Every summer, especially when the temperature approaches or exceeds 40 degrees Celsius, doctors and pharmacists issue the same warning: The heat not only affects our daily lives, but can significantly burden the health of people suffering from chronic diseases.
Their message does not only concern the effects of high temperatures on the human body, but also extends to the way they behave and certainly to the particularities of each group of patients, including the medication they receive.
For example, people with hypertension, diabetes mellitus, heart failure or chronic kidney disease are more vulnerable to high temperatures, as their body is called upon to deal with heat stress, their illness itself and in some cases the side effects of their medications which can either be altered due to the heat or can lead to unwanted side effects, such as, for example, gastrointestinal disorders.
"It doesn't mean that medicines become dangerous in the summer. Most risks are related to dehydration, loss of electrolytes, a drop in pressure, the body's difficulty in expelling heat, and poor storage of medications or devices. Medications remain necessary and should never be discontinued or changed without medical or pharmaceutical advice. Particular attention is needed in the proper storage of medicines, always according to the instructions of each product", explained to "F" the professor of Pharmacognosy and Chemistry of Natural Products at the University of Nicosia, Christos Petrou. Medicines, he said, "should not, for example, be left in the car, in a bag exposed to the sun or on the beach, because high temperature can affect their quality and effectiveness."
Dr. Christos PetrouSo, what are these drugs that may lead patients to unpleasant adventures? With the help of Professor Christos Petrou, we record examples of the most common side effects of the summer on medications and, of course, on the people who take them.
For hypertension and the heart
In medications for hypertension and heart disease, attention is mainly on dehydration and hypotension. ACE inhibitors and sartans are used in hypertension, heart failure and chronic kidney disease. In severe dehydration, the risk of dizziness, very low blood pressure or temporary burden of kidney function may increase, especially when combined with diuretics.
In addition, diuretics need special attention. Medications such as furosemide or hydrochlorothiazide increase the elimination of fluids and electrolytes. In a heat wave, especially in the elderly or in people with heart or kidney disease, symptoms such as dizziness, weakness, confusion, intense thirst or decreased urination should lead to contact a healthcare professional. However, the patient should not stop the drug on his own.
Beta-blockers, given for hypertension, arrhythmias, coronary heart disease and heart failure, can in extreme heat affect how the body responds to heat stress. This does not mean that they should be discontinued. It means that the patient should avoid strenuous exercise during the warmer hours, stay in a cool place and seek advice if he experiences fainting or unusual fatigue. Calcium channel antagonists can also persist in most patients, but severe dizziness or weakness during a heat wave should be evaluated by a doctor or pharmacist.
For diabetes
In diabetes mellitus, heat needs special attention. Dehydration can make it difficult to control glucose, while high sugar values increase fluid loss through urine. At the same time, high temperature can affect insulin, test strips, meters and sensors for continuous glucose recording.
Insulin should be stored according to the instructions for each product. It should not stay, for example, in a parked car, in a bag exposed to the sun or on the beach.
An isothermal case can be used during transport, without direct contact with ice packs, so that it does not freeze. If it is suspected that he or she has been exposed to extreme temperature, the patient should consult a pharmacist or physician before using it.
Metformin remains a key treatment option for many patients with type 2 diabetes. Caution is mainly about severe dehydration, such as severe diarrhea, vomiting, fever or significantly reduced fluid intake, because it can burden kidney function and increase the risk of rare but serious side effects. In such cases, the patient should contact a doctor or pharmacist immediately for instructions and not improvise.
SGLT2 inhibitors, used in type 2 diabetes but also in some patients with heart failure or chronic kidney disease, increase the excretion of glucose and water through urine. That is why caution is needed in the elderly, in those taking diuretics or when there is a large loss of fluids.
GLP-1 agonists require different attention: The main issue is not the heat per se, but possible gastrointestinal side effects, such as nausea, vomiting or diarrhea, which in heat can increase the risk of dehydration and obviously their storage.
Antidepressants, antihistamines, anti-inflammatories, etc.
Other categories of drugs also need attention. Some antidepressants and antipsychotics may interfere with sweating, thermoregulation, or alertness.
Some first-generation antihistamines and drugs with anticholinergic action may reduce sweating.
As Mr. Petrou explained, "non-steroidal anti-inflammatories, such as ibuprofen and naproxen, can increase the risk of kidney damage in severe dehydration or kidney burden. Medicines with a narrow therapeutic range, such as lithium, also need special attention, because dehydration can increase the risk of toxicity."
What is drug-induced photosensitivity
Summer also increases the need for protection from the sun. "Some drugs can cause photosensitivity, i.e. a more intense reaction of the skin to ultraviolet radiation. This may appear as redness, rash, itching, burning sensation, or blisters. Medications that have been associated with photosensitivity include certain antibiotics, such as doxycycline and some fluoroquinolones, thiazide diuretics, amiodarone, some topical anti-inflammatories, retinoids, antifungals, and some antidepressants."
Proper storage concerns all medicines. Many pharmaceuticals should be stored below 25°C or 30°C, depending on product instructions, away from sun, moisture, and heat sources. The bathroom, the car and the beach bag are not suitable storage areas. If a medicine changes colour, smell, texture or appearance, it should not be used until it has been checked by a pharmacist.
Pay attention to instructions
High temperatures require caution, not panic. Patients should:
>> They are protected from the heat.
>> Drink plenty of fluids if they do not have different instructions.
>> Avoid long hours of exposure to the sun.
>> Store their medication properly and not change their treatment on their own.
If severe dizziness, weakness, confusion, fainting, symptoms of dehydration or an unusual skin reaction occur, contacting a doctor or pharmacist is the safest option.
"The main message to the public is simple," Mr. Petrou concluded: "In the summer we do not interrupt and change the medication ourselves. We always consult our doctor or pharmacist and take our measures and take care of their good storage."
