Supplements to traffic regulations: read the instructions for medicines! (part 2)
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. 6-2010
Published on the website "Remedium"
In the previous article, we examined in detail painkillers, antipruritic, antimicrobial and antiallergic drugs, the use of which can negatively affect the management of transport, the performance of work requiring increased reaction speed and concentration of attention. Of course, the circle of "dangerous" drugs for drivers is by no means limited to the listed medicines.
Cardiovascular drugs
Among cardiovascular drugs, several groups of drugs pose a potential danger to patients who are driving. Thus, almost all nitrates are capable of reducing the rate of psychomotor reactions – both various dosage forms of nitroglycerin (tablets, aerosols, transbuccal and transdermal forms), and long–acting drugs - isosorbide dinitrate (Isoket, Cardiket, etc.) and isosorbide mononitrate (Monosan, Efoxy, etc.). You should also avoid driving the car when taking the nitrate–like drug molsidomine (Sidnopharm) - especially at the beginning of the treatment course.
It is necessary to refrain from engaging in potentially dangerous activities that require increased attention and speed of psychomotor reactions, and when taking a number of beta-blockers – primarily sotalol (Sotahexal, Sotalex) and carvedilol (Dilatrend, Acridilol, etc.). As for other representatives of this group (drugs atenolol, betaxalol, bisoprosol, metoprolol, nebivolol), their drivers of vehicles should be used with caution, only after passing an assessment of the individual reaction to these drugs.
Due to the possibility of individual negative reactions in the form of drowsiness, dizziness and a number of other side effects, an individual sensitivity test is also necessary for drivers before taking some calcium channel blockers (BCC), such as verapamil (Finoptin, Isoptin, etc.), diltiazem (Cardil, etc.), amlodipine (Norvask, Normodipine, etc.). others), felodipine (Felodip). Another BCC – nifedipine (Corinfar, Nifekard, etc.) – requires abstinence from driving a car in the first days of admission. In the future, the degree of restrictions depends on the individual tolerability of drugs by the patient.
Other cardiovascular drugs
Certain contraindications to performing "reactive-speed" work occur when taking a number of other cardiovascular drugs. So, it is absolutely necessary to avoid potentially dangerous activities that require increased attention, speed of mental and motor reactions, while undergoing treatment with reserpine-containing antihypertensive drugs, which include Adelfan, Kristepin, Brinerdin, Trireside K, clonidine (Clofelin, Hemiton), methyldopa (Dopegit). The use of drugs from the group of ACE inhibitors (enalapril, fosinopril, lisinopril, captopril, etc.) implies great caution when driving vehicles, because against the background of their intake, dizziness is possible, especially after taking the initial dose.
Angiotensin II receptor antagonists, often prescribed in patients with intolerance to ACE inhibitors, such as losartan (Kozaar, Lozap), telmisartan (Micardis), valsartan (Diovan), also require careful use in the initial period of treatment when driving vehicles. Ideally, the patient should take a test for individual sensitivity to these drugs.
Another group of drugs potentially capable of reducing the driver's alertness and alertness are the diuretics furosemide (Lasix) and hydrochlorothiazide (Hypothyazide). It is not allowed to drive vehicles at the beginning of taking ethacric acid (Uregit). Caution should also be exercised at the beginning of the course of indapamide (Indap, Arifon), especially when combined with antihypertensive drugs.
Urological series
As you know, in men, one of the most popular drugs are drugs for the treatment of erectile dysfunction. What can we say about them in the context of our topic?
Against the background of taking sildenafil (Viagra), there was no direct negative effect on the ability to drive a car or other technical means. However, when taking this drug, it is possible to reduce blood pressure, develop chromatopsia (a change in the perception of shades of color), blurred vision, which obviously makes it difficult to drive vehicles. The risk of such effects increases at the beginning of treatment and when the dosage regimen of drugs is changed, which should be informed to the pharmacy visitor when the drug is dispensed to him.
Patients whose activities are related to driving vehicles and operating mechanisms should determine an individual reaction to other drugs of this group. This is due to the fact that against the background of taking tadalafil (Cialis), dizziness, swelling of the eyelids, pain in the eyes are possible. Udenafil (Zidena) can cause redness of the eyes, blurred vision, pain in the eyes and increased lacrimation. The latter effect, as well as impaired visual brightness, are sometimes noted when using vardenafil (Levitra).
The ability to drive a car and mechanisms may deteriorate (especially at the beginning of treatment and with an increase in the dose) when taking a number of drugs for the treatment of benign prostatic hyperplasia. We are talking about doxazosin (Cardura, Artesin, etc.), terazosin (Setegis, etc.), tamsulosin (Omnik, Tasulosin, etc.), alfuzosin (Dalfaz).
Uricosuric and hypoglycemic drugs
Visual disturbances, as well as dizziness, drowsiness, ataxia (disorder of coordination of voluntary movements), increased fatigue may accompany the use of the anti-gouty drug allopurinol.
Patients with type I diabetes mellitus receiving insulin replacement therapy should be aware that a decrease in the rate of psychomotor reactions and the ability to concentrate attention may occur with the initial use of insulin, a change in its type, or in the presence of significant physical or mental stress.
As for oral hypoglycemic drugs, you should refrain from driving when taking glimepiride (Amaryl, Glemaz). Glibenclamide (Maninil) can slow down the rate of psychomotor reactions at the beginning of treatment, with a change in the dose of the drug and with irregular intake of the drug. In general, during the selection (titration) of the optimal dosage, almost all hypoglycemic drugs used in type II diabetes mellitus pose a potential danger to drivers.
Antispasmodics and regulators of gastrointestinal motility
Of the antispasmodics, the greatest potential danger for motorists are preparations based on the extract of belladonna (Bekarbon, Bellalgin, etc.), which, on the one hand, often causes dizziness, and on the other – has a wide range of negative effects on the organs of vision (accommodation paresis, mydriasis, etc.). Due to the risk of dizziness, persons engaged in "reactive-speed" activities should also be careful when using mebeverine (Duspatalin). Another antispasmodic that requires increased caution when the patient is often driving is hyoscine butyl bromide (Buscopan).
Among the drugs regulating the motor function of the gastrointestinal tract, the well-known antiemetic metoclopramide (Cerucal, etc.) is "incompatible with the car". The popular antidiarrheal OTC drug loperamide (Imodium, Lopedium, etc.), which is often purchased by motorists before long trips, deserves special attention. In most cases, it does not disrupt the speed of psychomotor reactions, but in some cases, after taking it, a feeling of fatigue, drowsiness or dizziness may occur. In this regard, in order to be safe, the patient must undergo a test for individual sensitivity to this intestinal opioid receptor blocker.
Anti-ulcer and hepatological drugs
Individual sensitivity should also be taken into account when prescribing a number of anti-ulcer (antisecretory) drugs to "automobile" patients. We are talking about H2-histamine blockers – cimetidine, ranitidine (Zantak, Ranisan, etc.) and famotidine (Kvamatel, Famosan, etc.), as well as proton pump inhibitors – omeprazole (Omez, Ultop, etc.), esomeprazole (Nexium), rabeprazole (Pariet). The first group of drugs can cause the same dizziness and fatigue, the second – drowsiness, excitement or depression.
In the group of hepatological drugs, the "restrictive signs" for motorists are marked with the hepatoprotector ornithine (Hepa-Merc) and interferons (Roferon-A, Intron-A, Realdiron, etc.) used in the complex therapy of viral hepatitis. When taking ornithine, it is reasonable to refrain from driving a car throughout the entire course of treatment, in the case of interferon use – at the beginning of the therapeutic course and up to the period of stabilization of the drug.
In conclusion, we emphasize once again that the pharmacy specialist is an important link in monitoring the "compatibility of the drug and the car." This is due to the fact that often a doctor prescribing medicine to a patient simply loses sight of this "secondary" aspect of safety. And even more so is the responsibility of the "first-year student" for the well-being of traffic in the event that he independently recommends a drug to a motorist client within the permissible limits of self-medication.
Without knowledge of the range of over-the-counter drugs that can negatively affect the process of driving a car (Fig.), it is almost impossible to make this self-medication responsible, i.e. excluding the preponderance of harm over benefit.
Portal "Eternal youth" http://vechnayamolodost.ru11.05.2011