What you should know about your Medications
A guide for Polio Survivors

J.M.Walker Ph.D., PT,
AM Whelan, Phar. D,
1996

Written for Post-Polio Support (Inc)
11 Wyn Street, Christchurch 2,
New Zealand.

This is for your information - many medical professionals do not know PPS exists. You need to tell them you are a Polio Survivor and show them this.

Please note drug names are for New Zealand they may not be approved for use elsewhere including UK.
UK Version Available
Check with your Doctor, Dentist and Pharmacist before changing any of your drugs.

Why You Should be informed:

A survey in 1994 revealed that 57% of respondents, polio survivors, were over 60 years of age and 27% were over 70 years. Medications (drugs), may be by prescription, or Over-The-Counter (OTC). As a polio survivor you should become an informed user of drugs because:

• The drug effect may enhance post-polio symptoms while influencing the primary condition. Fatigue, muscle weakness, muscle irritability (cramps), ability to cough and clear secretions, anxiety feelings, may be increased so that your performance decreases.
• With increasing age the potential for interaction between drugs increases and this effect is often more severe.
• With increasing age individuals are more likely to be taking or be prescribed medications for a variety of conditions, such as hypertension, diabetes, arthritis, insomnia, indigestion, constipation....., the list can go on and on.

Who is at greater risk?

• individuals with respiratory muscle weakness or paralysis
• individuals with weakness of the muscles of swallowing
• individuals diagnosed with Post-Polo Seqeulae (Post-Polio Syndrome)
• older individuals (over 65 years)

You may have experienced a 'full recovery', Grade 5, Manual Muscle Test of involved muscles and were unaware of any involvement of your respiratory muscles, however, research has shown that these so-called 'normal' muscles are not necessarily normal and may be supplied by only 60% of the usual number of spinal nerve cells.

What you should do:

1. Change your lifestyle before resorting to use of an OTC drug or requesting a prescription.
2. Always inform your doctor(s) about which drugs you are currently taking regularly, prescription and OTC drugs.
3. Ask your doctor about potential side effects, particularly those that may increase or cause
   • fatigue
   • respiratory weakness
   • muscle weakness
   • dizziness and/or drowsiness which may impede your balance and cause falls
   • increase depression thus changing your perception of pain, making it seem worse
   • insomnia, sleeplessness, will increase fatigue
   • vaso-constriction, may increase cold intolerance.

Remember

• Taking fewer medication is better.
• It is no solution to use drugs and continue to abuse your joints, overuse your muscles.
• It is your responsibility to be informed about your medications so that you can monitor the side effects.
• When certain drugs are taken for a long time you can develop a tolerance so that larger and larger doses are needed.
• Physical dependency, addiction can develop from taking certain drugs, especially narcotic analgesics.

Drugs & Their Effects.

Alcohol:- is a drug. It may

• inhibit swallowing
• decrease balance & cause falls
• decrease muscle strength

Individuals with any respiratory weakness should avoid alcohol, especially before bedtime.

Laxatives:- before medications try

Firstly change your diet and drink more fluids. Get more exercise (If advised by your PPS doctor. LincsPPN)

• bulk forming stool agents, always with fluids (e.g. bran, Metamucil, Prodiem)
• stool softeners, avoid long term use (e.g. Colace, Surfak, Correctol)
• stimulant laxatives, occasional use only (e.g. Ducolax, Castor Oil, Ex-lax)
• Osmotic laxatives, occasional use only (e.g. Milk of Magnesia, Fleet enemas)

Cough Medicines & Expectorants.

May contain alcohol or a narcotic (e.g. codeine)

These suppress coughing or loosen secretions. They also cause drowsiness, decreased co-ordination, may give a feeling of chilliness.

Antihistamines, Allergy, Motion Sickness Drugs.

E.g. Seldane, Benadryl, Gravol, Chlor-Tripolon. These cause drowsiness and can increase fatigue.

Analgesics.

These are the most abused class of drugs and long term use can cause addiction. There are two classes:

1. Non narcotic Analgesics.
   Although some may be produced over-the-counter they are real drugs, with potential side effects, interaction effects or dependency effects. Examples are: Acetaminophen e.g. Atasol, Tylenol, Excedrin. Control pain only, not inflammation.

   Non steroid anti-inflammatory drugs (NSAIDs) such as: Aspirin, Advil, Orudis, Clinoril, Motrin, Indocin, Feldene. NSAIDs can control inflammation and pain but may cause dizziness, muscle weakness, drowsiness.

2. Narcotic Analgesics.
   These may be used in dental surgery, other surgeries, or as sedatives, pain relieving drugs. Examples: Codeine, hydrocodone (Hycodan), morphine, opxycodone (Percocet), meperedine (Demerol), propoxyphene (Darvon).
   • Produce central nervous system depression.
   • Can produce physical dependency
   • Increase respiratory depression
   • May require increasingly larger doses to gain the same effect.
   • May cause postural hypotension (fainting).

Things to consider:

• Can a pudendal, spinal or epidural anaesthetic be used instead of a general anaesthetic?
• Avoid unnecessary elective surgery.
• Appropriate use of analgesics helps to control pain.
• Avoid use of analgesics helps to control pain
• Avoid taking narcotics, try aspirin, NSAIDs.
• Protect your joints! Use a cane or other ambulatory aids. Wear your orthosis.
• Try hot or cold packs, taking a shower, a bath, going to a pool to relieve muscle and joint pains.
• Change your lifestyle, practice a work-rest routine.

Stimulents

Avoid amphetamines
Some anticholinesterase drugs, e.g. pyridostigmine (Mestinon), may influence fatigue level.
Avoid over exertion, use a work-rest lifestyle.

Antidepressants, Anti-anxiety drugs.

One third to one half normal dosage may be adequate. Many of these drugs (benzodiazepines e.g. Valium, Librium, Ativan) are also muscle relaxants, sedatives and may increase fatigue, decrease strength. Barbiturates may be used for sedative, hypnotic or anticonvulsant activities.

• Avoid drinks and foods that may enhance effect, e.g. Alcohol, coffee, especially at night and if you have respiratory muscle weakness.
• Seek counselling for feelings of depression.
• Join a polio survivors support group, become informed, involved.
• Seek out social contacts, go on outings, volunteer, play darts, play anything, get a hobby! Find a distraction.

In Conclusion.

This is only a brief review. Drugs taken for cardiopulmonary and other problems may have important interactions with polio related symptoms.

Only you can identify yourself as a polio survivor to your doctor (and dentist - LincsPPN), ensure your doctor knows what drugs you are taking, and become familiar with potential side effects.

Always remember, it is no solution to take medications and continue to abuse your joints and muscles; change your lifestyle and protect your joints and muscles FIRST.

ALWAYS CONSULT YOUR DOCTOR
BEFORE TAKING OR CHANGING DRUGS

J.M.Walker Ph.D., PT
School of Physiotherapy

AM Whelan, Phar. D
College of Pharmacy

4th Floor, Forrest Building,
DAlhousie University,
5869 University Ave.,
Halifax, NS Canada B3H 3J5

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Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.
Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/pharm/guidenz.html>
Created: 10th August 1997
Last modification: 29th April 2000