Tompkins Weekly

Multiple medications raise risk of adverse drug reactions



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Carlynn Smith-Thomas is the system director of pharmacy at Cayuga Health, which includes the Cayuga Medical Center and Schuyler Hospital. Photo provided.

Patients are increasing their risk for adverse drug reactions by taking a growing number of prescription medicines, over-the-counter drugs and nutritional supplements.

While adverse drug reactions pose a threat to anyone taking a medication, the problem is a particular concern for seniors. Nearly half of adults 65 and older take five or more medications each week. That puts seniors at the greatest risk of polypharmacy from taking multiple prescription drugs to manage health issues such as diabetes and hypertension.

Add non-prescription drugs to the daily doses of medications, and the chance of an adverse drug reaction increases. Acetaminophen, ibuprofen and aspirin are among the most often used over-the-counter drugs. Generally, the more drugs a person takes, the greater the risk of adverse reactions and drug interactions.

Reducing the risk of adverse reactions requires patients to be involved in their health care, particularly if several physicians are managing treatments for different illnesses. If your physician prescribes a medication, be sure you know the name of the drug, why it has been prescribed, what side effects it may have and how the medication may interact with other drugs and supplements you are taking.

What drug categories pose the greatest risks?

The drug categories frequently involved in adverse reactions are anticoagulants, cardiovascular agents, antibiotics, diuretics, hypoglycemics, steroids, opioids, anticholinergics, benzodiazepines and nonsteroidal anti-inflammatory drugs. These categories include some of the most frequently prescribed drugs in the U.S.

Why do seniors face the highest risks of drug interactions?

Older people react differently to medications than younger people. Aging alters body fat and water composition. These changes can alter therapeutic drug levels, causing greater concentrations of water-soluble drugs and longer half-lives of fat-soluble drugs. Compared to the general population, older people are more likely to have several chronic disorders, each requiring at least one medication and increasing the possibility of an adverse reaction.

How can I reduce the risk of an adverse drug reaction?

Whenever possible, use one pharmacy for all your prescriptions. Pharmacies keep track of what prescription drugs you are taking and can spot the potential for an adverse reaction and then work with your physicians for alternatives. Always read the labels on drugs and supplements. They may tip you off to drug interactions. Never take a new drug without asking your pharmacist about its side effects and interactions with other drugs.

Do you have a current medications list?

Make a list of all medications, including generic and brand names, dosages, dosing frequency and reason for taking the drug and the names of your current medical care providers. Take a copy of the list every time you visit your health care providers so they can include it with your medical records.

Many pharmacies offer wallet cards for keeping a current list of medications with you. Ask your primary caregiver or pharmacist to run your medication list through a drug interactions database to identify potential problems, especially if you’re on five or more drugs.

Can nutritional supplements pose risks?

Some supplements can have serious interactions. Many people take Ginkgo biloba hoping to improve memory and take Kava-kava to reduce anxiety. Ginkgo biloba can cause bleeding in patients taking prescription blood thinners like warfarin, or the familiar brand name Coumadin. Kava-kava can cause liver failure and severe liver disease when taken regularly by patients with preexisting liver disease. It is important to notify all your health care providers of the supplements you take.

What about vitamins?

Patients may face some risk of adverse drug interactions from vitamins, although the dangers are much less than posed by prescription medications.

High-potency vitamins sold at pharmacies, online suppliers and supermarkets can cause toxic levels of that individual vitamin that lead to side effects.

For instance, kidney stones can occur from taking high potency vitamin C at doses that are 10 to 25 times the recommended dietary allowance. Vitamins may also pose a risk for patients with some conditions such as inadequate liver or kidney function. Include any vitamins you take on the medication list you give to every health care provider.

Carlynn Smith-Thomas is the system director of pharmacy at Cayuga Health, which includes the Cayuga Medical Center and Schuyler Hospital. She is a registered pharmacist with a master’s in healthcare administration and has worked at Cayuga Medical Center since 2002.

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