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Minimize Your Risk of Illness or Injury from Multiple Medications
Hospitalizations are increasing due to drug side effects and complications from taking the wrong medicine or dosage.
We take medications to lower our blood pressure, fight off infections and treat serious illnesses. But all too often, the medicines aimed at improving our health can put us in the hospital due to side effects, interactions with other medications, or other complications.
The medicines that send people to emergency departments most often include painkillers, antibiotics, tranquilizers and antidepressants, and corticosteroids and other hormones.
Internist Fran Ganz-Lord, Director of Patient Safety and Quality for Weill Cornell Internal Medical Associates, explains that, aside from cancer-fighting agents that often have expected side effects, the drugs that account for the most serious and unexpected harm to patients in Weill Cornell’s offices are blood thinners, steroids, insulin, antibiotics, and narcotics and other pain medications. Cholesterol-lowering statins and blood pressure medications are also commonly associated with side effects, though they usually don’t require hospitalization.
“Often, the harm is not just from the medication itself, but from combinations of medications or supplements,” Dr. Ganz-Lord says. “Patients often think that herbs or prescription medications are free from risk; this is not the case.”
Handling multiple medications
The challenges facing patients who take more than one medication can be daunting. The costs alone can be prohibitive, but making sure you take the right drug at the right time and ensuring that your medications don’t interact negatively also can prove difficult.
And since every medication, prescription or otherwise, carries its own side effects, the more drugs you take, the greater the odds of interactions between the medications, Dr. Ganz-Lord says. “Patients with multiple doctors and multiple medical problems can have doctors prescribing one medicine without knowing that another doctor has prescribed something that interacts,” she says.
It’s critical that every one of your doctors knows what medications and supplements you take, and that you are honest about whether you are taking them as prescribed. Dr. Ganz-Lord stresses that it’s important not to be embarrassed if you can’t afford a particular medication. Bringing information from your insurance company or a list of discounted medications from a local pharmacy can sometimes help doctors find a regimen that will keep your costs manageable.
And having one main doctor coordinate yourtotal medication regimen is advisable. But specialists, particularly those you see frequently, may need to be included in this effort.
“The best person to help set up a medication regimen is usually the internal medicine doctor,” Dr. Ganz-Lord says. “Patients who have a serious medical illness and see their specialist more than their internist should also do this with their specialist. For example, a patient being treated for cancer should go over their medications with their oncologist.”
Common interactions
Among the most common drug interactions patients must overcome are those involving proton pump inhibitors, which can increase the absorption of heart medications, such as digoxin (Digitek, Lanoxin), causing levels to increase, escalating the drug’s effect and potentially putting your heart’s health at risk, Dr. Ganz-Lord says. She adds that proton pump inhibitors also decrease the absorption of some antibiotics and anti-fungal medications.
Some antidepressants can also interact with painkillers, such as codeine, and decrease their ability to improve pain.
Medication interactions with certain foods can also send you to the emergency department. For example, grapefruit juice can interact with medications such as atorvastatin (Lipitor) and simvastatin (Zocor) and cause a toxic level of the cholesterol medication in the body. Antidepressants and steroids also react similarly with grapefruit juice. “Taking the medications at a different time of day will not stop this interaction,” Dr. Ganz-Lord says. “Grapefruit juice should be avoided altogether when patients are on these medications.”
Antibiotics such as quinolones (Floxin, Maxaquin) and tetracyclines (Ala-Tet, Sumycin) should not be taken with dairy or calcium-containing foods or supplements, as the calcium diminishes the body’s ability to absorb the antibiotic.Calcium can also reduce the absorption of thyroid medications such as levothyroxine (Synthroid).
