Bad Taste Makes Patients Avoid Drugs.

• Position: Brief Article

The innate desire to taste food and derive pleasure from that sensation is so strong that people sometimes stop taking life-saving medication simply because it tastes bad or ruins the flavor of otherwise enjoyable foods, according to psychologists Susan Schiffman and Jennifer Zervakis, Duke University, Durham, N.C. A series of studies analyzing the taste effects of certain medications found that specific drugs used to treat AIDS, heart disease, and depression either had a foul taste or significantly distorted the flavor of foods, which accounts for why some patients fail to take medications as recommended.

Just a short lapse in taking a prescribed medication can have a dramatic health consequence for some patients, Schiffman emphasizes, enabling the human immunodeficiency virus (HIV) to reach dangerously high levels or to build resistance against drugs used to fight it, for example. In one extreme case, a patient of Schiffman's found his AIDS medications so bitter and unpalatable that he refused to take them and consequently died.

"Distortions in taste and smell are far more than a nuisance, especially for patients whose conditions necessitate proper nutrition and a tightly controlled medication regimen," she points out. "Patients with sensory distortions can suffer from malnutrition, accidental poisonings, and chronic diseases like hypertension and diabetes that require the ability to taste, and thus regulate, salt or sugar intake"

Schiffman and Zervakis examined the taste impact of 63 different medications by applying them topically to the tongue's surface, a process that mimics how the drug is secreted in the saliva, but does not allow it to enter the bloodstream. Among the drugs analyzed were protease inhibitors and nucleoside analogs, two commonly prescribed classes of drugs used to reduce HIV loads and stave off the onset of AIDS symptoms. Three of the protease inhibitors--indinavir, ritonavir, and saquinavir--were described by subjects as bitter, medicinal, metallic, astringent, sour, and burning. All of the nucleoside analogs--didanosine, lamivudine, zidovudine, and stavudine--were cited as having the same unpleasant tastes. Patients with HIV (but not taking medications) perceived the drugs as being more bitter than did subjects without HIV, suggesting that the disease process itself altered taste perception to some degree.

While unpleasant physical side effects are a common excuse that patients cite for halting their medications...