A contraindication is when certain factors, such as age, pre-existing conditions or injuries, militate against a particular therapeutic or medical intervention. This medical term is derived from the Latin language of “contra” = “against” and “indicare” = indicate. The technical language also speaks of contraindication. If physicians ignore the presence of a contraindication, the patient may suffer a worsening of the existing pre-existing condition or damage to the organ system.
What is the contraindication?
A contraindication is when the treating physician recognizes that a condition, disease, or situation prohibits the use of therapeutic or medical interventions on the patient. A contraindication exists when the attending physician recognizes that a condition, disease, or situation prohibits the use of therapeutic or medical measures on the patient. In this case, the presence of the contraindication prevents the achievement of a positive treatment goal. In the case of an absolute contraindication, physicians are forced to forgo a planned intervention because of its negative impact on the patient’s health. In the presence of a relative contraindication, physicians perform the planned therapeutic measure if the expected benefit outweighs the feared health damage. Before starting this measure, physicians carefully assess the risk-benefit ratio. Pregnancy is an absolute contraindication in most cases, as the administration of many drugs and therapeutic measures must be refrained from during this period to prevent prenatal damage to the embryo.
Function, effect, and goals
There are many reasons for the presence of a contraindication. Some drugs act too strongly or too weakly under particular conditions. The well-known pain reliever acetylsalicylic acid can cause stomach upset as a possible side effect. In the vast majority of patients, taking this painkiller for a short period of time is harmless. In patients with gastric ulcers, gastritic symptoms may worsen. Gastric ulcers are therefore a contraindication for this agent. Some contraindications must be strictly adhered to (absolute contraindication), while others leave the medical profession room for maneuver (relative contraindication). An absolute case exists if the patient suffers such serious side effects from the medication that its use must be discouraged under all circumstances. When using acetylsalicylic acid, in addition to gastric ulcers, an abnormally increased blood tendency or the last third of a pregnancy (3rd trimester) are absolute contraindications. This is also the case in the event of an allergic shock reaction to the administration of penicillin. A patient who has once had an allergic reaction to the administration of this drug must not take it again. In the case of a relative indication, the physician decides individually in each case whether or not it is appropriate to administer the medication and whether the expected benefit is greater than the health risk associated with the indication. A relative contraindication to the administration of acetylsalicylic acid is the first and second trimesters of pregnancy (1st and 2nd trimesters), children and adolescents under 16 years of age, and bronchial asthma. Cardiologists successfully use beta-blockers in cases of coronary heart disease (angina pectoris) and hypertension. One side effect of beta blockers is bronchial muscle spasm. If a heart patient also suffers from asthma and is administered beta blockers, he or she is very likely to 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, on the other hand, the administration of beta-blockers is usually harmless (relative contraindication). Specialist information indicates these contraindications under the headings “Interactions with other medicinal products and other interactions”, “Special warnings”, “Precautions for use” and “Fertility, pregnancy and lactation”. Each drug contains a package insert that patients must read carefully before taking it. This applies in particular to over-the-counter preparations such as dietary supplements and other seemingly harmless medicines.The package insert lists all contraindications in the form of side effects and interactions with other medications. Users take these medicines and dietary supplements without medical advice. In case of uncertainty, it is necessary to seek medical expert advice from a doctor or pharmacist. Certain circumstances exist that are mistakenly thought to be contraindications. These “false contraindications” often occur in connection with the administration of vaccinations. Lay people are more afraid of the possible side effects than of the harm that may result from not treating existing disease symptoms. Long package inserts on medications listing possible side effects increase fear without naming the risk of non-treatment. Responsible medical professionals always weigh the risks of indicated therapy against the risks of not treating. Patients cannot conclusively assess contraindications and interactions of individual drugs. This knowledge belongs in the pharmacology part of medical school. Corresponding lists give physicians a comprehensive overview of contraindications and interactions. Before treatment, physicians inquire about intolerances, allergies and previous illnesses in order to rule out contraindications when prescribing medication and interactions. Pharmacists reconcile prescription medications via computer lists before issuing them to patients. This double-checking increases therapy safety.
Risks, side effects, and hazards
As people age, the risks associated with contraindications increase because, in many cases, older people suffer from multiple diseases at the same time for which they take different medications. With increasing age, organs such as the kidneys and liver break down the harmful substances of various drugs more slowly due to a slower metabolism. If patients take several medications at the same time for the typical symptoms of old age, such as heart failure, senile diabetes, high blood pressure and pain due to wear and tear, it becomes increasingly complicated for physicians to take this situation into account and to use all medications according to guidelines and as standard. Not only do contraindications in the form of interactions between the individual drugs complicate treatment, but also side effects that may require the use of additional drugs. Such a complicated situation, which is present in many elderly people, requires specialist and general practitioner examination. The ideal situation is when the patient and the physician have known each other for some time, in order to work out an optimal medication for the present complicated disease situation. In this way, the physician is able to assess which medication the patient may be able to do without. Furthermore, the risk is reduced by spreading out the time the medication is taken. The physician critically questions the usual guidelines for treatment and considers which medications are essential to prescribe and which are not.
