Some drugs - the legal kind - are great. Most people just LOVE propofol (1) (See Your Next Colonoscopy May Be More Fun Than Golf). The drug, which is used for induction and maintenance of general anesthesia is a white suspension that is nicknamed "milk of amnesia" because it looks like milk of magnesia (magnesium hydroxide) and five seconds after it gets pushed into the IV line you'll get the best nap of your life and wake up asking "when are you going to start?" Even better, unlike older general anesthetics, propofol not only doesn't cause nausea and vomiting, but it is actually used to prevent it. There are other drugs that most people find rather enjoyable, for example, nitrous oxide (laughing gas) and Valium, a sedative.
On the other end of the spectrum of pharmaceutical gratification are drugs that elicit a very different response. People HATE them, usually because of side effects as well as the duration of treatment. Although "hate" is a subjective measurement, in the case of drugs it can be quantified. Sort of.
There is an informative website called Ask A Patient where people write about their experiences with various prescription drugs and also rate them on a scale from 1 (LOW - I would not recommend taking this medicine) to 5 (HIGH - this medicine cured me or helped me a great deal.
This can serve to either reassure or scare the hell out of you about a drug you might need or want to take. Reviewers, sometimes thousands, write about their experiences, often in graphic detail, with a wide variety of drugs. Some of the quotes are rather creative.
Although all people react differently to different drugs - some will do well with Advil while Aleve will kill their stomach - some drugs have a reputation which transcends those of your run-of-the-mill antibiotic or blood pressure medication; they are bona fide monsters to a substantial percentage of people who take them. I picked four** based on their nasty reputation and then went to the site to see how people rated them and what people/victims wrote.
1. Flagyl (metronidazole)
Flagyl is a powerful antibiotic which is used for vaginal and gastrointestinal bacterial infections as well as intestinal parasites. People hate it. The answer to the question "would you prefer to take Flagyl or X?" is automatically "X" even when X = Fukushima effluent, bat droppings, a swordfish embedded in your eye, or isoamyl mercaptan - the essence of skunk.
According to the medical site RxList (2), the common side effects of Flagyl include:
- nausea, abdominal cramps, vomiting
- diarrhea, constipation
- dark-colored urine
- a metallic taste in the mouth or changes in taste.
The Ask A Patient site has 1755 reviews and Flagyl gets an average rating of 2.4/5. Some of the more colorful comments include:
"I felt like I might lose my mind and need multiple therapy sessions a week."
"Makes you mental either want to cry or hide away in a ball somewhere maybe even disappear into the black abyss."
"Sweet Lord this stuff is vile."
(and my personal favorite...)
"OMG, I'd rather swallow vomit."
2. Fosamax (alendronate sodium), Osteoporosis, Ask A Patient rating 1.4/5 (1181 ratings)
Fosamax belongs to the bisphosphonate class of osteoporosis drugs, which prevent bone loss.
According to RxList,
- erosive esophagitis and ulcers
- gastric ulcers
- bone, muscle, and joint pain
- worsening of asthma
- skin rashes, sometimes severe
Fosomax is also known for causing jaw necrosis - the death of bone in the jaw. Although the risk to most users is very low, people who have had extensive dental work, tooth extractions, dentures, etc. are more likely to develop the problem. And the efficacy of the drug is not clear. In the short term, it increases bone density but over time it may induce bone fractures.
It is not clear how it is possible for a drug to get a much lower rating than 2 out of 5 but Fosamax managed to pull it off with a dazzling 1.4/5.0. Yikes. Some of the patient comments tell us why:
"Woke up in the middle of the night and felt as if a bomb had gone off in my body."
"Woke up spitting out pieces of my tooth!"
"My left eye swelled up twice its size."
"Felt like I was thrown from a building with the building landing on top of me!!!"
3. Tamiflu (oseltamivir phosphate), Influenza, Ask A Patient rating 2.2/5 (1341 ratings)
Tamifu has two problems. It can be very tough on the stomach and it doesn't work very well, especially if it is not taken very early after you come down with the flu (2). And even when taken early it still doesn't help all that much; the time to first alleviation of symptoms is cut by less than a day compared to placebo.
Some of the more common side effects from RxList include:
- eye redness
Although some people rated Tamiflu highly (some even called it a "miracle drug" and rated it 5/5) many more patients gave it a rating of 1:
"TAMIFLU NOT WORTH IT! I WOULDN'T WISH THESE SIDE EFFECTS ON NOBODY! (even English majors)
"I've also had a couple [of] instances of senseless babble according to my wife." (perhaps that was before he took the medicine)
"I'd much rather fight the flu 1 extra day [than] to ever go through 8 rolls of toilet paper "
"SO MUCH BARFAGE. the first night I was up all night chained to the toilet... "
4. Lyrica (pregabalin), Ask A Patient rating 2.6/5 (1372 ratings)
Lyrica, which is generally thought of as a more potent version of the epilepsy drug Neurontin (people don't like this much better) is used for seizures, neuropathic pain, and fibromyalgia. It works well for nerve pain in some people, but in the push to purge the US of opioid analgesics Lyrica and Neurontin are being used off label for other types of pain and usually fail miserably.
According to RxList some common side effects of Lyrica include:
- Loss of balance or coordination
- Breast swelling
- Blurred vision
- Weight gain
- Problems with memory or concentration
Some Ask A Patient reviewers are not especially fond of it:
"Some people swear by it. I just swear at it."
"I am now bald. I had hair like Jon Bon Jovi prior. "
"Little people sneaking up behind me"
"Since I am so fond of urinating, I believe I would like to continue. Lyrica seems to put an end to that."
WHAT THIS DOES AND DOESN'T MEAN
First, I am NOT suggesting that you should avoid these drugs, only that taking them may be rough going. If Flagyl is the only antibiotic that will treat a serious infection you may have to just swallow it, even though keeping it down may be difficult (4). Some people have no problem with Fosamax, and it needs to be noted anything that can prevent a broken hip should not be rejected outright. Broken hips can be disabling or fatal, especially in elderly women.
Second, the ratings and comments probably do not reflect the views of the average patient. People who have a bad experience with a given drug are more likely to report on it than those who don't. This is called reporting bias and it skews the results toward lower ratings.
Third, if you spend enough time looking through the comments it becomes clear that there are attorneys trolling for business. When "class action" is mentioned it's a pretty good bet that the comment was posted by a lawyer. Sometimes an email address is posted, again, probably by an attorney. So, this is by no means a comprehensive evaluation of the "worthiness" of a drug. It is merely a look at four drugs, all in different classes, which have a bad reputation. There are others out there that are worse.
Finally, the quotes I selected were themselves biased, so you should not assume that any of those awful things are going to happen to you.
**I have intentionally omitted chemotherapy drugs since they cannot legitimately be rated on the same scale; side effect, often severe, are expected, especially with cytotoxic (cell-killing) chemo drugs.
(1) Ironically propofol received only a so-so rating of 2.4, but there were only 62 reviews, which is puzzling given that other commonly used drugs received thousands of ratings and comments. The low rating can be explained in a few ways. First, reporting bias. Second, since there were so few reviews I looked them over and found that a good number of people were complaining about propofol when they were actually given it plus fentanyl - a common combination for surgery and some procedures - and that the complaints were more consistent with those from fentanyl - nausea and vomiting.
(2) RxList is owned and operated by WebMD.
(3) Tamiflu is for influenza only, not the misnamed "stomach flu" - norovirus. If you take Tamiflu on top of a norovirus infection you will regret being born.
(4) Case study! (OK, a story from my friend, Max, who just got back from India where he picked up a whopping case of giardiasis): "Antibiotics are essential. They save countless lives and we are lucky to have them. Still, I was floored by how horrid metronidazole made me feel. I found myself counting down the hours until the next dose, dreading the moment my alarm would ring. Each pill made me feel worse than billions of parasites ever did."