Based on commercials, life on medication seems great — you can finally hike that mountain, start a dance flash mob or work at a catering company!

That is, until the phrase “Serious risks may include…” introduces less-than-appealing symptoms.

Thankfully, your doctor isn’t watching ads to figure out what to prescribe.

Megan Clarke, a clinical pharmacist practitioner at Novant Health Heart & Vascular Institute - Wilmington, explains what your care team considers before writing a prescription, what you should ask before taking a new medication and whether you really need to read the fine print.

Weighing the risks and benefits of medication

How do medical professionals decide to prescribe a certain medication?

Your care team considers your diagnosis and health history, safety guidelines and their clinical experience before recommending a medication.

Before a prescription is written, the risks and benefits should always be weighed against one another. This should be a shared decision between the medical team and patient that takes into account specific considerations for the individual patient, like:

• The risk of the condition: If the benefit of a treatment is lifesaving, the patient and medical team may be more tolerant of potential side effects that may be more severe.
• The likelihood of benefits and side effects from the medication: If there’s a 100% chance of benefit and a 2% chance of a minor adverse effect, that’s very different than a medication that has a 2% chance of benefit and a 100% chance of a major adverse effect.
• The patient’s willingness to tolerate potential side effects: For some patients, an adverse effect like minor weight gain may be accepted. For others, that may be absolutely something they wouldn't want to happen.

Your preferences should always be an important part of the decision.

Why do some medications have negative side effects?

While we'd love for medications to have only one specific action, the body is very complex. A medication doesn’t always hit its target exactly and can hit other targets as well, which is why we don’t always see only one effect.

The most important thing is understanding what's expected and what's unexpected.

When prescribing a new medication, I think it's important for all care team members to have a discussion about the potential side effect(s), the expected timeline and how side effects should be handled.

The conversation can sound something like this: “You’re starting this new medication for pulmonary hypertension. I expect you’ll have a mild to moderate headache for the first few days of treatment. You can manage it with acetaminophen, and it should go away after a few days. But if it’s severe or persistent, contact me and we may need to reevaluate or change your dose.”

Do medication side effects always show up immediately?

With some medications, if you’re going to have a side effect, it will show up in the first few days.

With other medications, adverse effects can happen at any point in treatment. Make sure you know what to be aware of, and don’t be afraid to ask questions.

For some medications, your care team may require monitoring — such as regular blood tests — to make sure you aren’t having unwanted side effects. It’s important to attend those appointments.

Can there ever be positive side effects with a medication?

Yes, absolutely. Medications are developed for one specific target — but sometimes medications aren’t perfect at hitting the target. We’ve already talked about how this can create some negative side effects, but sometimes this creates side effects that people appreciate.

For example, diphenhydramine (which most people know under the brand name Benadryl) is most well-known to treat allergies, but it also makes people sleepy and is now an ingredient included in some sleep aids.

Minoxidil was originally used to treat high blood pressure, but was also found to cause hair growth. It’s also now marketed for assistance with hair growth.

Beta-blockers are typically prescribed for a heart condition, but can also be prescribed to help people deal with anxiety in very specific situations, like when they have to give a presentation.

What should I do if I don’t feel informed about a medication I’m already taking?

I think it's really important to understand why treatment decisions are made. If you don’t, I would reach back out to the prescriber and ask to have that conversation.

How to safely start a new medication

Whose job is it to make sure that any new medications being prescribed won't interact with existing medications that I take?

It is everyone’s job — including the clinician who is writing the prescription, other health care team members, the pharmacist and you.

One of the most important things you need to do is make sure you have given any medical provider an accurate, up-to-date list of your medications and supplements, including the dose and frequency.

This should include over-the-counter medications you’re taking and any emergency medications prescribed to you. Include what you’re injecting or using topically (putting on your skin).

Make sure that your list is updated and reviewed every visit. And if you’re taking medication differently than prescribed — like skipping doses or days — make sure you tell your provider that.

This process can be tedious, but it’s really important. No one can check for interactions unless they have a complete and accurate list of your medications to begin with.

Don’t assume it’s all “on the computer,” since some patients see multiple health care providers, which can mean moving in and out of different health care systems. Different lists in different computer systems can be prone to error.

Similarly, some patients use more than one pharmacy. When you go fill a prescription, the pharmacist can look at the profile they have for you, but they can’t check for interactions with medications they don’t know about.

Make sure your allergy list is current, too.

What if writing down all of my prescriptions is hard for me?

I encourage everyone to bring in everything you take in its original bottle. Then we can review one by one, going through the actual names and the real frequency with which you take it. It’s a good source of truth.

Why is it important to share what supplements I’m taking?

A lot of supplements and over-the-counter products can interact with other medications — and it can be hard to understand what’s in some supplements. This can even vary significantly from one brand to another of a similar supplement. It’s always better to provide too much information to your care team than not enough.

Should I check in with my doctor or other health care provider before I start a new supplement?

I highly suggest it. They can make sure that it’s safe to take given your other medications and conditions.

Supplement labels aren’t always clear. It might say that you’re taking a “muscle builder,” but what’s in it? Sometimes it will just say that it contains a “proprietary blend.” In those cases, we may not know the specific ingredients and amounts in it — and we may advise you not to take it.

Do I really need to read the long, tiny-print insert that comes with a medication?

Ideally, the prescriber reviewed the most clinically relevant or important side effects when they prescribed the medication. If they did, you may not need to read it in detail. It can be daunting and scary, and often it doesn’t explain the frequency of the occurrence of each side effect, which can cause undue concerns.

I would never say “don't read it and throw it away immediately” because information is valuable. But what's relevant for you, in particular, should be reviewed by the health care team member who prescribes the medication.

Dealing with medication side effects

What should I do if I start a new medication and I’m having negative side effects?

Alert the provider who prescribed it by calling their office, sending them a MyChart message or making an appointment. Then they can have a conversation with you about how to manage symptoms and whether they need to make a change.

What side effects constitute an emergency?

Seek emergency care if you have:

• Anaphylaxis (a severe allergic reaction)
• Chest pain
• Difficulty breathing
• Severe rash

Whether you’re having a medication reaction or an allergic reaction or something else, the severity of what’s happening to you may warrant being seen immediately.

What if I’m having side effects that weren’t expected?

There is a lot of safety testing that goes into getting a medication to market, but once it’s widely available, we may see new trends because there’s simply more people taking it. This can lead to new safety concerns or, on the flip side, may lead to off-label use of a medication (prescribing it for a medical condition other than what’s listed on the official label) because we found a new benefit.

If you’re having a side effect that wasn’t expected, it’s especially important to report it to your provider since there is a very specific way for them to report it back to the manufacturer. Sometimes the severity of concerns has led to actions like a labeling change or even withdrawing a medication from the market. It all starts with people reporting it.

It can be tricky to figure out whether the medication is causing it or something else, but your physician has standards they can use to see whether medication is a likely cause.

What to walk away knowing about medication side effects

Make sure your list of medications, supplements, over-the-counter medications and allergies is up-to-date at your health care offices and at your pharmacy.

You should be involved in the decision-making process before starting a new medication.

Before you start a medication, make sure you understand:

• What’s expected
• What’s unexpected
• The timeline of when to expect possible side effects
• How to handle possible side effects

If you experience unexpected or negative side effects, contact your health care provider.