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68 | THE AUSTRALIAN JOURNAL OF PHARMACY VOL.96 JANUARY/FEBRUARY 2015
THE AUSTRALIAN JOURNAL OF PHARMACY VOL.96 JANUARY/FEBRUARY 2015 | 69
TABLE 5: Some suggestions of counselling about common adverse effects of frequently dispensed medicines18-20,30,34
Information about harmful effects which should be offered
Acitretinin, griseofulvin, metronidazole,
Adverse effects when taken with alcohol.
All medicines require Label 1 as per SUSMP29
Warning about increased risk of additive effects when taken with alcohol and response to alcohol might be greater
Hypersensitivity reactions, e.g. swelling of the lips, neck or mouth rash, dizziness, nausea, vomiting. Dose to be reduced if
reduced renal function.
Warn about photosensitivity. Need for regular blood tests. Report any troubles with vision, cough, breathing difficulty
weight loss, skin discoloration.
Antibiotics, sulphonamide-containing medicines
Warn about possible skin rashes, and other allergic reactions. Excessive diarrhoea, vomiting, unusual symptoms e.g . dizziness
with quinolones, difficulty in swallowing, tingling of mouth, muscle aches. Lack of response. Photosensitivity with some.
Antibiotics, colchicine, metformin
Warn about excessive diarrhoea. Check dose.
Anticholinergic medicines e.g . tricyclics,
May cause confusion, dry mouth, blurred vision, urinary retention, constipation and increase risk of falls.
Anticoagulants e.g . apixaban, dabigatran,
Warn about bleeding risk; drug interactions, food interactions with warfarin, and action to take if bleeds. Surgery or dental
considerations should be discussed. Written information essential for the consumer taking health literacy into consideration.
Discuss benefits and time taken for response; time to take, dose, possible adverse events to contact doctor about, e.g. insomnia,
sedation, falls risk, bleeding (especially if used with low-dose aspirin); no improvement (concern about suicidal ideation).
Antihyperglycaemic medicines e.g. sulfonylureas,
Warn about possible hypoglycaemia, e.g. dizziness, headaches, and offer advice for treatment. Need for monitoring.
Antihypertensive medications; diuretics
Warn about possible postural hypotension, avoid dehydration. Warn against sudden cessation of betablockers. Check
Anti-Parkinsonian medicines e.g . levodopa
Antiplatelet agents e.g . aspirin, clopidogrel, prasugrel Increased risk of bleeding. Do not cease suddenly without medical advice.
Effect on driving, e.g. dizziness, blurred vision, sedation—usually goes away with time. Do not stop taking suddenly.
Asthma, COPD medicines
Lack of response to medicines, respiratory tract infections, increased incidence of pneumonia with high-dose ICS/LABA
(inhaled corticosteroids/long-acting beta-agonist) in COPD patients, prevention of osteoporosis (use of ICS), action plans.
Bisphosphonates e.g . alendronate, risedronate
Dental treatment prior to starting. Time to take and advice about swallowing to avoid oesophagitis. Report any signs of
heartburn, chest pain or difficulty swallowing.
Warn about anorexia, nausea, vomiting, diarrhoea, visual disturbances, slow pulse.
Hormone Replacement Therapy
Contraindicated in cerebrovascular or coronary artery disease; abnormal bleeding; >60 years increased risk of coronary
heart disease, stroke, venous thromboembolism, breast cancer. AMH 2014 offers numerical risk of cancers with HRT.
Immunosuppressants, biological medicines
Dose particularly with methotrexate. Warn about increased risk of infections. Need for regular monitoring with blood tests.
Report any rashes, severe sore throat, elevated temperature, unusual bleeding or bruising.
Insomnia: Medicines which cause insomnia e.g .
certain antidepressants, thyroxine, sympathometics
Sleep disturbances resulting in harm by inability to function.
Lipid lowering agents
Warn about excessive muscle aches. Areas that have received high publicity may require discussion if they are raised with
risk and benefits discussed, e.g. diabetes, fatigue, exercise intolerance, cataracts, memory loss.
Proton pump inhibitors
Possible increased risk of fracture, falls, enteric infections, diarrhoea, constipation pneumonia, B12 and magnesium depletion.
Those medicines which should be taken with/after food to minimise risk of gastrointestinal adverse effects. Care with drug
interactions, e.g. ACEI, ARB, diuretics causing renal damage.
Sedatives: Medicines which cause sedation, e.g .
sedating antihistamines, benzodiazepines, hypnotics,
opioids, certain antidepressants, antipsychotics, any
medicines which require C&A label 1 or label 1a.
Caution with those medicines which required Label 12
Warning about effects on driving, falls risk, additive risk with other medicines with same adverse effect. The sedative
effects of medications intended as a sleeping aid might still be present the next day.
Should not be used in patients who are temporarily or permanently immobilised due to risks of deep vein thrombosis. All
patients prescribed strontium should be fully informed of the risk of cardiovascular events and venous thrombosis. Patients
should be regularly monitored, every six months.
Warn about possible under supplementation, e.g. lethargy, or over supplementation, e.g. insomnia, hyperactivity,
decreased bone mineral density.
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