Funny drug side effects

Everything has a side effect, from coffee to Tylenol to eating too much pizza (that’s called “getting rad”). Most prescription drug side effects are usually not that big a deal. Who cares about having dry mouth when you don’t have blood clots, right? Unfortunately, some side effects are worse – or weirder – than others.

While most people start taking a medication with the understanding that it will make them healthy, they rarely realize their brain, gait, and even skin color may change irreversibly. Once you get about halfway through this collection of strange side effects, you’ll start to notice that a lot of medications can really mess you up, unless you’re into having lucid nightmares or disappearing fingerprints.

It’s unrealistic to think there are medications without side effects, but it’s also hard to believe that anyone would willingly subject their body to something knowing that there’s a small chance it could make them kill their family. This isn’t meant to be alarmist, but as Francis Bacon said, “Knowledge is power.” If you’re genuinely worried, talk to your doctor.

Dealing With Them

Some general things can help you ease side effects when taking your antidepressants:

  • Eat small, more frequent meals throughout the day to help your digestion.
  • Drink plenty of water.
  • Cut back on sweets and saturated fats
  • Eat plenty of veggies and fruits.
  • Keep a food diary so you can see if something you’re eating is ramping up your side effects.
  • Practice relaxation methods, like deep breathing or yoga.
  • Get regular exercise.

Depending on which side effects you have, there are specific things that can help:

Nausea: Suck on sugarless candy, and ask about a slow-release version of your antidepressant. Take the medication at night so the nausea doesn’t bother you as much.

Sexual issues: Have sex right before you take your antidepressant, when effects are lowest. Talk to your doctor about other things that can help, like estrogen cream or erectile dysfunction medication.

Fatigue: Take your meds at night before bed. Try to have a short nap during the day, too.

Trouble sleeping: Take your antidepressant in the morning instead of close to bedtime, stay away from caffeine, and ask your doctor about any medicines that can help you sleep.

Dry mouth: Carry water with you throughout the day, suck on ice chips, or chew gum. Try to breathe through your nose instead of your mouth. Talk to your doctor about medication that can help you make more saliva.

Blurred vision: Ask your doctor about special eye drops that can moisten your eyes.

Constipation: Eat plenty of high-fiber foods, or take a fiber supplement. Stool softeners can help, too.

Dizziness: Move slowly, especially when standing up. Take your antidepressant at bedtime.

Xanax Side Effects

Generic Name: alprazolam

Medically reviewed by Drugs.com. Last updated on Jan 12, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

Note: This document contains side effect information about alprazolam. Some of the dosage forms listed on this page may not apply to the brand name Xanax.

In Summary

Common side effects of Xanax include: ataxia, cognitive dysfunction, constipation, difficulty in micturition, drowsiness, dysarthria, fatigue, memory impairment, skin rash, weight gain, weight loss, anxiety, blurred vision, diarrhea, insomnia, decreased libido, increased appetite, and decreased appetite. Other side effects include: hypotension, sexual disorder, muscle twitching, and increased libido. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to alprazolam: oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release

Warning

Oral route (Tablet)

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for patients with inadequate treatment options. Limit dosages and durations to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation.

Along with its needed effects, alprazolam (the active ingredient contained in Xanax) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking alprazolam:

More common

  • Being forgetful
  • changes in patterns and rhythms of speech
  • clumsiness or unsteadiness
  • difficulty with coordination
  • discouragement
  • drowsiness
  • feeling sad or empty
  • irritability
  • lack of appetite
  • lightheadedness
  • loss of interest or pleasure
  • relaxed and calm
  • shakiness and unsteady walk
  • sleepiness or unusual drowsiness
  • slurred speech
  • tiredness
  • trouble concentrating
  • trouble performing routine tasks
  • trouble sleeping
  • trouble speaking
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual tiredness or weakness

Less common

  • Abdominal or stomach pain
  • blurred vision
  • body aches or pain
  • burning, crawling, itching, numbness, prickling, “pins and needles, or tingling feelings
  • changes in behavior
  • chills
  • clay-colored stools
  • confusion about identity, place, and time
  • cough
  • dark urine
  • decrease in frequency of urination
  • decrease in urine volume
  • diarrhea
  • difficult or labored breathing
  • difficulty in passing urine (dribbling)
  • difficulty with concentration
  • difficulty with moving
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • ear congestion
  • environment seems unreal
  • fainting
  • fear or nervousness
  • feeling of unreality
  • feeling warm
  • fever
  • general feeling of discomfort or illness
  • headache
  • hyperventilation
  • inability to move the eyes
  • inability to sit still
  • increased blinking or spasms of the eyelid
  • irregular heartbeats
  • itching or rash
  • joint pain
  • lack or loss of self-control
  • loss of bladder control
  • loss of coordination
  • loss of memory
  • loss of voice
  • mood or mental changes
  • muscle aching or cramping
  • muscle pain or stiffness
  • muscle weakness
  • nasal congestion
  • nausea
  • need to keep moving
  • painful urination
  • problems with memory
  • restlessness
  • runny nose
  • seeing, hearing, or feeling things that are not there
  • seizures
  • sense of detachment from self or body
  • shaking
  • shivering
  • sneezing
  • sore throat
  • sticking out of the tongue
  • sweating
  • swollen joints
  • talkativeness
  • tightness in the chest
  • trouble with balance
  • twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
  • uncontrolled twisting movements of the neck, trunk, arms, or legs
  • unpleasant breath odor
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • unusual facial expressions
  • unusually deep sleep
  • unusually long duration of sleep
  • vomiting of blood
  • yellow eyes or skin

Rare

  • Actions that are out of control
  • attack, assault, or force
  • chest pain
  • continuing ringing or buzzing or other unexplained noise in the ears
  • decreased awareness or responsiveness
  • deep or fast breathing with dizziness
  • ear pain
  • false or unusual sense of well-being
  • fast, irregular, pounding, or racing heartbeat or pulse
  • feeling jittery
  • feeling unusually cold
  • generalized slowing of mental and physical activity
  • hearing loss
  • hoarseness
  • lack of feeling or emotion
  • loss of control of the legs
  • loss of strength or energy
  • nightmares
  • numbness of the feet, hands, and around mouth
  • severe sleepiness
  • shakiness in the legs, arms, hands, or feet
  • sleep talking
  • swelling
  • talking, feeling, and acting with excitement
  • thoughts of killing oneself
  • uncaring
  • unusual weak feeling
  • voice changes

Incidence not known

  • General tiredness and weakness
  • light-colored stools
  • stomach pain, continuing
  • upper right abdominal or stomach pain

Some side effects of alprazolam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Absent, missed, or irregular menstrual periods
  • decreased appetite
  • decreased interest in sexual intercourse
  • decreased sexual performance or desire abnormal ejaculation
  • difficulty having a bowel movement (stool)
  • inability to have or keep an erection
  • increased appetite
  • increased in sexual ability, desire, drive, or performance
  • increased interest in sexual intercourse
  • increased weight
  • loss in sexual ability, desire, drive, or performance
  • stopping of menstrual bleeding
  • watering of the mouth
  • weight loss

Less common

  • Abdominal or bloating and cramping
  • blistering, crusting, irritation, itching, or reddening of the skin
  • change in taste bad unusual or unpleasant (after) taste
  • cracked, dry, or scaly skin
  • cramps
  • double vision
  • feeling of warmth
  • heavy bleeding
  • menstrual changes
  • pain
  • pelvic pain
  • redness of the face, neck, arms, and occasionally, upper chest
  • seeing double
  • sudden sweating
  • unexplained runny nose or sneezing

Rare

  • Acid or sour stomach
  • belching
  • bigger, dilated, or enlarged pupils (black part of the eye)
  • change in color vision
  • difficulty seeing at night
  • feeling of constant movement of self or surroundings
  • feeling of relaxation
  • heartburn
  • hives or welts
  • increased sensitivity of the eyes to sunlight
  • indigestion
  • redness of the skin
  • runny nose
  • sensation of spinning
  • stomach discomfort, upset, or pain
  • stuffy nose

Incidence not known

  • Blistering, peeling, or loosening of the skin
  • red, irritated eyes
  • red skin lesions, often with a purple center
  • sores, ulcers, or white spots in the mouth or on the lips
  • swelling of the breasts or breast soreness in both females and males
  • unexpected or excess milk flow from the breasts

For Healthcare Professionals

Applies to alprazolam: compounding powder, oral concentrate, oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release

General

Immediate-release formulations: The most commonly reported side effects included drowsiness/sedation, fatigue and tiredness, impaired coordination, memory impairment, and irritability.

Extended-release tablets: The most commonly reported side effects included sedation, tremor, headache, insomnia, and somnolence.

Nervous system

Immediate-release formulations:

Uncommon (0.1% to 1%): Amnesia, autonomic manifestations, coordination disorders, intellectual impairment, stimulation

Frequency not reported: Concentration difficulties, convulsions, dystonia, loss of coordination, seizures, sleepiness, slurred speech, taste alterations, transient amnesia, withdrawal seizures

Postmarketing reports: Autonomic nervous system imbalance, psychomotor hyperactivity

Extended-release tablets:

Uncommon (0.1% to 1%): Amnesia, clumsiness, depressed level of consciousness, hangover, hypotonia, stupor, syncope

Frequency not reported: Stimulation, withdrawal seizures

Other

Immediate-release formulations:

Very common (10% or more): Fatigue and tiredness (up to 49%)

Common (1% to 10%): Feeling warm, tinnitus, weakness

Frequency not reported: Rebound phenomena

Extended-release tablets:

Very common (10% or more): Fatigue (up to 13.9%)

Common (1% to 10%): Malaise, road traffic accident, weakness

Frequency not reported: Paradoxical reactions

Psychiatric

Immediate-release formulations:

Uncommon (0.1% to 1%): Adverse behavioral effects, altered mood, concentration difficulties, hallucinations

Rare (0.01% to 0.1%): Hypomania, mania, other adverse behavioral effects

Frequency not reported: Abuse, aggressive or hostile behavior, aggressiveness/aggression, anterograde amnesia, delusion, depersonalization, dysphoria/mild dysphoria, hostility, inappropriate behavior, intrusive thoughts, nightmares, physical dependence, primary/secondary major depressive disorders, psychic dependence, psychoses, rage, restlessness, suicide, withdrawal symptoms

Postmarketing reports: Abnormal thinking, anger, libido disorder

Extended-release tablets:

Very common (10% or more): Insomnia (up to 24.2%), nervousness (up to 21.8%), depression (up to 12.1%)

Frequency not reported: Adverse behavioral effects, aggressive/hostile behavior, hostility, intrusive thoughts, other adverse behavioral effects, sleep disturbances, rage, withdrawal syndrome

Gastrointestinal

Immediate-release formulations:

Common (1% to 10%): Increased salivation

Uncommon (0.1% to 1%): Gastrointestinal symptoms/various gastrointestinal symptoms

Frequency not reported: Abdominal cramps

Postmarketing reports: Gastrointestinal disorder

Extended-release tablets:

Very common (10% or more): Diarrhea (up to 12.1%), dry mouth (up to 10.2%)

Common (1% to 10%): Abdominal pain, constipation, dyspepsia, nausea, vomiting

Uncommon (0.1% to 1%): Dysphagia, salivary hypersecretion

Postmarketing reports: Gastrointestinal disorder

Metabolic

Immediate-release formulations:

Very common (10% or more): Increased appetite (up to 33%), decreased appetite (up to 28%), weight gain (up to 27%), weight loss (up to 23%)

Frequency not reported: Anorexia

Extended-release tablets:

Common (1% to 10%): Anorexia, appetite decreased/increased, weight decreased/increased

Uncommon (0.1% to 1%): Thirst

Cardiovascular

Immediate-release formulations:

Very common (10% or more): Tachycardia (up to 15.4%), chest pain (up to 10.6%)

Common (1% to 10%): Edema, hypotension, palpitations

Postmarketing reports: Peripheral edema

Extended-release tablets:

Common (1% to 10%): Chest pain, hot flush, palpitations

Uncommon (0.1% to 1%): Chest tightness, edema, hypotension, sinus tachycardia

Postmarketing reports: Peripheral edema

Genitourinary

Immediate-release formulations:

Very common (10% or more): Micturition difficulties (up to 12.2%), menstrual disorders (up to 10.4%)

Common (1% to 10%): Incontinence, sexual dysfunction

Frequency not reported: Menstrual irregularities, urinary retention

Postmarketing reports: Galactorrhea

Extended-release tablets:

Common (1% to 10%): Difficulty in micturition, dysmenorrhea, premenstrual syndrome, sexual dysfunction

Uncommon (0.1% to 1%): Urinary frequency, urinary incontinence

Postmarketing reports: Galactorrhea

Dermatologic

Immediate-release formulations:

Very common (10% or more): Sweating (up to 15.1%), rash (up to 11%)

Common (1% to 10%): Dermatitis

Frequency not reported: Pruritus

Postmarketing reports: Photosensitivity reaction, Stevens-Johnson syndrome

Extended-release tablets:

Common (1% to 10%): Pruritus, sweating increased

Uncommon (0.1% to 1%): Clamminess, rash, urticaria

Postmarketing reports: Stevens-Johnson syndrome

Respiratory

Immediate-release formulations:

Very common (10% or more): Nasal congestion (up to 17.4%)

Common (1% to 10%): Hyperventilation, upper respiratory tract infection

Extended-release tablets:

Common (1% to 10%): Allergic rhinitis, dyspnea, hyperventilation, nasal congestion, pharyngolaryngeal pain, upper respiratory tract infections

Uncommon (0.1% to 1%): Choking sensation, dysphonia, epistaxis, rhinorrhea, sleep apnea syndrome

Ocular

Immediate-release formulations:

Very common (10% or more): Blurred vision (up to 21%)

Rare (0.01% to 0.1%): Increased intraocular pressure

Frequency not reported: Diplopia

Extended-release tablets:

Common (1% to 10%): Blurred vision

Uncommon (0.1% to 1%): Mydriasis, photophobia

Musculoskeletal

Immediate-release formulations:

Common (1% to 10%): Muscle stiffness, muscle tone disorders, muscular cramps, muscular twitching, rigidity

Uncommon (0.1% to 1%): Muscular weakness

Frequency not reported: Musculoskeletal weakness

Extended-release tablets:

Common (1% to 10%): Arthralgia, back pain, muscle cramps, muscle twitching, myalgia, pain in limb

Frequency not reported: Increased muscle spasticity

Immunologic

Immediate-release formulations:

Common (1% to 10%): Infection

Extended-release tablets:

Common (1% to 10%): Influenza

Hypersensitivity

Immediate-release formulations:

Common (1% to 10%): Allergy

Postmarketing reports: Angioedema

Extended-release tablets:

Postmarketing reports: Angioedema

Hepatic

Immediate-release formulations:

Rare (0.01% to 0.1%): Abnormal hepatic function tests, jaundice

Frequency not reported: Elevated bilirubin, elevated hepatic enzymes

Postmarketing reports: Hepatic failure, hepatitis

Extended-release tablets:

Postmarketing reports: Hepatic failure, hepatitis, liver enzyme elevations

Endocrine

Immediate-release formulations:

Postmarketing reports: Gynecomastia, hyperprolactinemia

Extended-release tablets:

Postmarketing reports: Gynecomastia, hyperprolactinemia

1. “Product Information. Niravam (alprazolam).” Schwarz Pharma, Mequon, WI.

2. “Product Information. Xanax (alprazolam).” Pharmacia and Upjohn, Kalamazoo, MI.

3. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

4. Cerner Multum, Inc. “Australian Product Information.” O 0

5. “Product Information. Xanax XR (alprazolam).” Pfizer U.S. Pharmaceuticals Group, New York, NY.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Related questions

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  • How long does Xanax XR take to start working, and how long does it stay in your system?

Medical Disclaimer

More about Xanax (alprazolam)

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Other brands: Alprazolam Intensol, Niravam

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Related treatment guides

  • Anxiety
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Adverse drug reactions are unwanted side effects that have considerable clinical and economic costs, as they can lead to increased emergency department visits and prolonged hospital stays.1
Each year, an estimated 4.5 million Americans visit a physician’s office or emergency room because of side effects related to their prescription medications. Although it may be hard to pinpoint a reaction to one specific medication, the FDA requires drug manufacturers to list all side effects that have been reported in clinical studies in their product’s labeling.
The following is a list of 10 harmful and potentially deadly side effects of commonly prescribed medications.
1. Hallucinations
Hallucinations occur when sensing something that is not really present. Types of hallucinations include visual, auditory, olfactory, tactile, gustatory, and general somatic.
Hallucinations are a common symptom of schizophrenia, but they can also be caused by excessive alcohol intake, drug abuse, depression, sleep deprivation, dementia, or certain prescription medications.2
A number of psychiatric medications such as olanzapine (Zyprexa), quetiapine (Seroquel), and haloperidol (Haldol) have all been associated with causing hallucinations, in addition to zolpidem (Ambien), eszopiclone (Lunesta), clonazepam (Klonopin), lorazepam (Ativan), ropinirole (Requip), and some seizure medications.3
Finally, cephalosporins and sulfa drugs, which are 2 common classes of antibiotics, have been associated with causing hallucinations in rare cases.
2. Memory Loss
Although memory loss is a natural part of getting older, it may also be a side effect of certain medications.
The most notable medication class that can result in memory loss is the nonbenzodiazepine sedative hyponotics, which include Ambien, Lunesta, and Sonata. These medications can sometimes cause amnesia and trigger potentially dangerous behaviors, such as cooking a meal, having sex, or driving a car with no recollection of the event upon awakening.
Other medications that may result in memory loss include benzodiazepines, statins, certain seizure medications, opioids, and incontinence drugs.
3. Priapism
Priapism is an unwanted, painful, persistent erection that is not caused by sexual stimulation or arousal. If left untreated, tissue damage can occur, resulting in the inability to get or maintain an erection.
Causes of priapism include certain medical conditions, trauma, alcohol use, and prescription medications. Medications reported to cause priapism include trazodone (Desyrel), clozapine (Clozaril), hydroxyzine (Atarax), chlorpromazine (Thorazine), prazosin (Minipress), warfarin (Coumadin), testosterone therapy, and serotonin reuptake inhibitors such as sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).4
4. Blood Clots
Blood clots form in the body under many normal circumstances in response to injury. However, some prescription medications have been associated with blood clot formation. If left untreated, blood clots can break away from their original source and travel to other parts of the body, which can sometimes be fatal.
Female oral contraceptives and hormone therapy drugs all carry an increased risk for blood clot formation. Additionally, all testosterone replacement products share the same risk for blood clots.
5. Compulsive Behaviors
Compulsive behavior involves repeatedly performing an act without control, which interferes with an individual’s life.
Requip and pramipexole (Mirapex), which are dopamine agonists indicated for Parkinson’s disease and restless legs syndrome, can cause problems with impulse control or compulsive behaviors.
According to the drugs’ package inserts, “case reports suggest that patients can experience intense urges to gamble, increased sexual urges, intense urges to spend money, binge or compulsive eating, and/or other intense urges, and the inability to control these urges.”3
Carbidopa-levodopa (Sinemet) shares this same warning.
More recently, the antipsychotic aripiprazole (Abilify) has been linked with compulsive behavior side effects such as compulsive gambling in some patients.
6. Stevens-Johnson Syndrome
Stevens-Johnson syndrome (SJS) is a rare, life-threatening hypersensitivity reaction of the skin and mucous membranes. During SJS, large macules rapidly spread and form together, leading to blistering, necrosis, and shedding of the skin.5
Lamotrigine (Lamictal) has a relatively high incidence of SJS, especially when initiated at high doses, which led the FDA to require a black box warning on its package labeling to inform consumers of this risk. Other medications that may cause SJS include allopurinol (Zyloprim), acetaminophen (Tylenol), ibuprofen (Motrin), naproxen (Aleve), sulfa drugs, penicillin, barbiturates, and other anticonvulsants.6
7. Birth Defects
A birth defect occurs while a baby develops in the mother’s body. An estimated 1 in every 33 babies in the United States is born with a birth defect.7
Thalidomide is one of the oldest and well-known teratogenic medications. In 1954, thousands of women took the medication—which was then promoted as a wonder drug for treating insomnia, coughs, colds, and headaches—resulting in the death of approximately 2000 children and serious birth defects in more than 10,000 children.
Known teratogenic prescription medications include warfarin, divalproex (Depakote), Paxil, topiramate (Topamax), methotrexate (Rheumatrex), angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, oral contraceptives, statins, and tetracyclines.
Although the risk for birth defects is highest during the first trimester, women should consult their health care providers about the risk and benefits of all medication use during any stage of pregnancy.
8. Cancer
One of the most surprising instances of a medication related to cancer came when tamoxifen (Nolvadex), which is used to treat breast cancer, was found to increase the risk of uterine cancer. In response, the FDA required the manufacturer to add a black box warning to inform consumers of the risk.
The labeling of type 2 diabetes medication pioglitazone (Actos) includes a warning about an increased risk of bladder cancer, which stemmed from data from an observational study.
All glucagon-like peptide-1 receptor agonists have a black box warning concerning the risk for thyroid C-cell tumors that has been seen in rats and mice. Animal studies have also shown metronidazole (Flagyl) to be carcinogenic.
9. Suicidality
This issue stems back to reports in 1990 that Paxil could lead to suicidality in patients.8 Today, all antidepressants have a black box warning in their labeling about the increased risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders.
Current clinical evidence on the topic is inconclusive. Some studies have shown that the use of antidepressants correlates with increased risk of suicidal actions, while other studies have not demonstrated any increased risk.
Other medications that may be associated with suicidal thinking and behavior include montelukast (Singulair), isotretinoin (Claravis), varenicline (Chantix), and mefloquine (Lariam).
10. Death
Sudden cardiac death is the largest cause of natural death in the United States, with an estimated 325,000 adult deaths annually.
A number of antipsychotics such as Seroquel, Zyprexa, and risperidone (Risperdal) have been associated with sudden cardiac death, with increased incidence seen in the elderly and those taking other cardiac medications in combination.9
Antiarrhythmic agents that list sudden cardiac death within their package inserts include sotalol (Betapace), amiodarone (Cordarone), and procainamide (Procanbid). Lastly, the labeling for morphine and Adderall includes warnings about increased risk of sudden death due to cardiac abnormalities.9

  1. Sultana J, Cutroneo P, Trifirò G. Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacother. 2013 Dec; 4(Suppl1): S73–S77. doi: 10.4103/0976-500X.120957.
  2. Wade M. Medication-related visual hallucinations: what you need to know. EyeNet Magazine-American Academy of Ophthalmology. March 2015. Accessed January 30, 2016.
  3. Requip . Research Triangle Park, NC: GlaxoSmithKline; 2014.
  4. Drugs reported to cause priapism. UCSF Medical Center. Accessed January 30, 2016.
  5. Rehmus W. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Merck Manual. Accessed January 28, 2016.
  6. List of medications associated with Stevens-Johnson syndrome and toxic epidemal necrolysis. Steven Johnson Syndrome Foundation. Accessed January 28, 2016.
  7. Birth Defects. Medline Plus: U.S. National Library of Medicine. Accessed January 28, 2016.
  8. Thomas KH, Martin RM, Potokar J, et al. Reporting of drug-induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011. BMC Pharmacol Toxicol. 2014 Sep 30;15:54. doi: 10.1186/2050-6511-15-54.
  9. Sicouri S, Antzelevitch C. Sudden cardiac death secondary to antidepressant and antipsychotic drugs. Expert Opin Drug Saf. 2008 Mar; 7(2): 181–194. doi: 10.1517/14740338.7.2.181.

Hallucinations

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Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.

  • Care Notes

What are hallucinations?

Hallucinations are things you see, hear, feel, taste, or smell that seem real but are not. Some hallucinations are temporary. Hallucinations that continue, interfere with daily activities, or worsen may be a sign of a serious medical or mental condition that needs treatment.

What are the types of hallucinations?

  • Auditory means you hear things, such as music, buzzing, or ringing. You may hear voices even though no one else is in the room. The voices may say negative things about you or tell you to harm yourself or others. You may hear the voice of a loved one who recently passed away.
  • Visual means you see things, such as a person or object that is not real. Flashes of light or shapes are other examples. Another example is an object that is real but looks different to you than it does to others.
  • Tactile means you feel things, such as an object that is not real. You may feel like something is touching you or is crawling on or in your skin. You may also feel that your body is being cut or torn. You may feel like something is in a body part, such as your stomach, even though tests show nothing is there.
  • Olfactory means you smell something that is not real. The smell may make you gag or choke if it is not pleasant. You may smell something good, such as food or flowers. Olfactory hallucinations may be a sign of a serious medical condition that needs treatment, such as a brain tumor.
  • Gustatory means you taste things that are not real. You may taste something even when your mouth is empty. Your food may taste rotten or sour even though others eating the same food think it tastes fine.

What increases the risk for hallucinations?

  • A mental condition, such as dementia or schizophrenia
  • Drug or alcohol abuse or withdrawal, or a reaction to a medication
  • A fever, infection, or heatstroke
  • A medical condition, such as thyroid problems or a brain tumor
  • A neurological condition, such as migraines or seizures
  • An eye condition, such as glaucoma or macular degeneration
  • An inner ear condition or infection
  • Low blood sugar or sodium levels
  • Emotional problems, such as from the recent loss of a loved one, PTSD, or abuse
  • Not enough sleep, or being between asleep and awake but still dreaming

How is the cause of hallucinations diagnosed?

Your healthcare provider will ask when the hallucinations started. Tell him about any recent stress in your life, such as the death of a loved one. He will also ask about medicines you take and if you drink alcohol or use drugs. Tell him if you have trouble sleeping or had any recent illness.

  • Blood or urine tests may be used to check for infection, or for alcohol or drugs. The tests may also be used to check thyroid or liver function.
  • A CT or MRI may be used to check for an injury, tumor, or infection.

How are hallucinations treated?

  • Medicines may be given to stop the hallucinations, reduce anxiety, or relax your muscles.
  • A behavior therapist may help you recognize and manage hallucinations. He may teach methods such as the talk-through method. You will learn to tell yourself that the hallucination is not real and what to do when it ends.

Call 911 if you or someone else notices any of the following:

  • You want to harm yourself or someone else.
  • You hear voices telling you to harm yourself or someone else.
  • You have a seizure.
  • You are confused, do not know where you are, or are not making sense when you speak.

When should I seek immediate care?

  • Your hallucinations worsen or return after treatment.
  • You vomit several times in a row.
  • Your heartbeat or breathing is faster or slower than usual.
  • You have trouble breathing or shortness of breath.

When should I contact my healthcare provider?

  • You have new hallucinations.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Learn more about Hallucinations

Associated drugs

  • Alcoholic Psychosis
  • Drug Psychosis
  • Psychosis

IBM Watson Micromedex

  • Acute Delirium
  • Brief Psychotic Disorder
  • Psychiatric Hallucinations

Distressing Visual Hallucinations after Treatment with Trazodone

Abstract

Trazodone, a second-generation atypical antidepressant, is increasingly being used off-label, in the treatment of insomnia. Although generally well tolerated, trazodone treatment can be associated with some complications. We describe a case of a 60-year-old man who received trazodone for primary insomnia. He returned, to the emergency department, two days later with distressing visual hallucinations, which prompted inpatient treatment. Trazodone was discontinued, leading to a complete resolution of his visual hallucinations, and he was treated with mirtazapine for 6 months. There has been no relapse in a follow-up period of two years. Patients presenting with visual hallucinations without significant psychiatry history can be a challenging situation. We highlight the importance of careful anamnesis with an accurate medication history. Given the widespread use of trazodone, clinicians should be aware of this possible side effect.

1. Introduction

Trazodone is a commonly prescribed atypical antidepressant with hypnotic properties and it is used as a short-term treatment strategy to improve sleep in a number of psychiatric disorders . It is generally well tolerated with a favorable side effect profile , but a recent review suggested that more studies are necessary to investigate possible new therapeutic indications and to scientifically demonstrate the benefit ratio, for the many conditions for which trazodone is used .

Hallucinations are sensory perceptions that occur in the absence of an external stimulus, in any sensory modality. Visual Hallucinations are more common in acute organic states with clouding of consciousness and in patients with neurodegenerative disorders. We report a case of trazodone-induced visual hallucinations that, to our knowledge, is the first described in the literature.

2. Case Presentation

A 60-year-old widower presented to the emergency department (ED) with a two-day history of visual hallucinations and was promptly referred to psychiatry assessment. He had hypertension and his daily medication included Amlodipine 5 mg and Losartan 50 mg. Though he had history of alcohol abuse, he had been consistently abstinent for the last ten years. The patient denied current and past use of illicit drugs, including Lysergic Acid Diethylamide (LSD) and other hallucinogens drugs.

Three days ago, he went to his GP, complaining about having difficulty falling asleep and frequent waking during the last week. He denied any associated snoring, abnormal movements, or leg twitching. In the absence of any emotional and behavioral problem, he has been diagnosed with primary insomnia, and he has been prescribed with trazodone 100 mg. Soon after he started the treatment, his insomnia improved slightly and he began to describe complex visual hallucinations. He was able to clearly see dead familiars, who were standing in front of him, waving at him, when he was sleeping, or when he was performing his daily activities. All of them have passed away several years ago. He knew that these visions were not real but he was frightened and concerned he could be losing his mind. These visions lasted only few minutes and tended to occur more often during the evening and were not related to the sleep initiation or termination. The experiences occurred in clear consciousness and he was able to continue whatever he was doing during the hallucinations.

There was no report of perceived stressor preceding current episode. The patient had no associated medical comorbidities such as coronary heart disease, obstructive airway disease, or endocrine abnormalities. The patient had no history of head injury, migraines, central nervous system infection, and significant medical or psychiatric illness, including mood or psychotic disorder. His family history for psychiatric disorders was unremarkable, as well.

On examination, he was apyrexial, with a blood pressure of 111/83 mmHg, a pulse of 88 beats per minute, and a respiratory rate of 18 breaths per minute. Confrontational visual field test did not show any visual impairment. On mental state examination, the patient was oriented both in time and space and described vivid and complex visual hallucinations. He did not develop a complex delusional system to explain this phenomenon and he denied hallucinations to sensory modalities other than vision. The remaining physical and neurological examination was normal. The Mini Mental State Examination (MMSE) was negative (27/30) for cognitive dysfunction.

The patient was then admitted to the psychiatry department for etiological study and treatment.

The following investigations were performed. Drug urine screening was negative to illicit substances. CBC (diff), electrolytes, thyroid function test, and liver enzymes were normal, along with a negative blood alcohol level. A head CT scan excluded acute ischemic or hemorrhagic lesions but revealed mild ischemic leukoencephalopathy and a stable small chronic infarct in the right basal ganglia. Neurology consultation was done by a neurologist with expertise on neuropsychiatry and was unremarkable.

3. Differential Diagnosis

There are many etiologies for visual hallucinations; therefore many differential diagnoses were hypothesized.

Delirium is a syndrome that involves an acute disturbance of consciousness and a diminished ability to sustain attention with multiple etiologies. This patient was known to have used alcohol in a dependent fashion, in the past, and visual hallucinations are relatively common in drug withdrawal syndromes. However, the patient had a negative alcohol blood level and negative urine drug test. Furthermore, visual hallucinations occurred in clear consciousness with sustained attention and were vividly recalled, both circumstances arguing against a delirium syndrome.

Visual hallucinations are also found in neurodegenerative disorders . They occur commonly in Parkinson’s disease and dementia with Lewy bodies, and less frequently in other neurodegenerative causes of parkinsonism, such as multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration syndrome . However, the preservation of cognitive function and the absence of any parkinsonian feature and functional impairment make the diagnosis of dementia unlikely .

Visual hallucinations are also present in Charles Bonnet Syndrome, which is a neurological disease characterized by recurrent visual hallucinations usually following visual loss . It typically occurs in older persons and it might be the clinical hallmark of the deafferentation of the visual cortex . They may also be present in a rare condition, Anton’s syndrome, in which patients with cortical blindness deny that they have visual loss . This patient had no visual impairment and his neurological examination was unremarkable.

Sensory phenomena such as hallucinations have been described within the complex clinical presentation of epilepsy, as epileptic discharges that occur in the primary visual cortex or visual association may produce sensory seizures. Albeit rare, a seizure with only subjective visual hallucination can occur in isolation . Usually it is stereotyped and lasting only for seconds . Moreover, a recent review showed that current use of antidepressants was associated with a twofold increased risk of first-time seizures compared with nonuse . Nevertheless, the absence of other clinical more typical seizure manifestations, unremarkable neurological examination, and personal history of epilepsy make this diagnosis less likely.

Hallucinations are listed as primary diagnostic criteria for various psychotic disorders . Insomnia, which is very common in people experiencing psychosis , was our patient’s first symptom. However, the patient’s insight into the fictional nature of his hallucinations and the fact that the visual hallucinations of schizophrenia are rare without auditory hallucinations makes this diagnosis highly unlikely . Besides, late-onset schizophrenia tends to be associated with complex systematized delusions .

Overall, antidepressant treatment is associated with an increased risk of subsequent mania, which might include visual hallucinations . However, in this case, there was no evidence of inflated self-esteem or overtalkativeness and no flight of ideas or racing thoughts.

Many prescription drugs can cause confusional states , and antidepressants have been cited as inducing hallucinations rarely . A subsyndromal delirium has been suggested for patients who have an incomplete form of delirium (only visual hallucinations, e.g.) . Considering there was no history of hallucinations prior to the use of trazodone, and the temporal relation between the start and end of the patient’s trazodone treatment and the onset of visual hallucinations, a mechanism of pharmacological induction makes the most likely explanation of this case.

4. Treatment

Trazodone was stopped and the patient has been started on mirtazapine 15 mg, at bedtime.

5. Outcome and Follow-Up

The hallucinations cleared up upon discontinuation of the drug, within 48 hours. The patient was provided also with supportive psychotherapy and psychoeducation on sleep hygiene. The patient reported sleep improvement, and, after a one-week stay at psychiatry department, he was discharged.

The patient started doing his routine activities and hallucinations did not recur during a follow-up period of 2 years.

6. Discussion

Trazodone was first approved by the Food and Drug Administration in 1981, as an antidepressant. According to recognized experts in the field, prescribing low dose trazodone as a hypnotic drug is considered to be the most frequent off-label use of a drug in all of psychopharmacology .

Trazodone is a multifunctional drug, with dose-dependent functions with more than one therapeutic mechanism. At low doses (50–150 mg), it has hypnotic actions due to blockade of serotonin receptors, as well as H1 histamine receptors and adrenergic receptors, and at higher doses (150–600 mg) recruits additional pharmacological actions through the blockade of the Serotonin Transporter (SERT), becoming a full antidepressant .

The pharmacological profile of trazodone on serotonin (5-HT) system is highly complex and his therapeutic edge over other antidepressants might be due to its simultaneous action on and receptors . blockade can raise the levels of several neurotransmitters, such as dopamine and norepinephrine, in the prefrontal cortex, enhancing antidepressant effects . In fact, on animal studies, trazodone at 30, 40, and 50 mg/kg, by blocking receptors stimulated the nigrostriatal dopaminergic neurons . Although lacking direct effect on dopaminergic receptors, this indirect pathway might be relevant, considering the fact that hallucinations might be understood as a phenomenological correlate of dopaminergic dysfunction in the brain .

Albeit less pronounced than tricyclic depressants, trazodone has still effects on cholinergic transmission, and so hallucinations might also result from a relatively reduced cholinergic activity, induced by trazodone. Other central nervous system effects such as confusion and decreased concentration were also observed in patients taking trazodone . A recent meta-analysis that looked for associations between drugs with anticholinergic effects and cognitive impairment and falls showed that Olanzapine and trazodone were associated with increased odds and risk of falls, as well as cognitive impairment, although the latest was more modest .

As we have seen, trazodone has serotonergic properties and is comparable, at least to some degree, to traditional serotoninergic antidepressants. There are several reports on the emergence of psychotic symptoms, including only visual hallucinations, during treatment with serotoninergic antidepressants , such as Sertraline , Duloxetine , and Citalopram . Visual hallucinations might also be part of the discontinuation syndrome that results from Paroxetine discontinuation . The serotoninergic model of hallucinations is related to cortical receptor hyperactivation, which appears to be the main mechanism of LSD induced psychosis . Interestingly, a long history of LSD abuse might predispose to the occurrence of LSD flashback syndrome (characterized by transient visual hallucinations), following initiation of antidepressant therapy with selective serotonin reuptake inhibitor agents . The underlying mechanism might be the destruction of inhibitory serotonergic interneurons caused by exposure of LSD, or serotonin receptors remaining in a state of permanent upregulation following previous LSD use. As a result, an acute increase of synaptic serotonin, from the initiation of SSRI treatment, would result in a highly enhanced serotonin signal, which might lead to hallucinogenic effects . Our patient had a history of alcohol abuse. Similarly to LSD, we speculate that heavy alcohol use in the past may have induced similar changes in the brain, increasing vulnerability to the development of hallucinations, after antidepressant treatment (in this case, trazodone). Here we first report a case of visual hallucinations, induced by trazodone. Related findings were already observed and published in the literature, particularly auditory hallucinations induced by trazodone , and a disorganized type of psychosis in which the patient’s psychotic symptoms included hallucinations as part of the clinical picture , after trazodone treatment. In all of them there was a clinical remission upon the discontinuation of the offending drug.

We would like to emphasize that trazodone-induced visual hallucinations, like any hallucinatory event, have the potential to be underreported. The low report of visual hallucinations may be explained by the embarrassment of the patient to report visions that they feel will not be perceived by others to be real, like in this case, where the patient was afraid to be confused by others as having a mental illness or excessive drug use.

In conclusion, a temporary dysfunction in neurotransmission involving serotoninergic and/or cholinergic pathways, induced by low dose trazodone administration, might contribute to the occurrence of hallucinations. Further studies or case reports are required regarding the underlying mechanisms of action before definitive conclusions can be reached.

Additional Points

Key Clinical Message. (1) Visual Hallucinations are not always indicators of neurological or mental disorder. (2) A full drug history should be considered mandatory in any patient complaining of visual hallucinations. (3) Trazodone, like other antidepressants, might seldom precipitate hallucinations. The awareness of this rare mechanism avoids the burden of unnecessary antipsychotics.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Still, sometimes testing doesn’t reveal everything about a drug’s side effects, and they don’t show up until after the medication enters the marketplace and more people start using it. That’s where MedWatch comes in. The FDA’s post-marketing surveillance program seeks voluntary input, mainly from health care professionals, on unwanted effects they see in ”the real world.” Sometimes these reports are numerous or serious enough for the FDA to take regulatory action, such as adding warnings to a drug’s label.

This happened with the psoriasis drug Raptiva. The FDA required that the drug carry the agency’s strongest warning, known as a black box warning, after it received reports of brain infections and meningitis in patients taking the drug. The drug was later taken off the market.

The FDA also wants input from consumers when it comes to side effects. All prescription drugs, and many OTC products, must be labeled with a toll-free number the agency has for letting it know about side effects with drugs, called “adverse events.” You can report possible new but severe side effects through MedWatch at 1-800-FDA-1088 or through the FDA website.

Sometimes, the post-marketing information coming in to the FDA is so disturbing that a drug is discontinued. Baycol, which lowers cholesterol, was strongly linked to a breakdown of muscle tissue that could be deadly. The drug was approved in 1997, and the manufacturer stopped selling it 4 years later. The anti-inflammatory drug Duract spent just 1 year on the market. It was approved only as a short-term use product, and the FDA found serious liver problems when people took the drug for longer than recommended.

Drug companies are also required to report adverse events to the FDA. Failure to do so can lead to prosecution. In 1985, employees of two drug companies were fined or sentenced to community service for not reporting adverse events involving the blood pressure drug Selacryn and arthritis drug Oraflex. Both products were pulled from the market.

What Drugs Cause the Most Insane Behavior?

Authored By American Addiction Centers Editorial Staff Posted to: Drug Abuse

Many substances that are addictive cause mental changes or unusual behavior. Even if a substance does not inherently have mind-altering properties, people who are addicted to it may display strange behavior if they need the drug are unable to obtain it.

Bath Salts

Bath salts are a relatively new addition to the drug scene. Bath salts are part of group of drugs sometimes called designer drugs, because they are synthesized to produce the same effects as illegal drugs. Because they are chemically similar but not the same, they can be sold legally and are often easy to obtain. The substance sold as bath salts is actually synthetic cathinone. Cathinone is naturally found in a plant sometimes called khat. Because of their growing notoriety, bath salts are illegal in forty-one states, though many other designer drugs are still legal and attainable. Bath salts can cause panic attacks, paranoia, hallucinations, violence, and suicidal behavior. A recent, widely reported incident in which a man high on bath salts ate parts of another man’s face in a brutal attack has drawn media attention to the drug.

Cocaine

Cocaine is an illegal, addictive drug that has stimulant properties. It is derived from the coca leaf, and it was used in the United States to treat a variety of conditions as an over-the-counter remedy up until the late 1920s. It was especially popular during prohibition, when many saw it as a safe and sane alternative to alcohol. It was one of the original ingredients in Coca-Cola. Today, cocaine has no accepted medical application and is used illegally for recreational purposes. The drug can be taken by rubbing cocaine powder into the gums, by chewing the coca leaf, by snorting the powder into the nose, by injection, by inhalation, and even by suppository. Cocaine is a serotonin-norepinephrine-dopamine reuptake inhibitor, which is one reason why it is very addictive. Cocaine affects the nervous system and can make users feel euphoric. It can also cause paranoia, anxiety, tremors, and convulsions. Large amounts or frequent use of cocaine can cause hallucinations, paranoid delusions, and depression. Those addicted to cocaine may experience symptoms like psychosis, depression, and an inability to sit still. Crack cocaine is an especially common form of cocaine in inner-city environments; it is characterized by a crystal or rock-like appearance.

Anabolic Steroids

Anabolic steroids were originally developed to treat health conditions that caused patients to be dangerously underweight. These drugs are sometimes also used by athletes, though that is controversial because long-term use of steroids can be dangerous and they can give the user an unfair advantage when competing. Anabolic steroids can be given orally, by injection, or topically. Abuse of anabolic steroids can cause a range of negative health effects, including high blood pressure, high cholesterol, and cardiovascular disease. Use of anabolic steroids can cause psychiatric effects, especially aggression. These drugs can also cause mania, psychosis, suicidal thoughts, and violent behavior. Users of anabolic steroids may experience mood swings and even mania. Anabolic steroids may be addictive, but further study is needed to verify that.

LSD

LSD use is characterized by some widely known psychological effects including hallucinations, inability to think clearly, synesthesia, and other issues. During an LSD trip, the user might have the illusion of seeing things even while his eyes are closed, and some users have spiritual experiences while high. Users may see many colors or objects that aren’t there. Items that are present may seem to shimmer, move or otherwise change. If LSD is taken in an environment that is distressing to the user, the trip can be frightening and unpleasant. Negative reactions to LSD can include paranoia, delusions, and anxiety. LSD stands for lysergic acid diethylamide, which is derived from ergot, a fungus that is found on rye. Typically, LSD liquid is absorbed by paper, a sugar cube, or another material, which is then ingested. It can also be administered by injection.
LSD was used by doctors administering psychotherapy during the 1950s and 1960s. LSD has been used treat alcoholism, chronic pain, cluster headaches, and even end-of-life anxiety. This usage is controversial, and therapeutic use of LSD is not approved in the United States. Some medical conditions, such as depression and schizophrenia, can be aggravated by LSD. In rare cases, LSD may cause people with no known pre-existing conditions to spontaneously develop psychosis.

Though nearly any addictive drug can cause bizarre behavior during withdrawal, some drugs are especially prone to causing undesirable psychological side effects. These side effects can range from hallucinations and anxiety to violence and aggression.

  • Think about your priorities and goals. Is relief from symptoms extremely important? If not, maybe you’re willing to live with some symptoms to avoid side effects. What are your main life goals? How might medication help?
  • Sometimes the only way to know if a medication is right for you is to try it. You may find that it helps you feel much better. If not, you can decide to stop later.
  • Talk to Someone Now

    MHA has a partnership with Walgreens and together we want to help if you have extra questions. Visit their Pharmacy Chat and speak to someone today for extra help.

    Getting the Most Out of Your Medication

    Some people get relief from their symptoms immediately, others after a few days or weeks; for others it may take even longer. Medications differ widely in how quickly they take effect. After a short time on the medication, it’s important to share with your doctor or therapist how you are doing with the treatment.

    Remember to be honest with your provider. Tell him or her about your symptoms. Also make sure to tell the provider about any drugs, alcohol, over-the-counter or prescription medicines and herbal supplements you’ve been taking. That way you’ll get the most appropriate treatment.

    Dealing with side effects

    If you’re having trouble with a medication, or experiencing unpleasant side effects, don’t suffer in silence. Your doctor or pharmacist will likely have suggestions that can help. You can use a side-effect checklist to keep track and quickly share information with your provider.

    Sometimes side effects can be addressed easily. If you have:

    • Dry mouth…Try sugarless gum or mints
    • Constipation…Drink plenty of water and eat lots of fruits and vegetables. Ask your doctor or pharmacist about over-the-counter remedies.
    • Nausea…Take your medication with a meal.
    • Feeling sleepy…Ask about changing when you take the medication.
    • Problems with sexual functioning…Talk with your doctor about changing or adding medicines. Talk with your partner about what’s happening.

    Try to keep track of your progress

    • Keep a chart of your medications and how you’re feeling. That way you can make sure you’re taking your medicines at the right times, and you can see how they affect your progress. You also might want to share your chart with your health care providers. It’s very important that your providers have all your recent information so they can figure out how best to support your recovery.
    • If you have any questions, consider putting them in your chart. It can be hard to remember everything you want to discuss with your doctor, especially if your appointment is short or you feel somewhat stressed about it.
    • Hold on to your records. If a doctor suggests a particular medicine, you can check your records to see if you’ve taken it in the past and how well it worked.
    • Keep track of who can help. Ask your doctor whom to call if you suddenly have troubling side effects. Pharmacists can be of tremendous help in understanding medications, how to use them safely, possible side effects and other treatment options. Give a list of your medications to a friend or family member in case of emergency. Carry one in your wallet too. Include the names of your pharmacy and your health care providers.

    If you are thinking about stopping your medication…

    There are many reasons people consider stopping their medication. Some people dislike the side effects, feel that there’s stigma about medication or worry about the expense. If these or other concerns are bothering you, know that you are not alone. Still, quitting is a big decision and can seriously affect your health, so think it through carefully.

    Some possible steps if you’re thinking about stopping include:

    • Take a look at your situation. Consider whether changes in your life or your body may be affecting how well the medication is working. Ask your doctor if switching or adding medications might help. And ask whether stopping a medication creates a risk that means it won’t work as well if you decide you want to go back on it later.
    • Talk honestly with your health care provider. Some people feel uncomfortable raising concerns with their providers. Remember that it’s your right to ask questions and make decisions. To help the conversation go smoothly, make sure you both have enough time to talk. State your concerns calmly, and try to agree on some reasonable next steps for promoting your recovery.
    • Talk to the people who support you. They may be able to help you decide. Even if you don’t want help with the decision, people close to you should know that you haven’t been feeling well. That way they can provide extra support if you need it.

    Staying Safe

    Following some basic guidelines will protect your health while taking medication:

    • Avoid using street drugs or drinking alcohol while taking psychiatric medications. The combination can be dangerous and even deadly.
    • Be careful while driving or using machinery, especially if your medicine makes you sleepy.
    • Women who may become pregnant, are pregnant, or are breast-feeding should talk with their doctor about possible special concerns related to medications.
    • Stopping medications abruptly may cause you to feel ill – and possibly could even cause a seizure. They should be stopped gradually and according to your doctor’s instructions.
    • If taking a medicine causes you to feel sick, have a fever, skin reaction or anything else that worries you, contact your doctor or pharmacist as soon as possible.

    Ask Important Questions

    To protect your health, be sure to ask your doctor or pharmacist the following questions:

    1. What is the name of the medication? Is it known by other names too? Is it a “brand name” or generic?
    2. When will the medication begin to work?
    3. What is the recommended dosage? How many times a day will I take it?
    4. Should I take the medication with food?
    5. What are the side effects that commonly occur with this medication?
    6. What are the less common but more serious side effects that can occur?
    7. Is this medication addictive? Can it be abused?
    8. Are there any laboratory tests that I need before beginning this medication or while I’m taking it?
    9. Are there any medications, foods or supplements I should avoid while taking this medication?
    10. How long will I be taking this medication? If I stop taking it, what are the chances of my symptoms returning?
    11. Is there any chance my symptoms will be worse once I stop?
    12. How soon will I see results?

    Side effects may vary, and occasionally take an odd turn.
    Everyone knows the common side effects listed on the label of virtually every prescription drug: nausea, constipation, drowsiness, dry mouth, or allergic reactions.
    But sometimes, bizarre side effects can present in certain patients.
    Here are some of the more peculiar prescription drug side effects that pharmacists may want to mention to patients:
    Urine Color Changes
    Many drugs can cause changes in urine color, but certain hues are more alarming than others.
    Pharmacists are already aware that phenazopyridine (Pyridium), a common OTC analgesic for urinary tract infections, can turn urine orange or even red. But did you know that other drugs can turn urine blue?
    Dyrenium, a CYP1A2 substrate used to treat fluid retention and high blood pressure, sometimes turns urine blue. Other medications with this peculiar side effect include amitriptyline (Elavil), indomethacin (Indocin), and propofol (Diprivan).
    Then there are the drugs that can turn urine dark brown or even black, including antimalarial drugs chloroquine and primaquine, and the antibiotic metronidazole (Flagyl).
    Although they are interesting, these abnormal urine colors could also signal that something is wrong with the body, such as dehydration or internal bleeding.
    Painful, Unwanted Erections
    Certain drugs sometimes cause priapism, a painful erection that lasts more than 4 hours. But this unusual side effect isn’t limited to erectile dysfunction drugs, as it has been reported with the antidepressant trazodone (Oleptro).
    In one case, a male patient sued a pharmacy on the basis that he was not properly counseled about priapism when he filled his trazodone prescription. He woke up with a persistent erection and sought medical attention 30 hours later.
    The patient had emergency surgery and was left permanently impotent. The pharmacy was found to be 51% negligent, and the plaintiff was awarded $357,000 in damages.
    Hair Growth
    Not every unexpected side effect is scary, as some patients welcome effects such as hair growth.
    For instance, finasteride (Proscar) was first introduced to treat noncancerous enlargement of the prostate gland, but now, it is also used to treat female hair loss in combination with an oral contraceptive due to a known birth defect potential.
    Similarly, minoxidil was originally marketed as an oral high blood pressure medication, but was later found to grow hair in patients. Now, it is a popular OTC remedy for baldness.
    Vanishing Fingerprints
    On rare occasions, patients taking the cancer drug capecitabine (Xeloda) have lost their fingerprints as a sub-side effect of hand-foot syndrome.
    In one case, a 62-year-old male patient with metastatic nasopharyngeal carcinoma was detained in US customs in December 2008 when immigration officers at the airport were unable to detect his fingerprints.
    He was later advised to travel with a letter from his oncologist confirming that his condition and associated treatment were the reasons he lacked fingerprints.
    Gambling Addiction
    One drug’s effect on decision-making and impulse control can cause a patient to develop a gambling addiction.
    Pramipexole (Mirapex), a treatment for Parkinson’s disease and restless legs syndrome (RLS), has been the subject of several successful class-action lawsuits against drug manufacturers Boehringer Ingelheim and Pfizer.
    In one instance, a retired police officer in Minneapolis, Minnesota, claimed that pramipexole caused him to develop a gambling addiction that lost him $260,000. The jury awarded him all of his gambling losses, in addition to punitive damages.
    Sleep-Living
    Prescription insomnia treatment zolpidem (Ambien) is effective for patients who need a good night’s sleep, but some users have reported bizarre behaviors while taking the drug.
    Patients taking Ambien have reportedly gotten up in the middle of the night and participated in activities such as sleep eating, sleep sex, and even sleep driving while in a dream-like state. Many have no memory of these events the next morning.

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