Mixing meds

[Guest guest]

One

body, multiple drugs:

It can be a recipe for disaster.

Edith

Manley of San Leandro, Calif., is

exceedingly careful when she takes medications for her arthritis, and with good

reason. Nearly three years ago, Manley's 39-year-old daughter, ,

died unexpectedly during a visit to Manley's home. had back pain for

several years and occasional bouts of depression. Although her medical

conditions weren't fatal, the combination of medications she took for them

apparently was. " She was taking antidepressants for her depression and

painkillers for her back pain, " recalls Manley. " Her primary cause of

death was listed as an accidental drug overdose. "

Manley

and 's teenage son, Mike, still grieve. And Manley is determined to get

the word out: Mixing medications can be deadly, especially for people with

arthritis or older Americans, who often have more than one health condition

that requires medication.

Multiple Meds = Increased

Dangers

Gluck, MD, clinical professor of medicine at

the University of Arizona School of Medicine and director of the Arizona

Rheumatology Center in Phoenix, says the majority of his patients have several

diseases. In addition to a rheumatic disease, the most common diseases his

patients have are diabetes, hypertension or cardiovascular disease. Although

people of any age can have multiple health problems, the greatest risk is among

those 50 and older, he says. As people age, their propensity to develop other

health problems - and the likelihood that they are taking other medications -

increases.

A

recent study of adults in the United

States showed that more than 90 percent of

people 65 or older use at least one medication per week. More than 40 percent

use five or more medications, and 10 percent use 12 or more.

" It's

not unusual to see people with arthritis taking a dozen drugs. And if they're

taking that many, I can usually find three or four that have the potential to

interact, " says Don , professor and chairman of pharmacy practice in

the College of Pharmacy Practice at North Dakota State University and

pharmacotherapy specialist at Veterans Administration Hospital in Fargo.

Obviously,

the more drugs you need to take, the more likely you are to be taking two that

don't mix. But even if you are young, relatively healthy and just occasionally

take medications for other problems, such as a cold, headache or infection, you

could be at risk for medication reactions - if you and your doctor aren't

careful.

The Actions of Interactions

Bad interactions can occur not only

when you are taking more than one drug - and not just literally at the same

time - but also when you're taking medications as well as consuming alcohol or

supplements. says St. 's wort is one of the most common offenders. (See

" Stuck in the Dumps " ) And the more drugs and supplements you add

to your personal mix, the higher your risk of a dangerous effect climbs. Not

all interactions are so blatant or their potential consequences life

threatening. Nevertheless, if you want to get the greatest benefits of your

medication with the least possible risks, all interactions bear watching.

Taking

two or more medications can lead to a drug-drug interaction that can block the

effect of one of the drugs you're taking - meaning it becomes ineffective and

you don't get what you need - or it can cause too much of one drug to remain in

your system or essentially produce an overdose. For example, if you take allopurinol (Lopurin or Zyloprim) for gout and add the

immunosuppressive drug azathioprine (Imuran) to

treat severe rheumatoid arthritis (RA), the azathioprine

can further suppress your immune system, possibly putting you at risk of a

serious infection. And both aspirin and the blood-thinning drug warfarin (Coumadin) decrease your blood's ability to clot, so

if you're taking warfarin for cardiovascular disease

and aspirin to ease arthritis pain, you could be unwittingly setting yourself

up for a life-threatening bleeding episode.

Reducing the Risks

The FDA recently took an important step

toward reducing the risk of drug interactions and other medication errors -- at

least in hospitals -- by proposing a rule requiring bar codes on all medication

packages. The mandate would require bar codes to include the National Drug Code

(NDC), a system that contains the drug's name, dosage, form and strength. Bar

code readers in hospitals would ensure that patients were getting the actual

drug they were prescribed and could check for potential interactions between

prescribed medications.

The

FDA mandate is a step in the right direction, but the only way to completely

eliminate the risk of drug interactions is to completely eliminate your drugs -

hardly an option if you need medications to live and function. But there are

ways you and your doctor can minimize the risk.

What Your Doctor Can Do

Eliminate the unnecessary. Are you

still filling a prescription your doctor wrote five years ago? Have you even

forgotten what a particular medication is for? There's a chance you may no

longer need the medication or that there are newer or safer alternatives to it.

Taking outdated, unnecessary medications is a particular problem for elderly

patients. Ackerman, MD, professor of family medicine at Mercer

University School of Medicine in Macon, Ga., says that

some older patients accumulate medications over decades.

Adjust the timing. Some

medications interfere with others by keeping them from being absorbed in the

intestine. For example, antacids can interfere with the body's absorption of

tetracycline and some other antibiotics. In those cases, just

adjusting the timing a bit - taking one drug an hour or two after the other -

will alleviate the problem.

Change the dosage -- or the

drug. Sometimes two drugs interact to increase or decrease the

effectiveness of one another. " NSAIDs, for

example, can blunt the effects of drugs that treat high blood pressure,

sometimes making it necessary to increase the dosage of the blood pressure

medication, " says Dr. Gluck. If a drug increases

the effect of another, lowering the dose of one may help. In other cases, your

doctor can switch you to a different drug that provides the benefits of the

original drug without the interaction risk.

Monitor closely. In some

cases you need all of the drugs you are taking, even if they have the potential

to interact. When that happens, your doctor will need to monitor you closely,

usually through frequent, regular blood tests. Unless a problem is actually

detected, the risk of taking you off a medication -- or perhaps even changing

the dosage -- may be worse than the risk of interactions.

Add another medication. Although

this is usually the choice of last resort, doctors must sometimes prescribe a

third medication to help alleviate the problems that an interaction between two

other drugs is causing. For example, if you need both NSAIDs

and corticosteroids, yet taking them together causes stomach upset or increases

your risk of developing a stomach ulcer, your doctor may prescribe a third drug

such as cimetidine (Tagamet),

omeprazole (Prilosec) or lansoprazole (Prevacid) to ease

your stomach upset and reduce your ulcer risk.

Only

your doctor can make these changes, but there are several things you can do on

your own to make dangerous interactions less likely.

What You Can Do

Stick with one pharmacy. Choose one

pharmacy to get your prescriptions filled and stay with it. Most pharmacies

have computer programs that alert the pharmacist if another prescription(s) you

had filled at that pharmacy has the potential to react with your newest

prescription.

Brown bag

it. Once a year fill a bag with all of the medications and

supplements you are taking and have your pharmacist check them. The bag will

contain the information -- names of drugs, supplements and their dosages --

that your pharmacist needs to determine if drug interactions are likely.

Have one doctor coordinate

your care. Sometimes people end up taking unnecessary

medications or potentially dangerous combinations of medicines because multiple

doctors are prescribing them without being aware of what other doctors are

prescribing. If you have one doctor -- usually an internist or family physician

-- who coordinates your care and is aware of all the medications you take, he

or she can alert you to possible interactions.

Speak up. Every time

a doctor writes a new prescription, remind her of the supplements and medications

- prescription and nonprescription - you are already taking. " I use a Palm

Pilot to check the Physicians' Desk

Reference (, 2003) for potential drug interactions every

time I prescribe a new medication, " says Dr. Gluck.

Be mindful of potential

interactions. If two drugs you are taking have the potential to

interact, ask your doctor what symptoms you should watch for. Keep in mind that

interactions aren't always immediate, nor are they always evident. But knowing

what to watch for can help ensure you get medical attention (including a dosage

or medication change) if you need it.

Much

Love,

Deanna

LUPUS

Serenity Prayer...

Lord, grant me the

serenity to accept the things I cannot change, the courage to change the things

I can, and the wisdom to hide the bodies of doctors I shot when they said,

You're perfectly healthy, it's all in your head "