Modern medications are so powerful that they both save lives and endanger them. After age 50, just when people are most likely to take several medications prescribed by multiple health professionals who often don't communicate with each other, they become increasingly vulnerable to adverse drug reactions.
Reasons: Aging slows recovery...diminished liver and kidney functions result in altered metabolism and excretion.
Also: Reapportionment of fat and lean body tissue changes drug distribution.
Surprising: The drugs most commonly implicated in adverse drug reactions are time-honored medications prescribed for chronic conditions.
Examples: Diuretics (water pills), such as hydrochlorothiazide and furosemide (Lasix), to reduce fluid retention and blood pressure... oral anticoagulants (blood thinners), such as warfarin (Coumadin), to limit clotting after a heart attack or stroke.
DANGEROUS INTERACTIONS
An often-quoted study published in the Journal of the American Medical Association found that in the US, more than 2.2 million people a year have serious adverse reactions to prescribed drugs and 100,000 of them die, making drug interactions one of the leading causes of hospitalization and death. Watch out for these...
- Drug-food interactions. Some labels say, "Take with food." Which food? Grapefruit juice often triggers a drug-food interaction that may be good (helps the body absorb certain AIDS drugs) or bad (deactivates some blood pressure drugs and cholesterol-lowering drugs). Oat bran also can make blood pressure medication less effective.
Solution: Ask your doctor or pharmacist which foods might affect the actions of your medications and how.
Although taking drugs with a meal may reduce stomach upset, food may delay the drug's absorption, alter its characteristics or make its actions less predictable. Speak up—ask whether this applies to any medication you take.
Reduced body mass and increased fat make older people more sensitive to alcohol, which interacts with many commonly prescribed drugs and many commonly prescribed sleep aids, such as sedatives and hypnotics.
Danger: Alcohol is a major ingredient in many liquid medications, especially cough syrup.
- Drug-drug interactions. Prescription drugs known for interacting with other drugs include cholesterol-lowering statins, such as atorvastatin (Lipitor and pravastatin (Pravachol), and blood pressure-lowering antihypertensives, such as furosemide, propranolol (Inderal) and clonidine (Catapres).
Self-defense: Find out which potential interactions apply to each medication you take now...and whenever a new one is prescribed, ask your doctor and/or pharmacist which drugs or foods not to take with it. Perhaps just separating the food and the drug by two or three hours would be safer.
Over-the-counter (OTC) drugs can wreak as much havoc as prescription drugs.
Examples: Antacids, antihistamines and heavy use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin). According to an estimate by James Fries, MD, of the Stanford University School of Medicine, NSAID-induced gastrointestinal bleeding sends about 76,000 Americans to the hospital each year...and kills about 10% of them.
Antacids (Milk of Magnesia, Tums, Amphojel) can reduce the effectiveness of antibiotics, such as tetracycline and ciprofloxacin (Cipro)...antihypertensive drugs, such as propranolol and captopril (Capoten)...and heartburn drugs, such as ranitidine (Zantac) and famotidine (Pepcid AC). But antacids can also increase the potency of valproic acid (Depakote/Depakene), for seizures and bipolar disorder...sulfonylurea (Glucotrol), for diabetes...quinidine (Quin-Release), for arrhythmias...and levodopa, for Parkinson's disease.
The older (first-generation) antihistamines, taken widely for allergies, colds and flu, can have dangerous interactions when taken with other drugs that cause drowsiness, such as antidepressants, alcohol, pain relievers, muscle relaxants and medications for seizures or anxiety.
Examples: Brompheniramine (in Robitussin Allergy & Cough) and doxylamine (in NyQuil). The examples listed above are drops in the bucket. Check your own medications.
PERILOUS FALSE ALARM
Some drugs can drain certain vitamins from the body. If these vitamins aren't replaced, resulting symptoms may mimic those of dementia or other age-related conditions.
Examples: Tuberculosis drugs can deplete vitamin B-6, leading to amnesia, and vitamin-B complex, leading to apparent senility. Seizure drugs (anticonvulsants) can deplete vitamin D, leading to hearing and walking problems and general weakness. An older person displaying characteristics that are associated with dementia may just have an easily corrected vitamin deficiency.
MEDICATION ERRORS
More than 7,000 deaths in US hospitals were caused by medication errors in a single year, according to a maior report published by the Institute of Medicine.
As it happens, the drugs found by the United States Pharmacopoeia* to be most frequently implicated in medication errors are commonly taken by seniors.
Examples: Insulin (for diabetes)...warfarin and heparin (to control clotting, such as in cardiovascular disease)...albuterol (Proventil, for asthma or bronchitis).
The Joint Commission asked hospitals to start providing every hospital patient with a list of all his/her prescribed medications and instructions for taking new ones. Patients, the Joint Commission said, should be encouraged to show the list to everyone providing care in the hospital, atany follow-up facility and after going home.
Have an advocate—a family member or friend—with you when you're in the hospital. Anyone hospitalized in my family is attended by a relative night and day.
Potentially fatal danger: Poor communication about meds when a patient is moved, such as from a critical-care unit to a general medical unit or from one health-care facility to another...or when nurses or other caregivers change shifts.
Self-defense: If you don't get a list from the hospital, maintain and hand out a list of your own. A free form is available online from The Joint Commission at www.jointcommission.org.
*The nonprofit public standards—setting authority for prescription and OTC medicines, dietary supplements and other health-care products made and sold in the US.
Also, question every drug you're given by anyone, anywhere, anytime.
For the most expert care, find a geriatrician—a physician specializing in seniors' medical needs. Medication needs differ as we age.
Example: A child's dose of digoxin (Digitek), used for congestive heart failure and other cardiac conditions, may be sufficient after age 65.
MEDICATION STRATEGIES
- Brown-bag it. You'll get your doctor's appreciation and attention by bringing in a bag containing every drug you currently take. Include prescription and over-the-counter drugs, vitamins, herbal supplements and nutritional supplements (such as chondroitin for joint pain). Go through the bag together.
Once you've agreed on which ones, if any, to change or drop, make a list of the ones remaining. Include the drug name, dose (amount and interval) and the name, specialty and phone number of the health professional who prescribed it. With every change, update the file.
- Tell the world. Post your master list on your refrigerator in case of a medical emergency at home. Keep a copy in your wallet near your driver's license. Give a copy to all your healthcare providers, including surgeons, anesthesiologists and dentists. If you go to the hospital, take several copies and give them to all your health-care providers, including every nurse who hands you a pill or adds meds to your IV line. Ask to have a copy placed in your file or clipped to your chart.
- Collaborate in your own care. Our health system has no good mechanism for coordinating medical care. It's your job to give all your health-care providers the full picture. Patients underestimate physicians' willingness to collaborate. Doctors are rushed, but they care. Ways to help yourself...
- If you suspect a possible interaction between drugs you're taking, either from symptoms or research, call the doctor immediately.
- Don't be afraid to raise concerns. You may be able to switch to a different drug that doesn't interact with your other meds.
- If you have trouble getting your doctor's attention, ask an office nurse to field medication-related questions.
- If your doctor is routinely unwilling to discuss your medications and to look up what he/she doesn't know, find one who will.
- Submit all prescriptions to the same pharmacy or chain. Typically, pharmacy computer systems automatically flag potential drug interactions. Ask your pharmacist.
EASY STEPS TO REMAIN SAFE
Prevention is far better than cure. Keep medication crises at bay proactively...
- Use your eyes. When you pick up a prescription, open and examine it on the spot.
Example: Coumadin, a brand-name product of the blood thinner warfarin, comes in nine doses. Is yours correct?
Before taking a new drug, read the side effects and interaction warnings in the patient information enclosure. Print too small? Tirpe the drug name into Google or another search engine to find the manufacturer's Web site.
- Don't take others' medications. Doctors determine the best drug and dose according to age, weight, medical conditions and other drugs taken. What works well for someone else, even with the same condition, might be dangerous for you.
- Drink lots of water. Aspirin's tiny flakes can lodge in the esophagus, causing inflammation. Acetaminophen (Tylenol) in high doses can cause liver damage. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Anaprox DS, Aleve), can cause ulcers. To reduce the risk, take pills with a large glass of water and drink several more glasses throughout the day.
- Economize, but wisely. Request a prescription for double the dose you need—a 10-milligram (mg) pill for a 5-mg dose, 20 mg for a 10-mg dose, etc. Cut each pill in half with an inexpensive pill cutter. You'll be taking the right amount at a lower cost per dose.
Warnings: Don't cut capsules or pills coated to prevent nausea or cut your prescription, taking half the prescribed dose, to save money. Ask an expert—your pharmacist will know whether your pills can safely be cut.
