This is the first in a two-part series about prescription drug medicines. The second installment about antibiotic resistance is scheduled to run Jan. 19.

JOLIET – Timothy Baran wasn’t sure what was happening last December when he woke up with a sore mouth. It was particularly painful underneath his tongue, but his tongue itself, his cheeks and his palate also hurt.

The 25-year-old from Joliet previously experienced something similar – some mouth soreness and what he thought was a canker sore – but not as severe. He had thought at the time it was from a new toothbrush.

This time, however, things went to a different level. At first, it was soreness and a dry mouth. It progressed quickly throughout the day.

“It was like canker sores,” Baran said, “but at the same time, it was like I had burned myself and my skin was peeling away. ... I could hardly open my mouth.”

He had an odd rash on his torso that was a purplish color. By the end of the day, Baran was in the emergency room.

He had been taking the commonly prescribed medication Bactrim, which is a combination of the antibiotics sulfamethoxazole and trimethoprim.

After going to the hospital, Baran was taken off the drug, prescribed antihistamines, steroids and a liquid numbing agent for his mouth.

And he was diagnosed with Stevens-Johnson syndrome, which was confirmed two days later by his primary physician.

According to the U.S. National Library of Medicine, Stevens-Johnson syndrome, or toxic epidermal necrolysis, is a severe, life-threatening skin reaction most often triggered by medications.

The resulting skin damage can lead to a dangerous loss of fluids, overwhelming bacterial infections, shock and multiple organ failures. About 10 percent of people who have it die as a result.

Baran is lucky. A couple weeks later, he was back to normal.

“I feel very blessed,” Baran said. “I had a very, very mild case of it.”

Morris Hospital pharmacist Rebecca Capshaw said many people take prescription side effects with a grain of salt – but they shouldn’t.

“It’s very easy for us to make excuses for what’s going on,” Capshaw said. “Rashes could be absolutely nothing, but it takes the trained eye of a physician to know that. ... I’m shocked to see how often people wait to call their physician.”

Doctors and pharmacists normally warn patients of common side effects that new medications might cause, she said, but patients also should read the more comprehensive inserts pharmacists include with their prescriptions.

Capshaw said she doesn’t want to scare people about taking drugs, but they do need to be aware of when they are experiencing a dangerous reaction.

In particular, Capshaw advised patients to be aware of any difficulties in breathing, swelling in the mouth or throat, itching and hive-type rashes, which could indicate a dangerous anaphylactic allergy reaction.

Abnormal bleeding can indicate a problem with clotting, Capshaw said, which can lead to internal hemorrhaging or hemorrhagic strokes.

“See your doctor when you have any bleeding that doesn’t stop in seven to 10 minutes,” she said, “like a nosebleed. Or blood that is anywhere that it shouldn’t be.”

Serotonin syndrome resulting in tremors, vomiting, hallucinations, loss of coordination and a rapid heartbeat can be caused by reactions to antidepressants and other medications.

“The body temperature can become very high,” Capshaw said, “and the person can go into shock.”

Even achy muscles can be a symptom of a potentially severe reaction to some statin medications, she said, leading to rhabdomyolysis, or the breakdown of muscle cells. The resulting byproducts of the muscle breakdown can lead to renal failure.

Other medications, Capshaw said, such as Accutane, even can lead to suicidal thoughts. According to the U.S. National Library of Medicine, certain antibiotics, when combined with even small amounts of alcohol, can lead to severe side effects. Sometimes, physicians might not recognize that symptoms patients are having are from a drug reaction, Capshaw added.

They might prescribe an additional drug to treat the symptoms of the first drug, which is called a drug cascade.

Note to readers: Timothy Baran is the son of The Herald-News features editor Denise Baran-Unland.

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KNOW MORE

According to AARP, adverse drug effects send about 4.5 million Americans to their doctors or the emergency room each year. The organization suggests ways to avoid drug reactions, including:

• Tell your doctor if you experience a change that doesn’t feel right.

• Ask to be prescribed drugs that have been on the market for at least seven years.

• If taking several drugs, ask your doctor or pharmacist to review them.

• Ask if there are lifestyle changes you can make instead of taking a new drug.

• Ask your doctor what the risks and benefits are for new drugs.

• Don’t stop taking a drug without consulting your doctor.