Many Older Americans Take Risky Drug Combos

Millions of older Americans use risky drug combos

from The Associated Press

CHICAGO December 24, 2008, 06:24 am ET · At least 2 million older Americans are taking a combination of drugs or supplements that can be a risky mix — from blood thinners and cholesterol pills to aspirin and ginkgo capsules — a new study warns.

Among older men, the numbers are particularly alarming — one in 10 are taking potentially harmful combinations, according to the study.

The results aren't always disastrous, but older people are more vulnerable to side effects and drug-to-drug interactions. And patients need to know that just because lots of medicines and supplements don't require prescriptions doesn't mean they're harmless. Nor are some of these safe to take when you're prescribed other medications.

Experts say the take-home advice is to ask about any side effects of prescription drugs, and tell your doctor before taking other medicines.

The report showing just how many older people are using risky combinations comes from a study of nearly 3,000 interviews with people aged 57 to 85. The research, funded by the National Institutes of Health and University of Chicago, appears in Wednesday's Journal of the American Medical Association.

It's well-known that as people age, their medication use goes up. But the study highlights the potential problems with some sobering statistics.

Ninety-one percent in this age group use at least one medication, often for heart disease and related problems. That translates to more than 50 million people. More than half use at least five remedies, including prescriptions, over-the-counter medicines or supplements.

Virtually every medicine can have side effects, and with so many being used by so many older adults, the potential for harm is high.

For example, warfarin, a potent prescription clot-fighting drug, was often taken with aspirin. Both increase the risk of bleeding, so the odds are even higher when both drugs are taken. The researchers said these risks also occur when warfarin is taken with garlic pills, which some studies have suggested can benefit the heart and help prevent blood clots.

Signs of bleeding problems include bruising easily, hard-to-stop bleeding from the gums or from cuts and blood in the urine.

Other commonly used and risky combinations included:

—Aspirin taken with over-the-counter ginkgo supplements, increasing chances for excess bleeding.

—Lisinopril, a blood pressure drug, taken with potassium, which combined can cause abnormal heart rhythms. Potassium is often prescribed to restore low levels of this important mineral caused by certain blood pressure drugs.

—Prescription cholesterol drugs called statins taken with over-the-counter niacin, a type of vitamin B that also lowers cholesterol. This combination increases risks for muscle damage.

"Patients need to know that while medications are often beneficial, they're not always safe," said lead author Dima Qato, a University of Chicago pharmacist. "If they need to self-medicate with over-the-counter or dietary supplements, they should definitely consult with their physicians or pharmacists."

The study relied on data from in-person interviews with 2,976 adults questioned about which medications they routinely used. The nationally representative survey was done between June 2005 and March 2006, and results were extrapolated to the general population.

The researchers assessed how many people routinely used at least two medications of any type known to have dangerous or even fatal interactions. The number totaled at least one in 25, corresponding to 2.2 million nationwide.

Those interviewed weren't asked if they'd ever had a bad reaction from taking those combinations. And the study didn't assess whether patients were taking medications inappropriately.

Dr. Jerry Gurwitz, chief of the geriatric medicine division at University of Massachusetts Medical School, said taking multiple medications, despite possible bad interactions, isn't necessarily a bad idea as long as patients are in close contact with their doctor.

"There are definitely many instances where if they're monitored carefully and there's good reason for using them, that they could be used safely," said Gurwitz, who wasn't involved in the study.

Prescription drugs were the most commonly used and nearly one-third used at least five prescription drugs.

Michael Cohen, a pharmacist and president of the Institute for Safe Medication Practices, called the study an important snapshot of medication use in older Americans. But as someone who takes at least five medications himself, Cohen said the widespread prevalence isn't surprising.

Cohen said his group recently launched a new Web site, http://www.consumermedsafety.org that will allow consumers to enter names of their medications to check for any potentially dangerous interactions.

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On the Net:

JAMA: http://jama.ama-assn.org

Institute for Safe Medication Practices: http://www.ismp.org


http://www.npr.org/templates/story/story.php?storyId=98676403

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And Then There Are Just Mistakes. Yikes!!

Sometimes the problem is not side effects, poor research, or slick marketing; sometimes simple but deadly mistakes are made in the hustle and bustle of hospital life. Here is an intro with link, to a piece from Forbes on Hospital Risks.

Duncan



Scariest Hospital Risks
Matthew Herper and Melanie Lindner 08.25.08, 4:15 PM ET

Hospitals manufacture miracles by the millions. They can also be hazardous to your health.

According to The Institute of Medicine, a non-profit organization chartered by the U.S. National Academy of Sciences, at least 1.5 million Americans fall prey to hospital error every year.

"Errors will happen anytime you take a complex system and put human beings inside of it," says Dr. Brent James, vice president of medical research and executive director of Salt Lake City's Intermountain Institute for Health Care Delivery Research. "The notion that you can train doctors to completely avoid mistakes is just false."

The mistakes aren't exactly minor, either. Between 40,000 and 100,000 people die every year because of shoddy handiwork, including surgical mishaps and drug mix-ups. One big problem: Hospital patients may get the wrong drug one time out of five, according to a study by Auburn University. The death toll from mistakes is at least as bad as that from car accidents or breast cancer, and maybe as bad as that from strokes.....follow the link for more



http://www.forbes.com/2008/08/25/hospital-risk-pneumonia-ent-manage-cx_mh_0825riskhospital_print.html

http://snipurl.com/3ke6b

Gives a Whole New Meaning to "Sex and Drugs"

Here's a story from Jim Edwards' blog NRx. He gives some facts and figures on how SSRI's are having a devastating effect on people's sex lives. We have been going through all these years thinking about how sex and drugs were connected in a positive correlation(more drugs, more sex) when all of a sudden they have an negative correlation(more drugs, less sex).

Not to worry though. Another story of the day is about how a research study shows that if women taking Paxil are experiencing a rotten sex life, the solution is to take Viagra. A wonderful deal for Pfizer which just happens to manufacture both drugs. Ain't chemistry wonderful!!! -Duncan

Worst Side Effect Ever: The 'Pleasureless Orgasm'
July 21, 2008


File this one under "Why isn't this on the front page?!" It's a natural audience-grabber that actually has some proper science behind it:

SSRI antidepressants — such as Paxil, Lexapro, Zoloft, Luvox and Prozac — have rates of "decreased libido, delayed orgasm, anorgasmia, erectile dysfunction, and difficulties with arousal, of between 36 and 70%," according to a new study.

First reported on the excellent (but badly named) psychiatry blog "Clinical Psychology and Psychiatry: A Closer Look," the study is a comprehensive review of sexual side effects triggered by selective serotonin re-uptake inhibitors. (That's happy pills, for us lay-folk.)

One of the worst side effects, seemingly designed by the devil himself, is the "pleasureless orgasm." The condition goes hand in hand with "genital anaesthesia" (meaning "can't feel anything," presumably).

Let's do a little math: According to Scientific American, close to 10% of Americans are on antidepressants. Let's make it easy and say that's 30 million of 300 million yanks. Of those, possibly 23 million are walking around in a state of sexual frustration. And they have partners — so that's somewhere in the neighborhood of a possible 46 million of us who are inexplicably tetchy and bad tempered on most days. (Yes, I know that some of them will be dating each other — but you can see my point.)

http://jimedwardsnrx.wordpress.com/2008/07/21/worst-side-effect-ever-the-pleasureless-orgasm/

http://snipurl.com/33a84