Observers say a host of factors can create complications with medicines

Cindy Derouin, director of pharmacy at Valley Hospital Medical Center, heard the cough in the next supermarket aisle. It was a deep, dry cough.

“I couldn’t help myself,” she said. “I had to go over there.”

Once Derouin introduced herself as a pharmacist, the woman confided that she’d had the cough for a month, and it was driving her crazy. She’d even been to the allergist, who’d concluded that it wasn’t an allergy.

A few questions confirmed Derouin’s suspicion: The woman took an ACE inhibitor for high blood pressure. The cough was a side effect.

“She said, ‘What’s an ACE?’ ” Derouin recalled. (It’s an angiotensin converting enzyme.)

Derouin wasn’t telling the woman to stop taking blood pressure medication. Instead, she advised her to alert her doctor and ask for a different prescription.

A few months later, the woman ran down the supermarket aisle toward Derouin to thank her. The doctor hadn’t even been aware that the cough was a common side effect of the drug.

“I said, ‘It’s hard — there’s a lot of drugs,” Derouin remembered. “She said, ‘It’s just changed my life.’ ”

Like the woman in the supermarket, Dana Kaye took an ACE inhibitor for high blood pressure — and had the cough.

“I moved here in September of 2008, and so probably in 2009 I had developed this cough for several months, and I thought, it’s a desert cough,” she said.

Only when she went to see her cardiologist for a stent a year later was the mystery solved.

One commonly quoted statistic is that nearly 100,000 people die each year from adverse drug reactions, said Dr. Brian Solow, who oversees the Drug Interaction Alert Program for Optum Rx, a pharmacy benefit manager. The company deals with medication coverage for about 62,500 Nevadans.

And, Solow emphasized, undesirable side effects don’t come just from high-powered or rare medications.

Consider aspirin. Derouin said it can cause everything from gastric ulcers to problems with bleeding, ringing in the ears and asthma attacks.

For adults who maintain a baby aspirin regimen because they’ve had a heart attack, “the amount you’re taking is probably not enough to induce a lot of this stuff,” she added. “That’s why they say, don’t take an adult-sized aspirin. Take a baby aspirin.”

Then again, baby aspirin is misleading.

“We recommend that no children be given aspirin to lower a fever,” said Derouin, alluding to Reye’s syndrome, an aspirin-induced illness that can lead to organ failure in children. “That’s why Tylenol became so popular, because it doesn’t have the same effects as aspirin. It doesn’t happen frequently, but if it’s your child, it happened one time too many.”

Kid-sized physiology can result in drug-related pitfalls, said Kyle Gunter, pediatric clinic pharmacy specialist at Summerlin Hospital.

The majority of medications children take are commonly seen over the counter, he said. And that can cause problems.

“I think parents sometimes assume that just because it’s over the counter means it’s safe. And that’s pretty much never the case.” Gunter said. “You can take a medication that’s over the counter and it can be harmful if taken inappropriately. And that even includes your herbal supplements. Or your homeopathic remedies.”

Just because these kinds of remedies say “all natural” on the bottle, doesn’t mean they’re safe, or even appropriate, for what’s going on, Gunter said.

Gunter said over-the-counter medications can have the same name but different formulations; for example, adult Pepto-Bismol versus children’s Pepto-Bismol.

“They both say ‘Pepto-Bismol,’ but they’re two different products,” he said. “You have to read the labels. It may not be obvious to a parent, but the adult Pepto-Bismol has the aspirin product in it.”

Gunter also cautions parents to think twice before administering Benadryl to sedate unruly kids on long trips.

“Instead of putting the child to sleep, it can actually make them more agitated,” he warned.

Instead, he recommends the bottle, the pacifier and activities.

Patient ethnicity, gender and age and interactions between drugs can increase or decrease a medication’s effectiveness or spark other side effects, Derouin said.

And, Solow said, drug-food interactions are another consideration, whether that involves grapefruit juice blocking a particular enzyme that metabolizes certain drugs, or dairy products lessening the effectiveness of antibiotics.

Finally, there’s the “cascade of side effects” phenomenon described by Derouin.

“Let’s say the side effect is diarrhea,” she said. “So now we have to treat the diarrhea. But the drug used for the diarrhea may have other side effects. So now I have to use a different drug to take care of the side effects of the other drug. People can end up on several medications that, if they had figured out the original cause, might not have been needed.”

She knows something about the phenomenon, not just as a pharmacist, but also from her own personal experience, helping her mother reduce her prescription load from 11 drugs to seven.

“My mom was on one drug — which, to this day, I don’t know why,” she said. “The physician had no idea why she was on it. Because one of the specialists had prescribed it three years ago.”

Kaye herself once had a morning routine of throwing open her kitchen cabinet doors and popping nine prescriptions.

“I was going through my divorce and I was only going to have health insurance for one more year,” she said. “I was on nine prescriptions that, out of pocket, would have cost me close to a thousand dollars a month. So I went to my doctor and I said, ‘OK, we’ve got a year.’ ”

It took nine months. Diet and weight loss addressed her blood pressure, cholesterol and knee problems. She also avoided foods that caused inflammation. Kaye no longer takes any prescriptions.

Derouin still recalls moments of illumination from her time as director of pharmacy at Wyandotte Hospital, in a Detroit suburb, when the hospital offered senior citizens cheap meals coupled with brown bag events. That involved seniors dumping their prescriptions out on the table for a pharmacy consult.

Some seniors were still taking drugs for short-term conditions — such as rashes — long after the condition was gone, and experiencing dizziness, a side effect that’s particularly dangerous to those already prone to falling. Others were taking duplicate prescriptions, including one man who had three different prescriptions for a beta blocker.

“I was amazed he was still walking,” Derouin said.

That’s why she wants to ensure that people understand their medications, the potential side effects, and the importance of having someone help them coordinate. One suggestion is, always go to the same pharmacy.

“Even if one drug is a little bit more than the other, in the end it’s much safer,” she said. “Because they have a record of everything you have, and they have software programs to look to see if there are interactions.”

As for recognizing a side effect, the occurrence of something unusual after beginning a new medication is usually a red flag, both in adults and children, she and Gunter agreed. Then again, Derouin said, side effects can explode onto the scene after an extended time of taking the drug or if the patient’s health condition changes.

Getting a second opinion, including one from a trusted pharmacist, can make a difference for patients, she said. If it still seems obvious that the problem is a side effect, but the physician won’t agree, there’s always another doctor’s office.

“I’m convinced that the more important thing is, that the patient needs to know why they’re taking the medication,” Solow said. “That will empower them to think about all those other things that go along with it. Because maybe they don’t even need the medication.”