Older Americans Use Risky Drug Combinations
8 CommentsBy Ed Silverman // December 24th, 2008 // 11:24 pm
At least 2 million older Americans are taking a combo of drugs or supplements that can be a risky mix - from blood thinners and cholesterol pills to aspirin and ginkgo capsules - a new study warns. And among older men, the numbers are particularly alarming - one in 10 are taking potentially harmful combinations, the Associated Press writes.
The report showing just how many older people are using risky combinations comes from a study of nearly 3,000 interviews with people aged 57 to 85. The research, funded by the National Institutes of Health and University of Chicago, appears in the Journal of the American Medical Association (look here).
Ninety-one percent in this age group use at least one medication, often for heart disease and related problems. That translates to more than 50 million people, the AP writes. More than half use at least five remedies, including prescriptions, over-the-counter medicines or supplements.
Commonly used and risky combinations included:
- Aspirin taken with over-the-counter ginkgo supplements, increasing chances for excess bleeding;
- Lisinopril, a blood pressure drug, taken with potassium, which combined can cause abnormal heart rhythms. Potassium is often prescribed to restore low levels of this important mineral caused by certain blood pressure drugs.
- Prescription cholesterol drugs called statins taken with over-the-counter niacin, a type of vitamin B that also lowers cholesterol. This combination increases risks for muscle damage.
“Patients need to know that while medications are often beneficial, they’re not always safe,” Dima Qato, a University of Chicago pharmacist and lead author, tells the AP. “If they need to self-medicate with over-the-counter or dietary supplements, they should definitely consult with their physicians or pharmacists.”
The study relied on data from in-person interviews with 2,976 adults questioned about which medications they routinely used. The nationally representative survey was done between June 2005 and March 2006, and results were extrapolated to the general population.
The researchers assessed how many people routinely used at least two meds of any type known to have dangerous or even fatal interactions. The number totaled at least one in 25, corresponding to 2.2 million nationwide. Those interviewed weren’t asked if they’d ever had a bad reaction from taking those combinations. And the study didn’t assess whether patients were taking meds inappropriately.
Jerry Gurwitz, chief of the geriatric medicine division at University of Massachusetts Medical School, says taking multiple meds, despite possible bad interactions, isn’t necessarily a bad idea as long as patients are in close contact with their doctor.
“There are definitely many instances where if they’re monitored carefully and there’s good reason for using them, that they could be used safely,” Gurwitz, who wasn’t involved in the study, tells the AP. Prescription drugs were the most commonly used and nearly one-third used at least five prescription drugs.
Michael Cohen, a pharmacist and president of the Institute for Safe Medication Practices, says the study is an important snapshot of medication use in older Americans. But as someone who takes at least five medications himself, Cohen said the widespread prevalence isn’t surprising.
Cohen said his group recently launched a new web site that will allow consumers to enter names of their medications to check for any potentially dangerous interactions.
Source: Associated Press
Mike M
Thank you Ed, for following the horrible (but necessary) piece on a criminal pharmacist, with this example illustrating the profession’s contribution to the advancement of knowledge and the public’s health!
Mourning The Living
Warfarin or Coumadin with Aggrenox
If you think a stroke from a blockage is bad, try a bleed in the basal ganglia region (is it?). Loss of limb control to the extent of severe flailing. It is the most horrible thing I have ever witnesses and I saw it daily, for months, in my mother. Beating herself bloody broken and bruised. Shunned in a nursing home by other residents because she was knocking everything over and was considered to be too disruptive. Disliked by the CNAs because it was horrifying and exhausting to deal with. Frustrated and exhausted and crying and completely aware. Unable to participate in physical therapy to relearn to walk because she had no control of one leg or one hand needed to grasp a walker. It’s been nothing short of heartbreaking. I fed her all of her meals until she learned to pin down one leg by crossing the other over top of it. She finally learned to pin down one arm with the elbow of the other so she could attmpt to hold a sippie cup. On holding down the offending limbs the movement shifted to her hip and side.
Trust me when I tell you that there is no benefit to living life in that condition. I don’t say that lightly. She is my best friend. When it came down to being responsible for her medical decisions I cried for days after signing her DNR. Fought to allow her a mind by refusing Haldol when it started almost immediately to harm her hearing and speech. Requip did nothing and it was a rediculous attempt. She was finally given Valium so that she could get some rest until they gave it to her so often that she was doing nothing but sleeping. I had them stop that and worked with her until she can now get by with the help of constant care. That is one drug combination that should be made illegal.
Insider
I’m sorry mourning.
I think you’ve done a valuable service by describing this.
Unfortunately the consequences of the bleed you describe is also a side effect of certain neuropsych drugs (not due to bleeds) and I fear we will be seeing much more of it in the future.
Insider
pharmavet
I would guess that if you asked most physicians to name one drug metabolized by cytochrome p 4503A4 or 2D6, they would give you a blank stare. Most of the older ones went to medical school before the drug metabolizing phenotypes were worked out. For these doctors, I would respectfully suggest a refresher course in clinical pharmacology, learning the drugs commonly used by the various metabolic pathways and how they are influenced by age. This is easier than trying to memorize drug labels. This might help to reduce drug interactions. I’m pretty sure there are CME courses in this area.
Van
I’m going to go out on a limb here, this isn’t just older individuals. In a number of cases people will get away with something once but be unaware of the dangers so they continue on….
I know plenty of people in the range of 25 to 40 that take dangerous combos of drugs / substances. Simply because they are ignorant of what can happen.
Drinking and meds, aspirin with other meds… This is nothing new. Is it a problem, yes, but it’s nothing new.
V
http://vansantos.com
cdrillin
mourning- has your mother’s physician considered plavix instead of the aggrenox?
Garry RX
As always we have the scenario of a patient being place on medications which cause harmful interactions and someone saying, its OK because someone will follow them. HELLO !!! Who is this someone. Dr. are hard to reach and don’t respond in a timely fashion to calls from nursing homes or to patients. Where does the patient or family turn to. HELLO AGAIN… it is quite often the pharmacist who is asked to sort out the problem or to ” suggest” alternatives. In a lot of cases the community pharmacist is not compensated for time spent reviewing inappropriate therapy and trying to put together an case to convince the physician their are potential problems. Most institutions will not allow documentation on the chart such as ‘ Physician advise of harmful side effects or drug interactions’ This is an open invitation to the legal profession to take action. It seems this is the only way to establish a deterent to bad practice.
Mourning The Living
Her doctor has never suggested Plavix. I am afraid to suggest a change now. Every drug they gave her took something away. Nothing but time and hard work gave anything back. She is still on Aggrenox but no longer on Coumadin. I forgot to mention Dopamine and a few other things which will not come to me, that also didn’t work to relieve the violent movement.
Wish I had taped and YouTubed it if what insider says is true. Anyone taking something that could cause the same reaction would stop medicating after ten minutes with mom at her worst. The CNAs would scowl at her like she hit them on purpose even though she had no control of her arm. It takes a special kind of personality to do that job but that is another story.
And you sadly wonder
does the nurse treat your old man
the way she should.
She made you tea,
asked for your autograph
what a laugh.
[Jethro Tull]