It is rare to find someone who has never suffered from the side effects of a medicine. Importantly, these effects increase the more potent the drug, the greater the number of medicines taken and as we age. To offset the problem, however, there are some controls  –  medicines are only allowed to be sold if their benefits far outweigh their risks. But while most of the more common side effects, such as rashes, tummy upsets and tiredness are minor, sometimes they can be serious, even life-threatening. 

To help us know what to expect and to understand the risks, by law the side effects of a drug are listed in detail in the ‘Patient Information Leaflet’ enclosed with each product. These leaflets also offer advice on how problems might be avoided and what steps to take if they do arise. 

This blog is about a surreal moment when, knowing the contents of the leaflet I went to our local hospital to allow me to test whether I would develop a side effect that was described and which worried me enormously. The potential threat was an attack of asthma; the medicine involved was the beta-blocker – bisoprolol. 

There are several important background elements to this story. In my career I was a clinical pharmacologist so professionally knew about medicines, how they worked, the risks they carried and how best to use them. I was also a hospital consultant and amongst my patients were those with asthma. Thirdly, and by coincidence, I am asthmatic myself. Asthma, and its potential risks, have been part of my life. 

Finally, following a recent heart scare I have started on a four-drug regime that has been shown to improve outlook by years. Building up to the four takes time and a few weeks ago I was asked to add in the third medicine – the said bisoprolol, and the reasons for my concerns were straightforward. The older beta-blockers, such as propranolol, slow the heart and in so doing lower the blood pressure and prevent angina. Because of a wide range of actions they can also affect the lungs when they cause the airways to narrow which in susceptible patients results in an asthma attack.  Bisoprolol is a new beta-blocker that is selective so mainly affects the heart with relatively little effect on the lungs. Even so, the patient information leaflet warns ‘Do not take bisoprolol ……. if you have ever suffered from severe wheezing or severe asthma as it can affect your breathing’ and ‘If you experience shortness of breath call your doctor immediately’. As a possible candidate for this side effect, and despite receiving reassurances of its safety from my doctors, I decided it would be better to be ‘safe that sorry’ and with their agreement arranged to do an experiment – I would take my first tablet where help was immediately available. The risk of developing asthma is at its greatest from one to four hours after the tablet is swallowed so the experiment would take some time.

On the allotted morning, I presented myself to the receptionist in the Accident and Emergency department of our local hospital. She asked what was wrong and when I said ‘Nothing, yet’ her face responded with a mixture of puzzlement and incredulity. And her expression changed little as I went on to say how I planned to take bisoprolol which might cause severe asthma and I had come to A & E as I might quickly need urgent medical attention. Without it I might die! There was a moment of silence then ‘Yes, dear’. Then she listened carefully to my account and after more ‘Yes dears’ wrote down my name ‘Professor Joe Collier’ and the name of the medicine. Next with a face that was now resigned but sympathetic she wished me well! 

I swallowed my bisoprolol tablet (see illustration), noted the time and walked to the hospital restaurant where I slowly had lunch and read. Nearly four hours later and symptom-free I wandered back to A and E to report. I explained to the receptionist – the same one – that I had not become ill and with a lot more reassuring ‘Yes dear’ and ‘Of course dear’ coupled with a kindly smile she wished me well and I left for home.

For me, being able to take a test dose of my new but potentially dangerous medicine in safe surroundings was an enormous relief. I could have taken a risk but knowing how severe attacks of asthma can quickly kill it was something I wished to avoid. Some might see my behaviour as excessive but I would advise any one to take the warnings in the patient information leaflet seriously. 

The illustration shows a 7-pill blister pack next to which is the white pill containing 1.25mg of bisoprolol that has just been squeezed from the flattened blister at its upper right corner. 

For helping me write this blog, I would like to thank Caroline, Rohan and Vivien.