Photo by on Unsplash


Contraindications: The Game


by Mark Levy
Contributing Columnist                 

I thought of a new game. I call it Contraindications. Here’s how you play it: I list one or more possible adverse side effects of taking a particular medication and you tell me the name of the drug. A contraindication is a symptom or condition that makes a particular drug, procedure, or surgery inadvisable. Absolute contraindication means that the substance could cause a life-threatening situation. Relative contraindication means that caution should be exercised when two drugs are used together. This results in drug interactions. For purposes of my game, we’ll just deal with side effects that might occur when a person takes only one drug.

Scientists and physicians have a whole gamut of ailments to treat, from relatively harmless but painful conditions like gout, hot flashes, and constipation to the potentially fatal, like seizures, diabetes, and cervical cancer.

Sometimes I can’t figure out what an advertised medication is intended to cure, but the contraindications are always explicitly stated. They’re unmistakable. I got some of the clues for these drugs from TV commercials and others from the Internet.

Let’s start my game off with a simple example: What medication can cause permanent, partial blindness, dizziness, drop in blood pressure, headaches, and upset stomach? I’ll give you a hint: The advantages may be worth the risk. Answer? Cialis for erectile dysfunction. Now with the more popular Viagra, you risk, in addition to permanent, partial blindness, chest pain, nausea, and facial flushing. But isn’t a satisfying sex life worth a touch of blindness?

For the second question, what medication can cause persistent fever, bruising, bleeding, paleness, fatal blood disorders, or serious infections like tuberculosis, and nervous system disorders such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes, or cancer? Here’s another hint: A second drug for treating the same condition can cause numbness, swollen face, and lymphoma. A third drug to treat the same condition can cause gastrointestinal hemorrhages and, well, death.

In this example, you get extra points for identifying the ailment. The drugs are, respectively, Enbrel, Humira, and Celebrex. They are all used to treat arthritis.

But the granddaddy of contraindications for arthritis is Vioxx. Its side effects include stomach and intestinal bleeding, serious kidney problems, hepatitis, jaundice, tiredness, itching, anxiety, blurred vision, colitis, confusion, depression, fluid in the lungs, hair loss, hallucinations, insomnia, palpitations, pancreatitis, ringing in the ears, and worsening of epilepsy.

Boy, if you can run that gauntlet of medical infirmities, you deserve to have your arthritis pain lessened. I think arthritis sufferers must be the bravest patients in the world, willing to risk even death to have their condition treated.

A certain medical condition has a number of medications for treatment that can result in chest pain, digestive problems, ulceration of the esophagus, inability to stand or sit upright for 30 minutes, and bone pain. The condition is osteoporosis and the treatment culprits are Actonel, Boniva, and Fosamax.

How about this one? You can risk sudden or severe changes in mood or behavior, like feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, hyperactive, overly excited, or even suicidal, in an effort to treat what ailment? Ironically, it’s depression, and Paxil and Wellbutrin are the medications. So if you are depressed, these medications can solve your problems by provoking suicide. Logical, I think, but extreme.

Anemia is a serious condition, as we all know, but you might think twice before taking Procrit to treat it, since you could be subject to hypertension, seizures, thrombosis, stinging, bruising, itching, headache, indigestion, heartburn, diarrhea, constipation, sneezing, coughing up blood, darkening around your mouth or nails, dizziness, fainting, blurred vision, slow or difficult speech, loss of memory or ability to concentrate, seeing things or hearing voices that do not exist, floppiness or loss of muscle tone, blood clots in your heart, legs, or lungs, wheezing, difficulty breathing or swallowing, or hoarseness. I don’t know all the symptoms of anemia, but I’ll bet they don’t hold a candle to the potential symptoms of the Procrit treatment.

Finally — and I bet you thought this would never end — what ailment can be treated with medications that can result in headache, diarrhea, abdominal pain, constipation, upset stomach, vomiting, cough, cold symptoms, dizziness, and rash? And what are two of the medications for treating that condition? The condition is heartburn or indigestion and the meds are Nexium and Prilosec.

I hope this new game has helped you decide whether you want to risk treating your ailments when, as Sir Francis Bacon observed, the remedy is worse than the disease.



About the author:

Mark Levy is an attorney with the Binghamton-based law firm of Hinman Howard and Kattell. He is a contributing columnist to, and an occasional contributor to NPR, where his comments can be heard some Saturdays at noon. You can read more about Mark in About Us.