually lasts about four to six weeks as your body adapts to the new drug. During this time, you may experience headache, nausea, muscle pain in your arms and occasional dizziness. These kinds of side effects typically lessen or disappear as your body adjusts.

Learn to recognize, monitor and manage side effects should they arise. Often, simple solutions exist to lessen many side effects. In other cases, a particular side effect may be an important signal that requires immediate medical attention.

Once you notice any unusual reactions after starting or changing a drug, report the side effects to your doctor. If possible, talk to others who have used the same drug. They may be able to offer solutions.

Fatigue

It’s not unusual to feel tired, especially when life is hectic. A sense of tiredness that doesn’t go away with rest is a problem. If ignored, fatigue can worsen.

Symptoms of fatigue can be physical—like it’s difficult to getting out of bed or walk up stairs. They can also be psychological—like having a hard time concentrating. Fatigue is also a symptom of another drug side effect—anemia.

Getting a handle on fatigue begins with acknowledging it. If you’re feeling fatigued, ask yourself: how long have you been tired? Are there activities that are difficult today that weren’t a problem a few months ago? Are you having trouble concentrating? Are you having trouble sleeping or sleeping more than normal? The more information you can give your doctor about your physical, psychological and daily habits, the more likely the two of you will be able to decide the proper treatment for your fatigue.

Tips for fatigue

* Try going to sleep at night and waking in the morning at the same time every day. Changes in your sleep schedule can actually make you feel tired.
* Try to get a little exercise. Exercise eases stress and makes you feel stronger and alive.
* Keep easy-to-prepare foods on hand for times you’re too tired to cook.

Diarrhea

Aside from being annoying, the biggest concern is that diarrhea can cause dehydration. So the first course of action is to replenish lost liquids by drinking plenty of fluids, like Gatorade, ginger ale, chicken or beef broth, herb tea or just plain water. Chronic diarrhea may lead to weight loss. Foods that provide nutrients, calories, and absorb liquid (like the BRAT diet—bananas, rice, applesauce and toast) are good tools in dealing with diarrhea.

Anti-diarrhea medications like Lomotil, Kaopectate, Imodium, or Pepto-Bismol? can help. So can bulking laxatives like Metamucil. Nutritional supplements, such as L-Glutamine?, Provir or Shaman Botanicals-Normal? Stool Formula (SB-NSF) may also help, but can be expensive.

Tips for diarrhea

* Eat foods high in soluble fiber, which slows diarrhea by absorbing liquid. In addition to the BRAT diet, these foods include oatmeal, cream of wheat, grits and soft bread (not whole grain).
* Try psyillium husk fiber bars (another source of soluble fiber). A recent study showed that two bars eaten one hour before bedtime with a large glass of water can really help diarrhea. They can be found at health food stores.
* Avoid foods high in insoluble fiber, like the skins of vegetables and fruits. These foods can make diarrhea worse.
* Try to avoid milk products and greasy, high-fiber, or very sweet foods. They tend to aggravate diarrhea.
* Try taking calcium supplements (500mg twice a day).
* Prevent dehydration by drinking lots of fluids.

Dry mouth

Dry mouth can result from taking certain medications. It is an uncomfortable condition, making chewing, swallowing and talking difficult. Dry mouth can affect your sense of taste and can promote mouth problems, like tooth decay and oral yeast infections (thrush).

Treating dry mouth can be as simple as drinking plenty of liquids during or between meals. Avoid sugary or sticky foods or caffeinated drinks since these can make your mouth even drier. Chewing sugarless gum can stimulate saliva flow. If these things don’t work, your doctor can prescribe a synthetic saliva or anti-dry mouth medication, such as pilocarpine.

Tips for dry mouth

* Rinse your mouth throughout the day with salted warm water.
* Try slippery elm or licorice tea (available in health food stores)—they lubricate the mouth and taste great!
* Suck on sugarless candies, lozenges or crushed ice to cool the mouth and give it moisture.
* Ask your doctor to prescribe products or mouth rinses to treat your dry mouth.

Hair loss

Most people experience hair loss as they get older. This is normal and affects some people more than others, especially if baldness runs in the family. Hair loss can be disturbing nonetheless and can damage one’s self-confidence.

Sudden or abnormal hair loss can result from taking certain medications (like some used to treat HIV, cancer, circulatory disorders, ulcers or arthritis).

Tips for hair loss

* To protect your hair from further damage and loss: avoid or decrease damaging hair care practices or use them infrequently. These include dyeing, perming, straightening, braiding, corn-rowing, using hair dryers, etc.
* Don’t be fooled by fraudulent claims for products that promise to cure baldness. They do not exist! The only remedy that comes close is the medication Rogaine, available over-the-counter. It has shown promising results for some (but not many) cases of baldness.
* Stress can make hair loss worse, so taking steps to reduce stress and anxiety often help.

Anemia

Anemia is low red blood cells. Those are the cells that deliver oxygen to different parts of your body. When your body is short on oxygen, you feel fatigued. Long-term or severe anemia can cause damage to your body. Most people with HIV have anemia at some point. HIV can cause it. So do many drugs used to treat HIV, like AZT (Retrovir). For women, problems with periods can also be a cause or symptom of anemia.

To monitor for anemia, have blood work done at least every three months, even if you’re not using anti-HIV medication. A change in diet or nutritional supplements can lower the risk of developing anemia. Using medication to correct moderate anemia (Procrit, Epogen) can also help. In some cases, stopping or changing the drugs that are causing anemia may be necessary. Treating severe anemia requires a blood transfusion.

Tips for anemia

* Know your red blood cell (hemoglobin) count! Get it checked regularly.
* Fish, meat, and poultry are high in iron and vitamin B-12, both of which may lower risk of anemia.
* Spinach, asparagus, dark leafy greens, and lima beans are high in folic acid, another nutrient that may lower risk of anemia.

Nausea and vomiting

Feelings of nausea and the urge to vomit vary greatly among people. The two symptoms often occur together. Certain medications used to treat HIV or related conditions can cause nausea. (See the Drug Side Effects Chart to identify drugs that may commonly cause nausea.)

Persistent vomiting can lead to serious medical problems, like dehydration, chemical imbalances and even tearing of the esophagus (throat). Call your doctor if you vomit repeatedly throughout the day or if nausea or vomiting is persistent and/or interferes with your ability to take your medication.

Tips for nausea and vomiting

* The BRAT Diet (Bananas, Rice, Applesauce, and Toast) helps with nausea and diarrhea.
* Leave dry crackers by your bed. Before getting out of bed in the morning, eat a few and sit in bed for a few minutes. This can help reduce nausea.
* Try some peppermint, chamomile or ginger tea—they can calm the stomach.
* Sip cold carbonated drinks like ginger-ale, 7-Up or Sprite. They can help avoid nausea.
* Avoid hot, spicy, strong-smelling and greasy foods.
* If vomiting occurs, replenish fluids with broth, carbonated beverages, juice, Jell-O or popsicles.
* Talk to your doctor about the benefits/risks of anti-nausea medications (such as Compazine, Marinol, Ativan, Tigan, Zofran and Phenergan).

Weight loss

Weight loss can be a serious problem in HIV disease. It can result from some of the side effects discussed in this section—like vomiting, nausea, dry mouth, anemia or fatigue.

Unfortunately, even though the signs of weight loss can be obvious, it is not always seen as a problem. In fact, many positive women who lose weight due to HIV-related problems are praised and told they “look good.”

If you’re losing weight and it’s not because you altered your diet or exercise patterns for that purpose, it’s never a good thing. Talking to a doctor to identify its cause is critical to treating unwanted weight loss.

Tips for weight loss

* Monitor your weight. If you are losing weight, work with your doctor to determine the cause. Is it stress-related? Is it accompanying nausea or vomiting? Has it occurred after starting a new medication? What other things are going on?
* Try high protein shake mixes, like Med-Rx? or Metabol. Look for products high in protein and low in sugar. These are available at most health food and vitamin stores.
* Ask about discounts at health food and vitamin stores. They sometimes provide people with life-threatening diseases special savings on nutritional products.

Period problems

Period problems are common in all women, but particularly in women with weakened immune systems. These problems include irregular, heavier, lighter and/or painful periods or the end of menstrual bleeding altogether. Problems with periods can be a side effect of some medications. Most recently, excessive menstrual bleeding has been seen when using ritonavir (Norvir).

More research is needed to determine which anti-HIV drugs have an effect on menstruation. Meanwhile, it’s a good idea to track your periods, noting changes if they occur, particularly around the time of beginning a new anti-HIV drug.

Tips for period problems

* Consider what else is happening in your life. Have you lost weight? Are you stressed out? These factors might give you clues as to why you’re having period problems. Addressing them might help in more ways than one!
* For menstrual cramps, hold a hot water bottle or a heating pad over your lower stomach or back. Or take a hot bath. This reduces stress, too!
* Do mild exercise, like walking or stretching. Exercise may increase blood flow and decrease period pain.
* Oral contraceptives (the Pill) are sometimes used to regulate abnormal periods. Some anti-HIV drugs interact with the Pill. A list of drug interactions can be found in Project Inform’s publication, GYN Conditions and HIV/AIDS.

From Project Inform. For more information, contact the National HIV/AIDS Treatment Hotline, 1-800-822-7422, or visit our website at www.projectinform.org.

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