Recognizing Side Effects

Loss of Interest in Sex. One of the prominent symptoms of depression is anhe-donia, a lack of interest or pleasure in life. Anhedonia is commonly manifested by a decreased libido or a lack of interest in sex. This is different from the sexual dysfunction of delayed ejaculation, delayed orgasm, or anorgasmia seen with all antidepressants that block serotonin reuptake. The problem, however, is that loss of 

TABLE 13.1. Side Effects Associated with Neurotransmitter Changes 

Transmitter Side Effects from Increasing Side Effects from Decreasing 

Serotonin Anxiety (short-term) Nausea Diarrhea Sexual dysfunction Depression 

Akathisia. This is a restless inability to sit still. It is an extremely nnpleasant sensation that can arise when a patient is treated with an antipsychotic drng (this is 

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Two rather broad structural classes account for the large majority of drugs that have proven useful in the clinic for treating depression. Each of these has associated with it some clearly recognized side effects the monoamine oxidase inhibitors, most commonly derivatives of hydrazine, tend to have undesirable effects on blood pressure the tricyclic compounds on the other hand may cause undesirable changes in the heart. Considerable effort has thus been expended toward the development of antidepressants that fall outside those structural classes. An unstated assumption in this work is the belief that very different structures will be associated with a novel mechanism of action and a different set of ancillary activities. One such compound, trazodone... 

A. Although many drugs can evoke a reaction such as a rash, a rash and a dry cough are well-recognized side effects of angiotensin converting enzyme... 

Weitzel T, Plettenberg A, Albrecht D, Lorenzen T, Stoehr A. Severe anemia as a newly recognized side-effect caused by lamivudine. AIDS I999 I3(I6) 2309-11. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Although the information is important, especially for the manufacturer of phytophar-maceuticals, it should also interest the pharmacist and doctor which indications, contraindications, side effects, interactions, dosages, manner of use, and effects are, as it were, officially recognized in some cases, where the evidence is insufficient, the Commission E came to the conclusion not to advocate therapeutic use - this, of course, in no way prohibits their use, but the pharmacist in his discussions with his clients will be hesitant in recommending or will inform them of the fact. Since the information regarding the constituents of the drugs in this book is mostly more detailed than in the monographs of the Commission F, as a rule this has been omitted here. 

The separation of enantiomers is a very important topic to the pharmaceutical industry. It is well recognized that the biological activities and bioavailabilities of enantiomers often differ [1]. To further complicate matters, the pharmacokinetic profile of the racemate is often not just the sum of the profiles of the individual enantiomers. In many cases, one enantiomer has the desired pharmacological activity, whereas the other enantiomer may be responsible for undesirable side-effects. What often gets lost however is the fact that, in some cases, one enantiomer may be inert and, in many cases, both enantiomers may have therapeutic value, though not for the same disease state. It is also possible for one enantiomer to mediate the harmful effects of the other enantiomer. For instance, in the case of indacrinone, one enantiomer is a diuretic but causes uric acid retention, whereas the other enantiomer causes uric acid elimination. Thus, administration of a mixture of enantiomers, although not necessarily racemic, may have therapeutic value. 

The use of diet aids began around 1900. Since then, many drugs have been used to assist with weight loss. Some of these drugs, while very effective, produced serious side effects. These side effects were often not recognized until many people became sick, or even died. 

In 2002, the Supreme Judicial Court of Massachusetts joined a growing number of state courts that have recognized a responsibility of pharmacists to warn patients of possible side effects from prescribed medications. In the case of Cottam v. CVS Pharmacy (764 N.E.2d 814), that court affirmed a jury verdict in favor of a patient who had not been warned of the risk of priapism by the pharmacist who dispensed trazodone to him. The facts of the case disclosed that the pharmacy provided a short list of warnings to the patient but priapism was not included on the list. The court ruled that when a patient can reasonably conclude that a list of side effects is a complete and comprehensive list, the pharmacy has undertaken a legal duty to provide complete warnings and information. 

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