Posted August 14, 2008

Mixing meds: A recipe for disaster

When an 83-year-old woman was admitted to the hospital because she was falling down and feeling disoriented, a close look at her medications revealed the culprit to be polypharmacy. Polypharmacy, explains Patrick McDonnell, Pharm.D, of Temple University’s School of Pharmacy, means an individual is taking multiple drugs that have similar side effects or ingredients. Consequently, the side effects, such as sedation, are magnified. Oversedation can lead to respiratory arrest as in the case of actor Heath Ledger, who was taking six different medications at the time of his death. Or, a certain ingredient reaches a toxic level and causes complications, such as bleeding, or even death. The risk of such consequences is 5 percent when taking three drugs and shoots to 50 percent when taking six or more drugs.

Polypharmacy can be intentional or accidental. Some people, especially the elderly, see many different kinds of doctors, such as cardiologists, endocrinologists and psychiatrists, all of whom might prescribe medications without knowing what the patient is already taking. Other individuals might intentionally or unwittingly get their medications from several different pharmacies. So there’s no one healthcare professional overseeing all medications for potentially dangerous interactions. Pennsylvania has put in place a safeguard against polypharmacy dangers. The PDUR, or prospective drug utilization review, requires that all pharmacists obtain a complete medication history from all patients. “Pharmacists need to ask patients if they are going to more than one pharmacy for their medications and if they are taking any non-prescription drugs or folk remedies,” said McDonnell. Many consumers mistakenly assume all over-the-counter or non-prescription medications, which include herbal supplements, are safe and don’t need to be mentioned when a medication history is taken. In fact, non-prescription drugs can interact with prescription medications and must be accounted for in the medication mix. Anticholinergics (pronounced an-ti-koh-luh-nur-jiks) are a case in point. This class of drugs is used to treat a variety of conditions including depression, incontinence and nerve pain, and can cause drowsiness. A possible scenario, which can be dangerous, occurs when anticholinergics are combined with non-prescription drugs containing similar ingredients like Benadryl® or sleep aids. Another example is Coumadin, which is used to treat blood clotting disorders. A number of herbal medications could adversely interact with Coumadin and cause bleeding complications. Elderly most at risk Most at risk of polypharmacy harm are the elderly, who take an average of eight different medications at the same time.	Temple performs medication checkups On Aug. 12, pharmacists and students from Temple's School of Pharmacy performed medication checkups at Jeanes Hospital. They were looking for potential drug interactions that can result from polypharmacy — taking multiple medications simultaneously. The School of Pharmacy and Jeanes Hospital will offer another medication checkup at a Health and Wellness Fair on the grounds of Jeanes Hospital, 7600 Central Ave., Philadelphia, on Saturday, Oct. 4, from 10 a.m. to 2 p.m. For more information, call 215-728-3313. Photos by Ryan S. Brandenberg/Temple University Sister Paulette Elking, (right) a retired pharmacist, takes 34 different medications for asthma and osteoarthritis, among other ailments. She consulted with Melissa Ranieri, (left) Pharm.D, of Temple's School of Pharmacy, and Tung Vu, (right) a fourth-year pharmacy student, about polypharmacy risks, but reported no troubling side effects from her medications. After talking with Pat McDonnell, (right), Pharm.D, of Temple University's School of Pharmacy, Tung Vu (rear), and Eda Hoxha, (left), both fourth-year pharmacy students, Marianne Haug (foreground) learned that three of the six supplements she was taking were unnecessary, and that two of her medications, if combined, could be dangerous.

“As our bodies age, the functions that help metabolize and excrete drugs are diminished,” said McDonnell. “We also suffer decreased cognitive function and make inadvertent mistakes with our meds.” He recalls the case of an 87-year-old woman who was poisoned to death from combining too many aspirin products. She was using three aspirin products at higher than recommended dosages along with an aspirin containing cream rub. Sometimes drug addiction plays a role in polypharmacy. An individual taking multiple medications might go to different pharmacies to avoid being found out, or won’t be forthright about their medication history. “The goal and the wonder of drugs is how they help and cure disease but we have to realize that drugs are also foreign to our body,” said McDonnell. “There’s a fine line between a drug being effective and a drug being toxic.”

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