Red flags and medicine side-effects
RED FLAGS AND MEDICINE SIDE-EFFECTS
Certain medicines may cause or exacerbate symptoms;2 for example, by relaxing the lower oesophageal sphincter, resulting in reflux.7 Pharmacists should consider reviewing their patient's medication to identify any issues that may then be discussed with the GP as appropriate.
Examples of such medicines include:2
- Alpha-blockers
- Anticholinergics
- Benzodiazepines
- Beta-blockers
- Calcium-channel antagonists
- Nitrates
- Theophylline
- Bisphosphonates
- Corticosteroids
- Tricyclic antidepressants
NSAIDs (including low dose aspirin) are a common cause of ulceration and gastrointestinal symptoms. They can inhibit the production of cytoprotective prostanoids.7
WHEN TO REFER
There are some symptoms that would indicate GP referral. Be aware that patients might have been using OTC products for a long time, masking symptoms and delaying a diagnosis. You and your team should remind patients that OTC products are for short-term use.
The following patients/symptoms may need referral to a GP:
- Patients who have tried OTC products and making lifestyle changes but still have symptoms
- Reflux symptoms that wake the customer at night might indicate Barrett's oesophagus4
- Patients who describe symptoms such as difficulty swallowing, nausea/vomiting, a cough that doesn't get better, unexplained weight loss, or change in the voice, as this may indicate oesophageal cancer8
- Patients who present with unexplained weight loss, aged over 55 with new or changed symptoms, nausea/vomiting, a lump in the abdomen, problems swallowing, feeling full very quickly or feeling very tired, as these may indicate gastrointestinal cancer9,1O
- Signs of a stomach ulcer: a burning or gnawing pain that develops in the abdomen (pain from a stomach ulcer often starts within a few hours of eating), indigestion/heartburn, weight loss, nausea/vomiting, loss of appetite. Signs of a serious complication that needs urgent referral include vomiting blood, dark tar-like stools and sudden pain in the stomach that gets worse.11
