Medicine Side Effects Families Should Watch For

Why older adults are more vulnerable

• Slower clearance: reduced kidney and liver function means medicines stay longer and build up.
• Body composition: less muscle and water, more fat, which changes how medicines spread.
• Many medicines: more interactions; see polypharmacy and deprescribing: taking fewer, better medicines.
• Sensitive brain and blood pressure control: more confusion, dizziness and falls.
• Existing conditions such as dementia, heart, kidney or liver disease, which change risk.
• Poor nutrition, dehydration, illness and heat alter how medicines act.
• Errors: missed or doubled doses, mixed-up packets, expired medicines.
• Limited complaints: people with dementia or hearing loss may not report symptoms.

Timing clues

• After starting a new medicine, or changing the dose: most side effects appear within days to weeks.
• After stopping a medicine (by a doctor): withdrawal effects can occur.
• After a hospital stay, when several changes are made.
• After illness or dehydration, when the same dose acts differently.
• After adding a supplement or herbal product.
• In hot weather, when some medicines affect fluid balance.

Always ask: "What changed in the last few weeks?"

Warning signs by body system

### Brain, mood and behaviour

• New confusion, drowsiness, agitation, restlessness, hallucinations, suspiciousness, or personality change: possible medicine effect or delirium; see confusion, hallucinations and sudden change: when to call.
• Excessive sleepiness in the day, slow responses, slurred speech.
• Memory worsening.
• Low mood, anxiety, irritability, disturbed sleep or vivid dreams.
• Tremor, stiffness, restlessness or involuntary movements.
• Seizures.

### Balance, falls and blood pressure

• Dizziness, light-headedness, unsteadiness, particularly on standing; see dizziness when standing: postural hypotension in older adults.
• Falls or near-falls; see falls risk assessment at home.
• Fainting, very slow or fast pulse, palpitations.
• Swollen ankles or feet.

### Stomach and bowels

• Nausea, vomiting, loss of appetite, bad taste, weight loss; see loss of appetite in older adults: causes and practical fixes.
• Constipation (very common); see constipation in older adults: fibre, fluids and movement.
• Diarrhoea, especially severe or after antibiotics; see diarrhoea and dehydration in older adults.
• Heartburn, stomach pain; black, tarry or bloody stools; vomiting blood or coffee-ground material.
• Dry mouth, mouth sores, difficulty swallowing; see swallowing problems (dysphagia) in older adults.

### Bladder and kidneys

• Difficulty passing urine, a weak stream, or inability to pass urine; see prostate problems and urinary symptoms in older men.
• New or worse leakage or urgency; see incontinence in older adults: causes and types.
• Passing much less urine, dark urine, swelling, tiredness (possible kidney strain).

### Skin, allergy and bleeding

• Rash, itching, hives, blisters, peeling skin, mouth ulcers, especially after a new medicine.
• Swelling of lips, face or tongue; wheeze; throat tightness: severe allergy.
• Easy bruising, nosebleeds, bleeding gums, blood in urine or stool, prolonged bleeding.
• Sun sensitivity.

### Blood sugar and metabolism

• Shakiness, sweating, hunger, confusion, odd behaviour: low blood sugar; see low blood sugar in older adults: recognising and treating it.
• Excess thirst, frequent urination, tiredness: high sugar.
• Muscle pain, weakness or dark urine.
• Weight gain, swelling or fluid retention.
• Changes in sodium or potassium (weakness, cramps, confusion, palpitations) detected by blood tests.

### Breathing, heart and chest

• New cough, wheeze, breathlessness.
• Chest pain, palpitations, a very slow pulse.

### Eyes, ears and mouth

• Blurred vision, eye pain.
• Ringing in the ears, hearing change, dizziness; see ringing in the ears (tinnitus) at home.
• Dry or sore mouth, taste change.

### Liver and general

• Yellow skin or eyes, dark urine, pale stools, itching.
• Unusual tiredness, fever, sore throat or mouth ulcers (blood problems).
• Loss of balance or numbness in hands and feet; see peripheral neuropathy and balance.

What to do when you suspect a side effect

1. Stay calm and check the person: alertness, breathing, colour, pulse, blood pressure, temperature, blood sugar if diabetic; see how to measure blood pressure at home accurately and digital thermometers: choosing and using them for older people. 2. Do not stop the medicine yourself unless the doctor or pharmacist tells you to, or you are following an emergency instruction already given. Some medicines are dangerous to stop suddenly. 3. Call the doctor or pharmacist the same day, describe the symptoms, the timing and the medicines; use the list; see keeping a health record at home. 4. Follow the advice: it may be to continue, to take it with food, to adjust the time, to pause, to stop or to attend the clinic. 5. For allergic reactions or emergencies, call 112 (see below). 6. Record what happened for the doctor. 7. Bring the packets to the appointment. 8. Do not add another medicine to treat the symptom without checking: it may be treating a side effect. 9. Keep the person safe: prevent falls, supervise bathing, maintain fluids.

What to record

• Date and time of each symptom, its duration and severity.
• Medicine names, doses and times taken that day, and any recent changes.
• Food, drinks, alcohol and supplements.
• Vital signs: blood pressure, pulse, temperature, sugar, weight.
• Other illnesses or events: diarrhoea, vomiting, fever, heat, a fall.
• What helped or worsened it.
• Photos of rashes or swelling.

A simple notebook or a phone note works. Use the same list to ask the doctor about causes.

Emergencies: call 112

• Swelling of the lips, face, tongue or throat, difficulty breathing, wheeze, hives all over: severe allergic reaction.
• Chest pain, severe breathlessness, fainting, a very slow or fast heartbeat with dizziness.
• Stroke signs: face droop, arm weakness, speech difficulty.
• Seizure, severe confusion or unresponsiveness.
• Uncontrolled bleeding, vomiting blood, black tarry stools with weakness.
• Severe low blood sugar with drowsiness or inability to swallow.
• Severe skin blistering or peeling, with fever or mouth sores.
• Suspected overdose or taking a double dose with symptoms: call 112 and keep the packet.
• Inability to pass urine with severe pain.

Prevention habits

• Know what each medicine is for; see preparing for a doctor's visit with a parent.
• Ask about common side effects when a medicine is started, and what to do if they appear.
• Review medicines yearly and after hospital stays.
• Use a pill organiser and one pharmacy; see pill organiser guide.
• Do not use leftover or borrowed medicines.
• Keep up fluids and nutrition; see hydration for older adults: how much and how to remember.
• Report supplements and herbs; see supplements and medicine interactions: a safety guide.
• Start new medicines when someone can watch, not just before a trip.
• Keep emergency numbers and the medicine list accessible; see emergency contact card and medical summary.

Reporting side effects in India

The Pharmacovigilance Programme of India (PvPI) collects reports of adverse drug reactions from healthcare professionals and, in some forms, from patients and families. Ask the doctor or pharmacist how to report, or check the official PvPI helpline and reporting forms; details may change, so check the current process. Reporting helps spot rare problems.

When to ask a professional

Ask the doctor or pharmacist about any suspected side effect, and request a medicine review if symptoms such as falls, confusion or weight loss appear. Ask a pharmacist to check interactions. Seek urgent help for the emergencies above; call 112.