Medication Safety and Management of Side Effects Unwanted or unexpected reactions to a medication or treatment.
Safety considerations of commonly used medications
We have included some key pieces of information regarding common medication classes prescribed to adults with SCI/D Spinal cord injury or dysfunction. , including what the medication classes are for, common medications (brand name and generic), and safety considerations.
| Name of Medication Class | Purpose of Medication | Common Medications in Class (Brand and Generic) | Safety Considerations |
|---|---|---|---|
| Opioids (narcotic analgesics) | Opioids are primarily used to treat and/or manage pain. | • Oxycodone • Tramadol • Codeine • Hydromorphone • Methadone • Buprenorphine | • Overdose • Abuse • Withdrawal effects • Hypotension • Dependence and tolerance • Constipation • Interaction with other medications • Respiratory depression • Falls (dizziness) |
| Antibiotics | Antibiotics are used to treat infections caused by bacteria and are commonly prescribed to individuals with SCI/D for urinary tract infections, osteomyelitis (bone infection), pressure injury infections, skin infections, and nail infections. Depending on patient history and the type/location of infection, different antibiotics may be prescribed. | • B-Lactams (e.g. oxacillin, ampicillin, cefadroxil, Duricef, Ancef) • Carbapenems (e.g. Meropenem) • Clindamycin (e.g. Cleocin) • Erythromycin (e.g. Erythrocin, Erythroped) • Fluoroquinolones (e.g., Ciprofloxacin, Noroxin, Levofloxacin, Levaquin) • Monurol (Fosfomycin tromethamine) • Nafcillin (e.g. Nallpen) • Nitrofurantoin (e.g. Macrobid, Macrodantin) • Tazocin • Tetracycline (e.g. Sumycin, Achromycin, Tetracyn) • Trimethoprim and sulfamethoxazole (e.g. Bactrim, Septra) • Vancomycin (e.g. Vancocin and Firvanq) | • Antibiotic resistance Allergic reactions • Antibiotic-associated diarrhea |
| Antidepressants | Antidepressants are medications used to treat symptoms of depression and anxiety. However, they may also aid in pain and sleep problems. | Serotonin and norepinephrine reuptake inhibitors (SNRIs): • Venlafaxine • Duloxetine • Desvenlafaxine Tricyclic antidepressants and norepinephrine reuptake inhibitors: • Amitriptyline • Nortriptyline • Trimipramine • Desipramine • Clomipramine • Maprotiline • Doxepin | • Cardiovascular complications: • Orthostatic hypotension – low blood pressure when standing after sitting or lying down. It can cause dizziness or fainting • Arrythmia – abnormal rate or rhythm of heartbeat (your heartbeat may become too fast or slow) Other symptoms: • Withdrawal • Constipation • Fatigue and sedation (low energy) • Serotonin syndrome (increase in serotonin levels leading to possible agitation, anxiety, nausea, and flushed skin) • Thyroid function problems (e.g. effect on heart rate, mood, energy level, bone health, metabolism) • Confusion and cognitive impairment |
| Muscle relaxants | Muscle relaxants are used to help decrease muscle tone and treat and/or manage spasticity and muscle spasms. | • Baclofen • Tizanidine • Dantrolene • Cyclobenzaprine • Botulinum toxin | • Hypotension (low blood pressure) • Tolerance and dependence • Fatigue and sedation • Dizziness (falls) • Withdrawal • Seizures if stopped abruptly • Difficulties breathing • Muscle weakness • Paralysis |
| Laxatives | Laxatives are medications that stimulate emptying of the bowel. | • Magic bullet (bisacodyl-rectal) • Dulcolax (bisacodyl) • Senokot (senna) • Docusate • Lactulose (lactulose) | • Tolerance or dependence • Dehydration • Falls (dizziness) • Renal disease (due to electrolyte imbalance) |
| Benzodiazepines | Benzodiazepines are commonly prescribed for anxiety disorders, panic disorder, insomnia, sedation, seizure disorders, skeletal muscle spasticity, and alcohol withdrawal. | • Alprazolam • Bromazepam • Chlordiazepoxide HCl • Clobazam • Clonazepam • Clorazepate Dipotassium • Diazepam • Flurazepam HCl • Lorazepam • Midazolam HCl • Nitrazepam • Oxazepam • Temazepam • Triazolam | • Substance use disorder • Overdose • Tolerance and dependence • Fatigue and sedation • Dizziness and loss of coordination (falls) • Withdrawal • Constipation • Muscle weakness • Confusion • Delusions and hallucinations • Anxiety |
References
Guilcher, S. J., Hogan, M.-E., Calzavara, A., Hitzig, S. L., Patel, T., Packer, T., & Lofters, A. K. (2018). Prescription drug claims following a traumatic spinal cord injury for older adults: A retrospective population-based study in Ontario, Canada. Spinal Cord, 56(11), 1059–1068. https://doi.org/10.1038/s41393-018-0174-z
Guilcher, S. J., Hogan, M.-E., McCormack, D., Calzavara, A. J., Hitzig, S. L., Patel, T., Packer, T., Guan, Q., & Lofters, A. K. (2020). Prescription medications A medication that is only available with written instructions from a healthcare provider (e.g., doctor, dentist, pharmacist). dispensed following a nontraumatic spinal cord dysfunction: A retrospective population-based study in Ontario, Canada. Spinal Cord, 59(2), 132–140. https://doi.org/10.1038/s41393-020-0511-x
Health Canada. (2023, February 8). Benzodiazepines Class of drugs that slow down activity in the brain and nervous system. Can be used to treat anxiety, depression, seizures or sleep disorders. . https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/benzodiazepines.html
Kitzman, P., Cecil, D., & Kolpek, J. H. (2016). The risks of Polypharmacy following Spinal Cord Injury. The Journal of Spinal Cord Medicine, 40(2), 147–153. https://doi.org/10.1179/2045772314y.0000000235
Skånland, S. S., & Cieślar-Pobuda, A. (2019). Off-label uses of drugs for Depression. European Journal of Pharmacology, 865, 172732. https://doi.org/10.1016/j.ejphar.2019.172732
Wong, S., Santullo, P., O’Driscoll, J., Jamous, A., Hirani, S. P., & Saif, M. (2017). Use of antibiotic and prevalence of antibiotic-associated diarrhoea in-patients with spinal cord injuries: A UK National Spinal Injury Centre Experience. Spinal Cord, 55(6), 583–587. https://doi.org/10.1038/sc.2016.193