CLINICAL TRIALS AND TRIBULATIONS
Will I Survive My Medication? Jim Waun, MD, RPh
I
am 80. After retiring from clinical medicine, I returned to pharmacy, my original profession, 10 years ago. I have especially enjoyed counseling older adults on the adverse effects and potential interactions of their usual polypharmacy collection of drugs. I want to relate a harrowing story of side effects from a drug I took for 3 years to protect my heart. Initially, I thought I was merely showing my age. The tale began one afternoon as I was riding an exercise bike before a tennis lesson. My wife glanced at the monitor and said my pulse rate was over 150. “These damn monitors aren’t reliable,” I said, and kept pedaling, but halfway through the lesson I felt winded, sat down, and said I wasn’t having fun. After showering, my pulse was still 140 and irregular. I went to my doctor’s office, had an electrocardiogram, and was sent to the hospital. Four days and a heart-zapping cardioversion later, I went home with a normal heart rate and rhythm, 81 mg of aspirin, and a 100-mg amiodarone tablet three times weekly. I returned to playing tennis until the heart irregularity returned a year later. Back to the hospital I went for another cardioversion to nudge things back to normal. Still one 100-mg amiodarone tablet three times weekly. Six months after that, while playing tennis, I turned to chase a ball and fell. When the bumps and bruises healed I went back to the court, and in the very first game, leaning over for a shot, I nearly fell again. I announced my tennis retirement to my buddies: “I’m getting old, you know.” They knew. I adjusted my exercise routine and was cruising along nicely when I noticed my hands shaking as I used them. Three-year-old grandson Grant asked why they shivered when I helped with his coat. I started using both hands when picking up tall, liquid-filled glasses. I began feeling tottery and insecure and used railings on stairs. Once, walking up a few steps without a rail, I lost my balance and grabbed a stranger for support. I avoided walking on grassy slopes. Then, although I’ve exercised regularly for 50 years, after walking half a block, my legs felt tired. I barely made it to the end of the Clown Band gig in the Mackinaw City
JAGS 62:968, 2014 © 2014, Copyright the Author Journal compilation © 2014, The American Geriatrics Society
parade last May. I occasionally felt a weird pain on the tops of two toes. What’s going on? I wondered. Yes, I’m aging, but could the problems be from amiodarone, the only drug I was taking—in the lowest of doses? The warnings of liver, nervous, and muscular system damages supposedly occur in only 4% of cases. Last spring, my blood tests showed liver damage for the first time. A neurologist discovered numbness and loss of position sense in my feet and weakness in my lower legs. Electromyelography showed severe peripheral nerve damage. Amiodarone was controlling my heart rate and rhythm well—and also destroying my nervous system and liver. I stopped taking it. My heart rate and rhythm problem returned. I was hospitalized, cardioverted again, and started taking dofetilide, a drug that does not affect the liver or nervous system. Several months later, my balance is improving, my legs don’t feel tired, I seldom have pain in my toes, and my hands shake less when I use them. It may be a year before I’ll know how completely I’ll recover. Now, other than the 81-mg aspirin tablet, dofetilide is the only drug I take. It interacts with grapefruit juice and possibly more than 100 other drugs, including commonly used antibiotics and a heartburn drug. What if I need those drugs someday? Their interactions can produce acute and often fatal heart problems. Remembering the cartoon where the doctor tells a family the operation was a success but the patient died, I wonder if I’ll survive taking a drug that keeps my heart rate and rhythm normal.
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: The author is the sole contributor to this article. Sponsor’s Role: None.
0002-8614/14/$15.00
Will I Survive My Medication? Jim Waun, MD, RPh
I
am 80. After retiring from clinical medicine, I returned to pharmacy, my original profession, 10 years ago. I have especially enjoyed counseling older adults on the adverse effects and potential interactions of their usual polypharmacy collection of drugs. I want to relate a harrowing story of side effects from a drug I took for 3 years to protect my heart. Initially, I thought I was merely showing my age. The tale began one afternoon as I was riding an exercise bike before a tennis lesson. My wife glanced at the monitor and said my pulse rate was over 150. “These damn monitors aren’t reliable,” I said, and kept pedaling, but halfway through the lesson I felt winded, sat down, and said I wasn’t having fun. After showering, my pulse was still 140 and irregular. I went to my doctor’s office, had an electrocardiogram, and was sent to the hospital. Four days and a heart-zapping cardioversion later, I went home with a normal heart rate and rhythm, 81 mg of aspirin, and a 100-mg amiodarone tablet three times weekly. I returned to playing tennis until the heart irregularity returned a year later. Back to the hospital I went for another cardioversion to nudge things back to normal. Still one 100-mg amiodarone tablet three times weekly. Six months after that, while playing tennis, I turned to chase a ball and fell. When the bumps and bruises healed I went back to the court, and in the very first game, leaning over for a shot, I nearly fell again. I announced my tennis retirement to my buddies: “I’m getting old, you know.” They knew. I adjusted my exercise routine and was cruising along nicely when I noticed my hands shaking as I used them. Three-year-old grandson Grant asked why they shivered when I helped with his coat. I started using both hands when picking up tall, liquid-filled glasses. I began feeling tottery and insecure and used railings on stairs. Once, walking up a few steps without a rail, I lost my balance and grabbed a stranger for support. I avoided walking on grassy slopes. Then, although I’ve exercised regularly for 50 years, after walking half a block, my legs felt tired. I barely made it to the end of the Clown Band gig in the Mackinaw City
JAGS 62:968, 2014 © 2014, Copyright the Author Journal compilation © 2014, The American Geriatrics Society
parade last May. I occasionally felt a weird pain on the tops of two toes. What’s going on? I wondered. Yes, I’m aging, but could the problems be from amiodarone, the only drug I was taking—in the lowest of doses? The warnings of liver, nervous, and muscular system damages supposedly occur in only 4% of cases. Last spring, my blood tests showed liver damage for the first time. A neurologist discovered numbness and loss of position sense in my feet and weakness in my lower legs. Electromyelography showed severe peripheral nerve damage. Amiodarone was controlling my heart rate and rhythm well—and also destroying my nervous system and liver. I stopped taking it. My heart rate and rhythm problem returned. I was hospitalized, cardioverted again, and started taking dofetilide, a drug that does not affect the liver or nervous system. Several months later, my balance is improving, my legs don’t feel tired, I seldom have pain in my toes, and my hands shake less when I use them. It may be a year before I’ll know how completely I’ll recover. Now, other than the 81-mg aspirin tablet, dofetilide is the only drug I take. It interacts with grapefruit juice and possibly more than 100 other drugs, including commonly used antibiotics and a heartburn drug. What if I need those drugs someday? Their interactions can produce acute and often fatal heart problems. Remembering the cartoon where the doctor tells a family the operation was a success but the patient died, I wonder if I’ll survive taking a drug that keeps my heart rate and rhythm normal.
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: The author is the sole contributor to this article. Sponsor’s Role: None.
0002-8614/14/$15.00
