Using Xopenex Without Side Effects

Andrew:
Ok, so this is a new medication that people may or may not know about – primarily because they don’t report the side effects to their doctor. I would think that if I was shaky and nervous after using a medication I would complain to my doctor.
Dr. Lanier:
A lot of times, doctors and patients get used to a certain level of side effects. I mean, doctors have in their own mind a threshold for what they will accept as an unacceptable side effect, knowing that there’s going to be a background of, you know, problems. And I think with the common drug albuterol for asthma, it’s a perfect example. We’ve used that drug so long, like 25 years, that we’ve established a certain level of acceptable side effects for that drug. So, as long as people don’t complain above a certain level, we don’t sort of hear it, and I think the first time they give those kind of medications to a person, we say, “Now, listen. This is going to make you nervous. It’s going to make you shaky. But it’s going to help you breathe.” And we sort of imply that that’s the price of breathing, and when that’s the best you can do, it sort of is the price of breathing.

But when new drugs that come out that have a better threshold for not producing problems, we have to sort of go back and reevaluate that. When I talk with doctors, I say, “Even though patients aren’t complaining, you ought to probably ask them.” And what most commonly patients do when they’re having difficulty with shaking and with the side effects of a drug like albuterol is just reduce the dose, so oftentimes what we prescribe and what people take is not exactly the same thing. Old people do that all the time, and even parents do it with children sometimes.

And, of course, when people reduce the dose, they reduce the effect, and you have to use it more often, and doctors oftentimes react to that by using stronger and stronger medicines. So, especially when a new drug like Xopenex or levalbuterol comes out that doesn’t have the side effects, we all go back and reevaluate, and we say, “Well, we’re not going to accept shakiness. We’re not going to accept not being able to go back to sleep at night as a normal course of events.”

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