When you are the pharmacist

Wednesday, April 21, 2010

The downside to being a pro athlete is the scrutiny that it brings. One would think that the athlete would be extremely aware of what they put into their body since drug testing is so good at finding what shouldn’t be there. When Edison Volquez took a medication prescribed by a Dominican physician to help start a family with his wife, he should have known that consequences would be far ranging, including as it turns out, a 50 game suspension. However, before we get too upset with Mr. Volquez, we should remember that this sin of taking unknown medications is all too common in the regular, non-sporting world. Consequences are not work suspension but instead, real medical complications that occasionally are life threatening.

In almost every grocery or drug store, shelves are filled with a variety of over the counter medications to treat almost any imaginable symptom. Some pills or liquids contain only one medication, while others have many drugs that have been mixed together to control multiple symptoms. Too often, taking a medicine with the best intentions to help a cough, stuffy nose or insomnia can cause significant side effects. Like any athlete, a patient should know the ins and outs of every medication that they put in their body, but in reality, it is sometimes too hard to decipher the chemical names and the complications of every drug on the shelf.

Two major culprits that hide in cold medications are phenylephrine and diphenhydramine or benadryl. The concept that over the counter medications are ultimately safe is put to the test with these two drugs. While they both have their place in the medicine cabinet, the fine print warnings are rarely read or adhered to. Phenylephrine works well to dry up secretions and make stuffiness and congestion of a cold easier to tolerate. Unfortunately, phenylephrine is closely related to adrenaline and can cause palpitations o rapid, irregular heartbeats and increase blood pressure. The warning label advises that patients with hypertension or heart disease avoid taking this drug but how many people bypass that warning. Phenylephrine hides in a variety of cold medications from Tylenol Cold to Walgreen generic cold remedies. Benadryl is just as sneaky. While it has great use as an antihistamine to treat allergic reactions and hives, if also has a potent side effect of causing drowsiness. The side effect is so common that it is the active ingredient in over the counter sleeping medications like Nytol and Sominex. Drowsy is good when getting ready for bed but not for people who drive or use heavy machinery. Driving under the influence applies just as much to medication as it does to alcohol.

Mr. Volquez was quoted as saying he must accept responsibility for his mistake and the use of a medication to treat a genuine medical problem even though it was banned by baseball. The same could be said for every person who takes an over the counter medication. The good intention can be overridden when something bad happens. Fortunately, there are resources available to decipher the chemicals that are present in over the counter medications and whether they might have unintended consequences and complications for a specific patient. Internet searches do wonders but the pharmacist is an underutilized resource when wandering the aisles of a drugstore. They have the ability to evaluate prescription medications, past medical history and other factors to decide whether one medication might be better than another and to balance upside benefit with downside risk.

While baseball can impose suspensions for as many games as it would like, the penalty pales in comparison to running a car off the road or developing symptoms from out of control high blood pressure. The bottom line for life and sports is that what gets into the body can affect performance and the responsibility begins before the pill is swallowed.

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