When good drugs do bad

Your head is throbbing, so you keep popping pain relievers to try to feel better. So why in the world is your headache suddenly worse? Surprisingly, some medications you might take to relieve common health complaints can cause the same problems they're designed to treat. That doesn't mean you shouldn't take those drugs; it's just good to be aware of that potential side effect.

Here's a rundown of 10 common types of medications that sometimes backfire and what you can do to try to prevent that from happening, or cope if it does.

Examples: drugs that end in "triptan," such as rizatriptan (Maxalt) and sumatriptan (Imitrex and generic)

How they can backfire. Using migraine pain relievers too often might lead to a condition known as medication-overuse headache, which affects up to two-thirds of patients who seek help at headache treatment centers in the U.S. It can also happen with nonprescription pain relievers.

What to try instead. Some types of migraines should not be treated with triptans, so your first step is to get a diagnosis from your doctor. You need to figure out what's triggering your migraines—if you do, you might be able to avoid them. Common triggers are chocolate, shellfish, and wine. Others include beer, cheese, hunger, strong odors, bright lights, the sun, glare from a TV or computer screen, insomnia, and stress. Instead of jumping to migraine meds, talk to your doctor about alternative therapies shown to reduce the frequency or intensity of migraines or to prevent them. Examples: hepatotoxic PA-free herb butterbur (75 milligrams twice daily); coenzyme Q10 (100 milligrams three times a day); and the B vitamin riboflavin (400 milligrams a day). Note that the Co-Q10 might take up to three months to be effective, and it's fairly expensive.

Example: phenylephrine (Neo-Synephrine Regular Strength Nasal Spray and Vicks Sinex Nasal Spray)

How they can backfire. If you use a decongestant spray for longer than three days, watch out for rebound congestion.

What to try instead. Whenever possible, first try nondrug options, such as elevating your head when lying down; inhaling steam from a hot shower, kettle, or vaporizer; and drinking plenty of fluids. If congestion lasts longer than a few days, try a decongestant such as pseudoephedrine (Sudafed and generic). (Warning: Don't use decongestants if you have diabetes, heart disease, or a thyroid condition.) You can also try a saline nasal rinse such as Ayr Allergy & Sinus. See your doctor if symptoms last longer than two weeks or you have thick, colored mucus or a fever over 101º F.

Examples: acetaminophen and ibuprofen

How they can backfire. Over-the-counter pain relievers are very effective for many headaches, but they can sometimes cause rebound headaches.

What to try instead. If you've been taking painkillers for headaches more than twice a week, talk to your doctor. Certain antidepressants, such as generic amitriptyline and mirtazapine, can help with chronic headaches, reducing how often or how long you suffer, but they do have side effects.

Examples: bisphosphonates such as alendronate (Fosamax, Fosamax Plus D, and generic), etidronate (Didronel and generic), ibandronate (Boniva), and risedronate (Actonel)

How they can backfire. Drugs designed to improve your bone density can, over time, actually increase risk of fractures. The FDA issued a black-box warning in 2010 that long-term use of bisphosphonates might increase the risk of thigh-bone fracture. It also warned of more serious and long-lasting issues, including abnormal heart rhythm (atrial fibrillation); incapacitating bone, joint, and muscle pain; and bone loss (osteonecrosis) in the jaw.

What to try instead. It's important to build bone strength by eating foods with lots of calcium and vitamin D, including dairy products such as low- or no-fat milk and yogurt, salmon, sardines, and green leafy vegetables. Doing weight-bearing exercise such as walking and lifting weights helps, too. For women with "pre-osteoporosis," or osteopenia, skip the drugs and minimize your risk of breaking a bone. Some tips: Limit how much alcohol you drink, avoid sleeping pills, and trip-proof your home. For those with osteoporosis who already take a bisphosphonate drug, consider taking a "drug holiday" after five years' use. You might also benefit from ipriflavone supplements with calcium (1 gram per day) and vitamin D (400 international units per day).

Examples: pioglitazone (Actos, Actoplus Met, and Duetact) and rosiglitazone (Avandia, Avandaryl, and Avandamet)

How they can backfire. One of the major complications of diabetes is an increased risk of heart attack and heart failure. Actos and Avandia lower blood sugar, but they can also increase your risk of heart failure. Avandia boosts your risk of heart attack, too, which is why the FDA has sharply restricted its use and why we recommend avoiding it. (It's off the market in Europe.)

What to try instead. Eating a healthful diet of whole grains, nuts, legumes, green leafy vegetables, fruits, lean meats, and fish is important. So is exercising regularly. Solid research has shown that in some people, even losing as little as 20 pounds can significantly reduce blood sugar levels and in some cases, eliminate type 2 diabetes altogether. (Type 1 diabetes is chronic and must be managed with insulin.) People who still need medication are better off with metformin (Glucophage and generic), either alone or taken with glimepiride (Amaryl and generic) or glipizide (Glucotrol and generic).

Examples: selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac and generic) and sertraline (Zoloft and generic), and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor and generic)

How they can backfire. These drugs can help many people suffering from anxiety or depression, but they can also bring about restlessness and anxiety. Those side effects are relatively rare and usually go away after a few weeks, but tell your doctor if they don't. But they can also cause thoughts of suicide, especially in teens.

What to try instead. When we recently surveyed consumers who sought help for anxiety and depression, we found that for many, talk therapy worked as well as drugs. Those who used both fared even better. Exercise can ease depression and anxiety, too. If you take antidepressants or anti-anxiety meds and want to stop, don't quit cold turkey; agitation and other symptoms might occur. Your doctor can help you explore options and taper off the drugs slowly. If medication is warranted, see here for our free Best Buy Drug report on antidepressants.

Example: estrogen (Cenestin, Menest, Premarin, and generic) and estrogen-progestin combos (Climara Pro and Prempro)

How they can backfire. HRT has been prescribed to relieve menopause symptoms, including hot flashes, but a major reason women were prescribed it was to prevent heart disease, so it was a shock that HRT was found to actually increase that risk. Women who took estrogen alone or with progestins have been found to have a higher risk of heart attacks, strokes, blood clots, breast cancer, and dementia.

What to try instead. If you must take hormones, do it for the shortest time possible and at the lowest dose. To relieve hot flashes, first try simple measures such as lowering the thermostat and avoiding hot-flash triggers, such as alcohol and spicy foods. Exercise also helps. Talk to your doctor about whether supplements such as St. John's wort or certain antidepressant drugs might be an option for you.

Examples: methylphenidate (Ritalin and generic) and amphetamine-dextroamphetamine combination (Adderall and generic)

How they can backfire. Common symptoms of attention deficit hyperactivity disorder (ADHD) include persistent difficulty focusing, controlling actions, and remaining still or quiet. Yet many sufferers take meds that could cause agitation, anxiety, and mania. Some are given amphetamines for improved attention, focus, and memory (called neuroenhancement), but those drugs can actually cloud thinking.

What to try instead. In our survey of parents of children with ADHD, many reported that kids with moderate or severe ADHD were helped by drugs, but side effects include irritability and anger. Knowing that the drugs can have those side effects should not be a signal to avoid them but to work with your pediatrician or psychiatrist to make sure you've explored nondrug strategies for improving behavior. See here for our free Best Buy Drug report on medications to treat ADHD.

Example: bimatoprost (Latisse)

How it can backfire. Latisse was originally approved to treat glaucoma, but a side effect, noted in clinical trials, was fuller lashes, so the manufacturer asked for and got approval for that use. But the drug has other side effects that do just the opposite of improving how your eyes look: it can cause red, itchy eyes; a permanent change in eye color; and darkening eyelids.

What to try instead. Just think about how many tubes of mascara and other eye-makeup goodies you could buy with the $120 a month you'd save by not getting a prescription for Latisse.

Example: benzoyl peroxide (Benoxyl, Fostex, Oxy 10, and generic)

How they can backfire. About a third of people who use benzoyl peroxide (over-the-counter or prescription strength) for acne experience side effects that can irritate the skin. Mild ones include dryness or peeling, a warm sensation, tingling, or stinging. Serious side effects are rarer, but contact a doctor right away if you experience burning, blistering, itching, redness, rash, or swelling.

What to try instead. Benzoyl peroxide is an effective acne fighter, but if the treatments you've tried are irritating your skin, a product with a lower concentration might work. Of course, you're trying to clear up your complexion and improve its appearance, so also avoid things that might irritate your skin, including abrasive soaps, scrubs, and cleansers; astringents and other products containing alcohol; oily cosmetics; sunlight; and tanning booths. Oh, and one other thing: Stop the picking and squeezing! That also makes things worse.