A pharmacist is warning of little-known dangerous side effects in common drugs — after a widely-prescribed asthma medication was found to cause suicidal thoughts.
That drug, called Singulair, is taken by 12million people including 1.6million of which are children and has been linked to dozens of suicides and attempts.
But HaVy Ngo-Hamilton, a pharmacist in Minnesota, tells DailyMail.com that other widely prescribed drugs make her nervous due to their harsh side effects.
One of these medications is Adderall and other stimulants for ADHD, which are taken by more than 16million Americans.
The powerful stimulant can cause major increases to blood pressure, which can lead to heart attacks, strokes and aneurysms, and insomnia which has devastating knock-on effects on the body.
Meanwhile, Ngo has misgivings about the prescription anti-smoking drug Chantix, which has held a bold-letter warning on its package about suicidal behavior and other psychiatric side effects since 2009.
And when a patient is prescribed a powerful painkiller for pain without an obvious cause, she brings that up with the doctor before dispensing it to make sure the patient isn’t just looking for drugs.
Below, DailyMail.com highlights the four medications Ms Ngo-Hamilton advises taking with caution.
HaVy Ngo-Hamilton holds a doctor of pharmacy degree and works at the University of Minnesota Medical Center
ANTIBIOTICS – THE RISE OF KILLER SUPERBUGS
For Ms Ngo-Hamilton, the problem of overprescribing antibiotics is paramount, and every order from a doctor should be scrutinized.
She said: ‘When there’s a new antibiotic prescription or order in the hospital, I always make sure that it is appropriate for the patient.
‘I definitely need blood work to back it up, I need to know, based on physical examination and blood work, that you truly have a bacterial infection for us to start you on an antibiotic.’
Doctors sometimes prescribe antibiotics as a preemptive strike against a possible infection after a severe bite or wound, for instance.
But this practice is believed to contribute to the growing number of bacterial infections that can evade medications, known as superbugs.
Gonorrhea bacteria have developed resistance to multiple antibiotics, including penicillin, tetracycline, and fluoroquinolones.
Ngo-Hamilton said that doctors sometimes prescribe antibiotics as a preventive measure against infection, such as after severe bites or wounds, but this practice is contributing to the rise of antibiotic-resistant superbugs
MRSA is resistant to methicillin and other penicillin-like antibiotics.
And Campylobacter jejuni, which causes food poisoning, has developed resistance to fluoroquinolones and other antibiotics commonly used to treat bacterial gastroenteritis.
A recent study found more than 39million people will die from antibiotic-resistant infections between now and 2050.
Between 1990 and 2021, more than 1million people died from drug-resistant infections each year, and 92million lives could be saved between 2025 and 2050 if there were more appropriate antibiotics to treat infections.
But Ms Ngo-Hamilton said when people go to the hospital or the doctor’s office, they expect to leave with medicine for whatever ails them, even a viral infection that can’t be helped with an antibiotic.
She said: ‘The thing is, people don’t feel the effect of antimicrobial resistance immediately. You will feel that later on when you get sick and there are no antibiotics that would work for you.’
CHANTIX – DEPRESSION AND SUICIDES
Chantix for smoking cessation requires careful review of a patient’s medical and psychiatric history due to its potential for severe side effects, including suicidal thoughts, changes in behavior, sleep disturbances, and disturbing dreams
Ms Ngo-Hamilton does a similar comprehensive review of patient information when a doctor prescribes Chantix, a medication prescribed to help people stop smoking.
The FDA found the drug sets off changes in behavior — hostility, agitation, depressed mood, suicidal thoughts and attempts at suicide.
Before slapping a warning on the drug’s label in 2009, the FDA received reports of 112 cases of suicide and 205 incidents of suicidal thoughts in people taking Chantix or a similar drug.
Ngo-Hamilton said: ‘We need to look into their psychiatric history to make sure that they’re not at risk for increased suicidal thoughts or ideation.
‘Everybody will be so surprised to hear about that, especially the patient. But it’s definitely one that you should not disregard because the adverse effects of that are so very severe.’
The drug can also cause unpleasant non-psychiatric side effects as well. One in three people enrolled in the drug’s trials experienced nausea, and one in 20 vomited more than once.
Ngo has issued the warning after a widely-prescribed asthma medication was found to cause suicidal thoughts
Chantix works by activating nicotine receptors in the brain, much like smoking a cigarette would, but does so only partially.
This provides some of the pleasurable effects of smoking by stimulating the ‘feel good’ hormone dopamine and acetylcholine – which plays a role in memory and arousal- but not to the same extent as a cigarette, which can help reduce cravings and withdrawal symptoms while trying to quit.
Dopamine and acetylcholine are also integral to regular sleep and dreaming.
Higher levels of dopamine in the brain cause a person to feel more alert and therefore less able to fall asleep.
Acetylcholine, meanwhile, is a key regulator of REM (rapid eye movement) sleep, the stage in which the most vivid dreaming occurs. With Chantix, the brain’s activity increases during REM sleep, leading to more vivid or even scary dreams because the brain is more stimulated.
OPIOIDS – ADDICTION
In addition to their high potential for abuse, opioids can cause severe constipation and other GI symptoms, as well as shallow breathing and drowsiness that could put an older person at increased risk of a bad fall
The adverse effects of overprescribing or improperly prescribing opioids are incredibly severe – the risk of addiction is chief among them.
Ms Ngo-Hamilton said: ‘For both a hospital and retail setting, pharmacists should be, and I feel like are, very diligent about evaluating the patient to make sure that the opiate or the benzodiazepine [an anti-anxiety medication with addiction potential] is appropriate for that patient.’
Opioids can hijack the brain’s reward processing system to the point where nothing matters as much as getting access to the drugs and staving off withdrawal – not even food and shelter.
Between three and 19 percent of people who take pain medication prescribed to them become hooked and in 2023, there were 81,100 opioid-related deaths in the US.
When the doctor’s prescription runs its course, people who have become dependent on the drug often seek it on the black market in the form of heroin or pills that have been laced with deadly fentanyl.
In addition to their high potential for addiction, opioids can cause nausea, vomiting, and severe constipation, as well as dizziness and drowsiness that puts someone at higher risk of suffering a dangerous fall.
Even a single dose of an opioid can cause severe breathing problems.
Opioids attach to opioid receptors in the brainstem, which controls the body’s breathing rhythm.
Normally, when carbon dioxide levels in the blood rise, the body signals to the brainstem to increase breathing to expel some of that CO2.
But opioids impair the brainstem’s ability to sense increasing CO2 levels in the blood and to trigger the necessary response of increasing the rate and depth of breathing.
As a result, the person might not feel the urge to breathe as much, resulting in shallow or slow breathing.
ADHD MEDICATIONS – OVERMEDICATING
Ms Ngo-Hamilton is cautious when dispensing stimulants like Adderall and Ritalin, particularly to teens and young adults
Ms Ngo-Hamilton is just as cautious when it comes to dispensing stimulants, such as Adderall and Ritalin for ADHD, particularly to adolescents and young adults.
While designed to treat ADHD, the stimulants have become popular study aids across college campuses, as well as party drugs.
Pharmacists join doctors and nurses in carefully evaluating the patient before starting treatment.
Patients need to be assessed thoroughly to ensure they legitimately need the medication and it’s ‘not just so that they can stay up all night and study for some exam,’ Ms Ngo-Hamilton said.
Stimulants such as Adderall, Ritalin, and Vyvanse carry the potential for addiction and come with a myriad side effects, though they are usually manageable, including loss of appetite, insomnia, jitteriness, headaches, fast heart rate, and irritability.
Doctors, more often than not, will consider a patient’s entire medical history before sending a prescription to the pharmacy.
But the pharmacist, whose specialty is how the drug works and interacts with other drugs, adds a much-needed extra layer of security that could save a patient’s life.
Some physicians have criticized what they see as an over willingness to dole out these medications to children, for whom the long-term effects are still unclear.
Prescriptions exploded during the pandemic with the rise of telehealth services – with prescriptions jumping from 35.5 million in 2019 to 45 million last year.
And an estimated one in four American teens are abusing prescription stimulants such as Adderall, according to research from the NIH.
Among all American children and adults, around 6million take a prescription ADHD drug.
The disorder is typically detected in children but a growing number of adults are being diagnosed.
There are detailed criteria for a diagnosis laid out in the DSM-5. A clinician looks for five or more symptoms of inattention or hyperactivity-impulsivity that have lasted for at least six months, are causing significant disruption in daily life, and cannot be better explained by another mental health condition.
***
Read more at DailyMail.co.uk