Americans take way too many medications. They mix and match with barely a second thought.
Researchers found that 81 percent of older adults took prescribed drugs. More than half “used 5 or more prescription medications, over-the-counter medications, or dietary supplements” (Journal of the American Medical Association, Dec. 24/31, 2008).
Some combinations are potentially dangerous, if not lethal. We often hear from readers of this column concerned about their relatives:
“My mother is 85 and under the care of an internist, a cardiologist and a neurologist. She has almost no energy and is quite depressed. She takes: Aldactone, atenolol, Crestor, Diovan, hydrochlorothiazide, Lexapro, Miacalcin, Neurontin, Nexium, Nitro-Dur, Norvasc, Plavix, Rhinocort, Synthroid and tramadol. In addition, she takes Aleve for arthritis pain and aspirin twice a day as needed.”
Counting the OTC pain relievers, this woman is taking 17 different drugs. Some combinations could be life threatening. Taking aspirin, Aleve and Plavix together could increase the risk of hemorrhage, including bleeding ulcers. Perhaps that is why the internist prescribed the acid-suppressing drug Nexium. The trouble is, Nexium and similar medicines may undo the vascular benefits of Plavix.
Aleve can increase drowsiness resulting from Neurontin and reduce the effectiveness of atenolol to lower blood pressure. There are other potential interactions, but the point is that three specialists each prescribed medicines that may not play well together.
This is not an isolated case. Many elderly people have several health conditions and see a range of experts.
Another woman was worried about her sister who is taking two antidepressants: Prozac (fluoxetine) and Zoloft (sertraline) plus a sleeping pill (Ambien). In addition, she takes Tegretol (carbamazepine), atenolol, Lipitor, Zantac and several more drugs for high blood pressure and diabetes. Is it any wonder that this woman is drowsy, weak, unsteady on her feet and has breathing problems?
One of the findings of the recent study is that older adults often add over-the-counter drugs and dietary supplements to their prescription medications. They might not realize that pain relievers like aspirin or Aleve can cause mischief with prescribed medications.
Some years ago we heard from a retired judge who took enalapril to control his blood pressure. It worked well until he started taking coated aspirin for back pain. Then his blood pressure soared to over 210/90.
Physicians and pharmacists are so busy these days that they may not take time to look up every possible drug interaction. That is why people have to look out for themselves and each other.
We include a Drug Safety Questionnaire in our Guide to Drugs and Older People. This can prompt a conversation about incompatible drug combinations with both the doctor and pharmacist.
