Be aware of these side effects of diabetes, heart medications

My patients often ask me when I prescribe a medication, "Does it have any side effects?"  The answer is that ALL medications have POTENTIAL side effects. You may take a drug and not have any problems, so for you there are no side effects. 

If you have diabetes, chances are you're taking some sort of medication to control it. These medications are life savers—but they can also cause dangerous side effects that you should know about and look out for. So can some of the medications used to treat heart disease, which, unfortunately, often goes hand in hand with diabetes. Here's an interesting article from the Harvard Heart Letter that discusses which drugs are most likely to cause serious side effects—and what you should do if you experience them.

Each year, more than 175,000 Americans over age 65 end up in a hospital emergency department because of bad reactions to a prescribed medication. Such adverse reactions range from a rash or itching to bleeding, trouble breathing, an irregular heart rhythm, and more. See the chart below for a list of the top 10 medications that send people to the emergency room, according to the Centers for Disease Control and Prevention (CDC).

Necessary but tricky drugs

If warfarin, insulin, digoxin, and the other drugs on the CDC list had equally effective but safer alternatives, the take-home message from this study would be a no-brainer: switch! But these are all necessary and important drugs. The findings aren't meant to frighten anyone away from these medications, but people taking them should be aware of potential side effects.

We certainly can't replicate the wealth of information you can — and should — get from your doctor about taking any prescribed medication. Instead, here are some general tips about taking the drugs on the CDC list.

Warfarin, prescribed as Coumadin or generic warfarin, is used to prevent blood clots.

Check your bleeding time (INR) at home, if at all possible, or on the schedule your doctor has set.

Take care if you are also taking a nonsteroidal anti-inflammatory drug, such as ibuprofen, naproxen, or aspirin. When added to warfarin, these increase the chances of gastrointestinal bleeding. Acetaminophen is an alternative, but note that taking it several times a day can increase the bleeding risk of warfarin. Try to keep your intake of green, leafy vegetables and alcohol steady from day to day.

Call your doctor if you experience any of the signs and symptoms of bleeding, including nosebleeds that won't stop, red blood in the stool, black and tarry stools, bloody vomit, a cut that won't stop bleeding, or coughing up blood.

Insulin is an injectable medication used to control blood sugar. It is prescribed under a variety of names. These include Apidra, Humalog, Humulin, Lantus, Levemir, Novolin, and NovoLog.

Check your blood sugar several times a day. There aren't any rigid rules on this, but good times include soon after getting out of bed, just before and 90 minutes after meals, if you think you are having low blood sugar symptoms, before bed, and before and after exercising. Check more often if you are sick or whenever you change any of your medications.

Take care to store insulin properly and carry a ready supply of insulin and glucose wherever you go.

Be aware of the signs and symptoms of low blood sugar, including nervousness and shakiness, perspiration, dizziness or light-headedness, fatigue, confusion, difficulty speaking, feeling anxious or weak, and feeling tired, irritable, or confused when you wake up.

Digoxin is usually taken to help an injured or weakened heart pump better. It is prescribed under the names Cardoxin, Digitek, Lanoxicaps, and Lanoxin.

Check your pulse when you are calm and relaxed early in the day. If it is slower than it should be (ask your doctor to specify a safe lower limit), call your doctor or nurse about whether you should take digoxin that day.

Take care if you begin using one or more over-the-counter medications that may interfere with the effects of digoxin, especially antacids; cold, cough, or sinus medicines; and laxatives or medicines for diarrhea.

Call your doctor if you experience changes in vision; drowsiness, headache, confusion, depression, or fatigue; muscle weakness; vomiting, diarrhea, or loss of appetite; or an irregular heartbeat or slow heart rate.

Aspirin and clopidogrel

Aspirin is sold under a variety of names; clopidogrel is available only as Plavix. Both are used to prevent blood clots.

Check that you are taking the dose your doctor prescribed and at the recommended times.

Take care when you are using these medications together or with warfarin. If you are taking clopidogrel after placement of a coronary stent, don't stop it without talking with your cardiologist.

Call your doctor if you experience any of the bleeding warning signs listed above for warfarin.

Oral medications for diabetes

A number of oral medications are used to keep blood sugar in check. These include metformin (Fortamet, Glucophage, Glumetza, Riomet; also in Actoplus Met, Avandamet, Glucovance, Janumet, Metaglip), glyburide (Diabeta, Glynase, Micronase, Gluconase), and glipizide (Glucotrol, Metaglip).

Check your blood sugar on the schedule your doctor recommends.

Take extra care with these drugs if you have any type of kidney disease or heart disease.

Be aware of the signs of low blood sugar listed for insulin.

Are you on any of the above medications? What kind of side effects have you experienced?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Diabetes

Nearly 21 million Americans suffer from diabetes, and as anyone who has been affected by the disorder knows, it is about much more than a statistic: it means a new way of life. Diabetes: A plan for livingis a special report from Harvard Medical School that will help you learn how to better understand and manage your diabetes, including type 1 and type 2, as well as other variations of the disease. This report will show you that it's not just possible to live with diabetes; it's possible to live well.

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