Contraindication

A Contraindication occurs when certain factors such as age, previous illnesses or injuries speak against a particular therapeutic or medical measure. This medical term is derived from the Latin language from "contra" = "against" and "indicare" = to show. The technical language also speaks of contraindication. If doctors ignore the existence of a contraindication, the patient's existing pre-existing illness or damage to the organ system may worsen.

What is the contraindication?

A contraindication exists when the attending physician realizes that a condition, illness or situation prohibits the use of therapeutic or medical measures on the patient. In this case, the presence of the contraindication prevents a positive treatment goal from being achieved.

In the case of the absolute contraindication Doctors are forced to forego a planned measure, as this has a negative effect on the patient's state of health. If there is a relative contraindication the medical professionals carry out the planned therapeutic measure when the expected benefit outweighs the feared damage to health. Before starting this measure, the doctors carefully assess the risk-benefit ratio.

In most cases, pregnancy is an absolute contraindication, as many medications and therapeutic measures should not be administered during this time in order to prevent prenatal damage to the embryo.

Function, effect & goals

There are various reasons for the existence of a contraindication. Some medicines work too strongly or too weakly under special conditions. The well-known pain reliever acetylsalicylic acid can cause stomach upset as a possible side effect. In the majority of patients, taking this pain substance over a short period of time is harmless.

In patients with gastric ulcers, the gastric symptoms may worsen.Gastric ulcers are therefore a contraindication for this active ingredient. Some contraindications must be strictly adhered to (absolute contraindication), others leave the medical professionals room for maneuver (relative contraindication). An absolute case is when the administration of medication to the patient has such serious side effects that it should not be used under any circumstances.

When using acetylsalicylic acid, in addition to gastric ulcers, an abnormally increased tendency to blood or the last third of a pregnancy (3rd trimester) are an absolute contraindication. This is also the case in the case of an allergic shock reaction to the administration of penicillin. A patient who has ever had an allergic reaction to the administration of this medication may no longer take it. In the case of the relative indication, the physician decides individually in each case whether the administration of medication is appropriate or not and the expected benefit is greater than the health risk associated with the indication.

Relative contraindications to the administration of acetylsalicylic acid are the first and second trimester of pregnancy (1st and 2nd trimester), children and adolescents under 16 years of age and bronchial asthma. Cardiologists successfully use beta blockers in the case of coronary heart disease (angina pectoris) and high blood pressure. A side effect of beta blockers is the spasms of the bronchial muscles. If a heart patient also suffers from asthma and is given beta blockers, there is a high probability that they will suffer from shortness of breath and the risk of suffocation is high. In this case there is an absolute contraindication.

In cardiac patients without asthma, however, the administration of beta blockers is generally harmless (relative contraindication). Specialist information lists these contraindications under the items "Interactions with other medicinal products and other forms of interaction", "Special warnings", "Precautions for use" and "Fertility, pregnancy and lactation". Each medication has a patient information leaflet that patients should read carefully before use. This is especially true for over-the-counter products such as dietary supplements and other apparently harmless drugs. All contraindications in the form of side effects and interactions with other drugs are listed on the package insert.

Users take these drugs and dietary supplements without medical advice. In the event of uncertainty, it is necessary to seek medical advice from a doctor or pharmacist. There are certain circumstances that are mistakenly believed to be contraindications. These “false contraindications” often occur in connection with vaccination. Laypeople are more afraid of the possible side effects than of the harm that may result from not treating the symptoms of the disease. Long package inserts for the medication listing possible side effects increase anxiety without specifying the risk of non-treatment.

Responsible medical professionals always weigh the risks of an indicated therapy against the risks of non-treatment. Patients cannot conclusively assess contraindications and interactions between individual drugs. This knowledge belongs in the pharmacological part of medical studies. Corresponding lists give doctors a comprehensive overview of contraindications and interactions. Before treatment, doctors ask about intolerances, allergies and previous illnesses in order to rule out any contraindications for prescribing medication and any interactions. Pharmacists compare the prescription drugs using computer lists before they are given to patients. This double check increases the safety of the therapy.

Risks, side effects & dangers

The risks associated with contraindications increase with age, as the elderly often suffer from several diseases for which they are taking different drugs.

With age, organs such as the kidneys and liver break down the harmful substances of various drugs more slowly due to a slowed metabolism. If patients take several medications at the same time for the typical signs of old age such as heart failure, old-age sugar, high blood pressure and pain due to wear and tear, it is becoming increasingly difficult for doctors to take this situation into account and to use all medications according to guidelines and as standard.

Not only do the contraindications in the form of interactions between the individual drugs make treatment more difficult, but also side effects that may require the use of other drugs. Such a complicated situation, which is common to many elderly people, requires a specialist and family doctor examination. The ideal situation is when the patient and the doctor have known each other for a long time in order to work out the optimal medication for the complicated illness at hand. In this way, the doctor is able to assess which medication the patient can possibly do without.

Furthermore, the risk is reduced by taking the medication more widely. The doctor critically questions the usual guidelines for treatment and thinks about which drugs must be prescribed and which not.