A Double Latte and Advil to Go? Not If You’re Working Out

You had a little too much to drink last night, so you really need that morning jog to clear your head. But first, you pop two aspirin for your headache plus a decongestant for your allergies, then wash it all down with a double espresso.

Fifteen minutes into your jog, your heart starts doing the mambo. You check with a doctor and discover that the irregular heartbeat was likely triggered by excessive use of stimulants.

“People tend to be very lackadaisical about all the different chemicals they put into their body at the same time,” says Daniel Albrant, a spokesman for the American Pharmaceutical Assn. who heads Pharmacy Dynamics, an Arlington, Va., health-care consulting firm. “And they often think, mistakenly, that any drug they can pick up at the convenience store is harmless.”

In reality, a wide variety of commonly used drugs--including prescription, over-the-counter and herbal products--can affect the body’s response to exercise and potentially increase the risk of injury.

Although most people know that the caffeine in coffee, colas and some aspirin is a stimulant, many don’t realize that cold medications, diet pills, allergy remedies and herbal teas also may contain compounds that can elevate the heart rate. For most people, taking any one of these stimulants in a normal dose probably wouldn’t cause a problem. But throw a few on board, then add exercise (also a stimulant), “and it’s not surprising,” Albrant says, “that worrisome things can happen, especially if you’re dehydrated” from drinking too much the night before.

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Some drugs may hurt performance by impairing coordination and judgment, causing drowsiness or accelerating dehydration. Others may enhance performance, although often at some health risk. That’s why the International Olympic Committee has banned the use of certain stimulants, pain relievers, steroids, diuretics and hormones. Prohibited products include many popular over-the-counter preparations such as Actifed, Sudafed, Dexatrim, Metabolife, Midol, Alka-Seltzer Plus, Vicks Inhaler and herbal teas with ma huang (herbal ephedrine). Most of these drugs have acceptable alternatives.

Furthermore, a class of antibiotics called fluoroquinolones has recently attracted the attention of sports medicine experts because it has been linked to serious tendon injuries, often in the Achilles, shoulder joint or hand. Tendon problems are increasingly being reported while the most commonly prescribed fluoroquinolone--a drug known as Cipro--has become a popular remedy for a variety of infections including those in the skin, upper respiratory system and urinary tract.

“Cipro is a great drug, but I generally will not use it in an athlete,” says Riley Williams, an orthopedic surgeon at the Weill College of Medicine at Cornell University in New York.

In a recent study, Williams incubated human musculoskeletal cells with differing strengths of Cipro and found that the cells made destructive enzymes in response to the drug. Higher doses had more severe effects, according to the study, which will be published in the May-June issue of the American Journal of Sports Medicine.

“In most cases, there’s a [preliminary symptom], which usually is a slight twinge of pain or soreness that occurs during or after activity,” Williams says. “It’s common for athletes to try to work through this sort of thing, but if they do that while they’re on this drug, they’ll get into trouble.”

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The U.S. Food and Drug Administration recently updated labeling for fluoroquinolones to include a warning about the possibility of tendon rupture, and to recommend stopping the drug and refraining from exercise at the first sign of tendon pain or inflammation. Yet many doctors aren’t aware of this advice, notes Williams, who says exercisers at greatest risk are those who do high-impact activities, heavy weightlifting, or sports involving jumping and rapid acceleration and deceleration.

Athletes can also run into trouble by ignoring usage directions for medication. For example, it was reported last month that hockey star Eric Lindros made the migraine headaches he was experiencing after a concussion worse by taking up to 18 over-the-counter ibuprofen pills a day, three times the maximum recommended dosage on the label.

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Touted in ads featuring older athletes such as baseball’s Nolan Ryan and tennis great Jimmy Connors, ibuprofen and other nonsteroidal anti-inflammatory drugs are often overused by aging exercise enthusiasts, says Carol Newman, editor of the American Running Assn.’s newsletter, Running & FitNews. “As baby boomers rage against age,” she says, “many think, ‘I can’t do my five-mile run unless I take an Advil with my coffee and toast.’ ”

There is some controversy over whether chronic overuse of these drugs can cause permanent damage to cartilage, she notes. However, Newman says most experts agree “that people should not be taking nonsteroidal anti-inflammatories to remain active through an injury.”

Exercisers who rely on these drugs to mask pain, “will buy themselves a bigger problem,” says Mark Chamberlain, a drug information specialist at the University of Maryland. Pain is the body’s signal that something is wrong, he notes, so trying to block it out may lead to serious injury.

Injury also can occur when exercisers take drowsiness-inducing medications, such as alcohol and many antihistamines, before activity, Chamberlain says. “These medications can decrease reaction time, balance and coordination,” he adds. “People taking them should avoid things like cycling or using mechanical equipment like a treadmill.”

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Each person reacts differently to the chemicals in medications, herbal products and beverages such as coffee and alcohol, say experts who offer this advice:

* Read labels carefully and follow directions. Discuss concerns with your doctor or pharmacist.

* Give your body a chance to tell you how it reacts to a new drug. Take it for a day and pay attention to its effects.

* Try another, similar compound if one medication has unpleasant side effects.

* Don’t think that because a product is labeled “natural” it’s harmless.

* Drink plenty of water, especially if you’re taking medications and even more if you’re exercising.

* Don’t become obsessed with exercise. If you’re sick enough to require medication, you may benefit more from rest.