Dr Pam St Leger of Express Medicals Ltd gives an expert insight into Champix (which is one of the drugs used when trying to give up smoking).
As we approach the closing weeks of 2011, many smokers will be planning to give up tobacco as their New Year’s resolution.
Certain medicines have long been known to affect a person’s ability to drive or operate machinery, often by causing drowsiness either as the desired effect, for example sleeping tablets, or as a side effect to the main reason for use.
There are many groups of drugs that can cause such effects. Most are only available on prescription from a doctor, but some, including antihistamine containing medicines, can be bought without a prescription.
There is some help for the patient in alerting them to this possibility.
In the UK such medicines have to carry a warning to this effect on the product label and if the patient reads through the information leaflet that comes with the medicine it will list the side effects there.
However, in addition to the more obvious problems of drowsiness some drugs may cause dizziness, nausea, loss of hearing or blurred vision, all of which can substantially affect ability to drive, operate machinery or work at heights but which are not covered by the rules that require a warning label – for any information about these effects the person will need to read the detailed information on the drug’s side effects.
For anyone who has looked at the information leaflet that comes with a medicine and tried to work out for themselves what, if any, risk there is in taking the medicine – this can be far from clear.
The person is presented with a list of possible side effects that may affect their mental or physical ability and left to decide themselves whether they should work or drive.
Such leaflets are written to comply with the manufacturer’s legal requirement to provide such information and, while genuinely intended to try and help the patient, the same leaflet is included regardless of the “use” of the medicine. As such, it is independent of the condition of the patient.
As a pharmacist, I am frequently asked by patients to help them make sense of these leaflets and many come in concerned about potential side effects.
In many cases, a simple seeming request is made more complicated by the fact that they are often taking more than one medication, so in addition to the effect of a single drug I have to consider whether the combination of drugs might share similar side effects such that together they pose a greater threat than if taken singly.
Often my role is one of helping them identify what they are likely to “feel” if they experience such a side effect and if they do think they have a problem, how to decide if they are fit to drive.
I am also looking to put a time frame on how soon after starting medication they might experience a problem, whether it is likely to be permanent or whether they will get used to it and it will no longer cause concern. I am also frequently asked whether alcohol is safe to consume while taking the medication.
All of the above problems were brought into even greater perspective when I began providing medication advice in an occupational health environment.
Suddenly, what had been almost an empirical question – “Can I drive to the shops and can I drink with this medicine?” – turned into one where the person’s ability to go to work or not was under discussion. Could he/she work in a safety critical environment?
Did they need to be accompanied while on duty? If so, for how long? In addition to the medicine concerned I now needed to consider the type of work involved and as much information about the underlying condition as possible.
Often this was not disclosed so I was left having to extrapolate from my knowledge of the medicine – but while if a person if taking insulin it is probably safe to assume they have diabetes, it is far from this cut and dried with most other medicines.
Left without a full picture on which to base a decision a more cautious approach has to be taken and more of a limitation on what the person may do must be imposed.
I also found new factors to consider when looking at the time line for side effects becoming evident when a new medicine was started or when a dose was increased.
For example, some medicines to treat high blood pressure may causes a fall in blood pressure sufficient to make them feel dizzy when they start treatment. Usually, to avoid this problem I would tell the patient to take their first few doses at bedtime.
For a shift worker who cannot always marry the need to take the medicine at the same time of day with the pattern of his shifts – this suddenly becomes a very real problem.
Problems with the timing drowsiness and dizziness appearing as side effects also arises when looking at one of the drugs used to help stop smoking.
Here the main problem stems from the pattern of increasing the dose over the initial days of treatment which complicates assessment of likely time scales for the appearance of these side effects.
Ordinarily, I would consider a recommendation of avoiding safety critical work after first starting the medication and monitoring the person for 72 hours to see if they experience any drowsiness, dizziness or loss of concentration.
However, where the treatment program is to increase the dose after 3 days then again after a further 4 days – you need to consider removing the person from driving duties for 9-10 days before you can be sure they are stabilised and are unlikely to be affected.
This really does have a major impact on a person’s ability to work effectively and can place a worthwhile objective – to stop smoking – in conflict with their work.
As with everything in life most people on most of their medications are perfectly able to carry on a normal working life.
However, with Health & Safety in the workplace becoming ever more important it is clearly important to check on an individual basis each time a person’s medication changes.
It is a complicated field and one best left to those who have experience and the necessary training to make these decisions. After all – it’s what we are here for.
