Long-term Effects
By Rear Adm. Joyce Johnson, D.O., M.A.

For 10 years, I took nonsteroidal anti-inflammatory drugs (NSAIDs) to treat joint pain, with no side effects. All of a sudden, I vomited blood, was hospitalized, and almost died. What happened?

Side effects from drugs can be divided into immediate and delayed problems. Immediate side effects result from the acute impact a drug has on the body and occur shortly after the drug is taken. For example, a penicillin allergy may manifest itself within a few minutes, even seconds, of taking the drug. Likewise, tetracyclines frequently can cause diarrhea within a day or two. Every time a pill or tablet is taken, there is some risk of an acute side effect.

Delayed side effects occur with drugs taken over a period of months or years. Over time, some side effects are additive, but symptoms may not occur until there is serious disease. (Think of the straw that broke the camel's back.) NSAIDs can irritate the gastrointestinal tract, including the stomach and bowel. Patients may not notice any nausea or abdominal pain until serious ulcers (erosion of the mucosal tissue) develop. These ulcers can bleed and cause symptoms such as bloody vomit or red or black stools. This can explain your bleeding after no apparent problems for years.

Drugs can have chronic effects on other body systems. Some antihistamines were taken off the market recently because high doses over long periods of time caused a specific type of irregular heartbeat that could be fatal. Medications such as estrogen have effects on many different parts of the body; some changes can take many years to manifest.

The body usually repairs itself or compensates, especially if a drug is taken intermittently. However, if a drug that is a minor poison to the kidneys, for example, is taken in combination with another agent that can cause kidney disease, the effects can compound each other, and serious disease can result.

People sometimes assume that only prescription drugs have side effects. However, over-the-counter products, herbal and food supplements, and even vitamins can produce toxic effects and interact with prescription drugs and with each other. Keep a complete list of all products you take, and bring it to every medical appointment. If you have taken some products for long periods of time, note that on the list.

The positive effects of prescription drugs are far more common than adverse reactions. However, you should discuss both the risks and benefits of all the products you take with your doctor. This will help you and your doctor work together to prevent adverse drug reactions.