Supplements to traffic regulations: read the instructions for medicines! (part 1)
The effect of medicines on motor vehicle management: "risk drugs"
D.I.Trukhan, MD, Prof., L.Yu. Trukhan, PhD, Omsk State Medical Academy
Russian Pharmacies Magazine No. 4-2010
Published on the website "Remedium"
Hardly anyone will dispute that the best way to combat accidents is their prevention. What do pharmacies and pharmaceutical specialists have to do with this? Far from the last. A number of medications (drugs), including over-the-counter, can negatively affect a person's attention, lead to a decrease in the speed of mental and motor reactions. Knowing the range of such drugs, the "first-time patient" in the process of counseling can prevent the risks they pose for patients driving transport.
Nonsteroidal anti-inflammatory drugs
We will start our review with a group of medicines that are among the most prescribed worldwide. Among the side effects of such representatives of nonsteroidal anti-inflammatory drugs (NSAIDs) as ketoprofen, dexketoprofen, ketorolac, lornoxicam, nimesulide, naproxen and meloxicam, dizziness and drowsiness are noted, as a result of which, when taking them, one should refrain from driving a car and engaging in other potentially dangerous activities. A decrease in the speed of mental and motor reactions is also possible during treatment with diclofenac, as well as with the combined drug Ambene containing phenylbutazone. Stricter instructions are given for indomethacin and ibuprofen – against the background of their use, all activities that require increased attention, rapid mental and motor reactions should be avoided.
Above, we have already named meloxicam among the drugs that provoke dizziness and drowsiness. It should be added that with the widespread use of this NSAID, undesirable phenomena such as blurred vision, confusion, disorientation were also noted, the connection of which with taking the drug was regarded as possible. Obviously, these effects do not improve driving in any way.
Analgesics and triptans
Most drugs used to combat headache and toothache are combined drugs, which include components acting on the central nervous system and therefore capable of reducing the speed of psychomotor reactions of a patient driving a motor vehicle. An example is the popular painkiller Pentalgin, which, along with paracetamol and analgin (Pentalgin-ICN) or naproxen (Pentalgin H), contains 3 "neurotropic" drugs at once – caffeine, codeine and phenobarbital. As a result, before taking this remedy, it is necessary to assess the individual tolerability of these components by the motorist. But in the instructions for the drugs Sedalgin-neo and Sedal-M, similar in composition, it is recommended to refrain from driving at all.
It should not be used during the performance of work that requires increased attention and speed of psychomotor reactions, and such an analgesic as Tempalgin: the reason is the presence of the tranquilizer tempidone in its composition.
Due to the danger of developing drowsiness, drivers of vehicles should use multicomponent painkillers with caution, which include the narcotic analgesic codeine, H1-histamine blockers chlorphenamine, pheniramine, promethazine (see the memo). Caution should also be exercised in the pharmacotherapy of migraine: the disease itself, as well as the reception of triptans used for its treatment (Imigran, Zomig, Relpax, Naramig), may be accompanied by the same drowsiness or dizziness.
Antimicrobial drugs
Medicines from the "risk group" for motor transport drivers also include many drugs used in the treatment of infectious diseases. Among antibiotics, fluoroquinolones deserve special attention. For example, it is necessary to avoid activities that require vigilance and alertness when using ofloxacin, ciprofloxacin and moxifloxacin. Other drugs of this group – lomefloxacin, norfloxacin, pefloxacin – can cause dizziness and impaired attention, so the question of the possibility of engaging in potentially dangerous activities during their administration should be resolved only after establishing the individual patient's reaction to these drugs.
In turn, when taking hemifloxacin, visual disturbances (diplopia, color perception changes), hearing loss are sometimes noted; all this also dictates the need for an individual drug tolerance test.
Finally, levofloxacin, in addition to dizziness, attenuation and optical disorders, can cause stiffness and drowsiness. This also limits its use among motorists.
"Dangerous for traffic" drugs are also among the antiprotozoal drugs. From activities that require increased attention and the speed of psychomotor reactions, you should refrain from taking tinidazole. Metronidazole is also used with caution in motorists, since there is a risk of developing dizziness, impaired consciousness, ataxia, tinnitus, hearing disorders during treatment with this drug.
Some antifungal drugs also pose a different degree of risk for drivers. Strict restrictions on driving vehicles take place when using griseofulvin. Against the background of taking ketoconazole, dizziness, photophobia, paresthesia may occur in individual patients; when treating this drug, a personalized approach is required to solve the issue of the admissibility of machine control.
An individual assessment of the patient's reaction to the drug to resolve the issue of its "auto safety" is also necessary when using itraconazole, since among the undesirable effects of this drug there are dizziness and peripheral neuropathies.
Antihistamines
We have already indicated a number of old antihistamines that, as part of complex analgesics, can negatively affect the vigor and alertness of the patient. Of course, the range of anti-allergic drugs, potentially dangerous for those who are driving, is not limited to them.
The most stringent warnings regarding possible risks when driving vehicles are contained in the instructions for such H1-histamine blockers of the first generation as Tavegil, Diphenhydramine, Fenistil. Driving is also not allowed in the early stages of the use of Suprastin, Pipolfen (promethazine), Diazoline and Peritol. In the process of further treatment with these drugs, the degree of restrictions depends on the individual tolerability of the drug by the patient.
In classes that require increased attention and reaction speed, Fencarol and Semprex should be taken with caution.
As for antihistamines of the latest generation, such as cetirizine, loratadine, fexofenadine, Kestin, Xizal, Erius, when taking these drugs at the recommended doses, clinically significant violations of the ability to concentrate and the speed of psychomotor reactions were not revealed. However, in most instructions it is recommended to check the individual reaction to the drug used before starting to drive a car or perform other complex tasks, since the development of drowsiness and fatigue when taking these drugs is still not excluded.
Note, by the way, that different manufacturers interpret the safety of the same active substance in different ways. For example, in the instructions to Claritin (USA), the manufacturer allows the patient to perform "potentially dangerous activities that require increased attention and speed of mental and motor reactions, including driving a car." But the leaflet for the Russian generic loratadine - Clarotadine contains the following recommendation: "during treatment, it is necessary to refrain from engaging in potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions."
In this regard, the instructions in the instructions for Xizal (levocetirizine) are worthy of respect: "no adverse events were detected when taking the drug at the recommended dose, nevertheless, it is advisable to refrain from engaging in potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions."
Other antiallergic drugs
In the context of our topic, it is not superfluous to mention also drugs of other groups used for the treatment of allergic diseases.
So, abstinence from potentially dangerous activities associated with the need for increased attention is necessary when taking the stabilizer of mast cell membranes ketotifen. But before using the anti-bronchoconstrictor agent Erespala, the patient should undergo a test for individual sensitivity to the drug, since when taking it, drowsiness may develop.
Manufacturers of Acolate and Singular drugs – drugs from the group of leukotriene receptor inhibitors – note that there are no facts indicating that their intake affects the ability to drive a car or moving mechanisms. However, the instructions note that when taking Acolate, there may be increased fatigue and apathy associated with possible liver dysfunction, as well as headache; all this, as in the case of Erespal, necessitates an assessment of the patient's individual response to the drug.
Taking the Singulare, in turn, in accordance with the instructions, may be accompanied by the appearance of side effects from the central nervous system (hallucinations, drowsiness, irritability, excitement, including aggressive behavior, fatigue, insomnia, very rarely convulsive seizures), which, if they develop, obviously implies a refusal to drive vehicles.
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