Doctor's Diary: Taking prescribed drugs indefinitely can have unknown consequences

The dangers of polypharmacy, a recurring theme in this column, are prodigiously compounded, observes retired Professor of Cardiology Desmond Julian, by the current practice of prescribing drugs indefinitely, “even though their long-term safety and efficacy are unknown” – as he knows only too well from personal experience.


The dangers of polypharmacy CREDIT: ALAMY

 James Le Fanu 

7 DECEMBER 2015 • 7:00AM

Long-term safety of drugs for life

The dangers of polypharmacy, a recurring theme in this column, are prodigiously compounded, observes retired Professor of Cardiology Desmond Julian, by the current practice of prescribing drugs indefinitely, “even though their long-term safety and efficacy are unknown” – as he knows only too well from personal experience.

Following a heart attack in his early seventies, Professor Julian commenced the currently recommended quartet of “preventive” drugs: statins, aspirin, Ace inhibitors and betablockers. These were initially well tolerated but after a decade of taking the Ace inhibitor Ramipril he developed the distressing, if well recognised, side effect of an intractable cough.

Several years later he had an episode of internal bleeding from the stomach caused by his daily aspirin. Most recently his beta blocker has resulted in two separate, potentially lethal, complications of a profound fall in blood pressure on exertion and slowing of the heart rate (sinoatrial block). “These could have been fatal had immediate help not been available,” he notes. 

 
Aspirin CREDIT: ALAMY

Two separate issues are at stake here. The first is the “gap of knowledge” (to put it mildly) between the evidence for the short and long-term effects of the use of these drugs. They will over a period of five years modestly reduce the risk of a further heart attack but no one has the slightest clue whether they continue to do so over decades.

Next, it is highly likely that medicines prescribed in late middle age will cause problems later on, and for several obvious reasons, notably an age-related decline in their “clearance” by the liver and kidneys and altered sensitivity to their action.

The scale of adverse effects caused by this (so far) unchallenged routine of prescribing these drugs “for life” could be readily resolved by a “discontinuation” trial - comparing the outcome in those who stop them after an appropriate interval with those who continue taking them. Meanwhile common sense would suggest that, given Professor Julian’s experience, those who do opt out will be doing themselves a favour.

http://www.telegraph.co.uk/wellbeing/doctors-diary/doctors-diary-taking-prescribed-drugs-indefinitely-can-have-unkn/

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