Drug Therapy

 There are many different types of medication available to improve symptoms, quality of life and, in certain situations, prognosis. These drugs have been developed and refined over many years and their benefit demonstrated in numerous well-designed and well–conducted clinical trials. As a consequence there is generally a very clear algorithm for determining which drugs will help any one particular patient and the doses necessary to achieve optimum benefit.

Unlike, say, a short course of antibiotics, most drugs for the heart are usually prescribed for the long term, since their action is often to suppress a symptom or condition rather than cure it; the benefits of statins in lowering cholesterol in patients with coronary artery disease, for example, have been shown to accrue over the years. Perhaps for this reason many patients fear that once they start a drug they can never stop it. This is, however, not strictly true; although the benefits may only be seen with long-term therapy it does not mean that a patient cannot stop the medication, but of course this should only ever be done after seeking medical advice.

As with any medical treatment, careful consideration is given to the potential for benefit and also the potential for harm when prescribing medication; it should go without saying that the risk:benefit ratio must be highly favourable before a drug will be considered for licensing. An important medical skill is the ability to determine as accurately as possible, by extrapolating from large clinical trials and population data, the potential for benefit in any one individual.

Patients view medication very differently; some embrace it with alacrity, others resist it with suspicion and fear. Ultimately the decision as to whether to take any form of medication resides wholly with the patient; a doctor’s role is to try to explain the aims of treatment, mechanism of benefit and the potential for risk, and to put this into a useful context for the patient, who should then be in a position make an informed decision. Female patients planning a pregnancy should discuss the potential risks of drug therapy on the developing foetus with their doctor and balance this against the risk of stopping or changing medication at this time.