Researchers have estimated that medications cause 17 million visits to emergency rooms and 8.7 million hospitalizations each year [Johnson, J.A. and Bootman,, J. L. “Drug-Related Morbidity and Mortality: A Cost-of-Illness Model.” Archives of Internal Medicine, 1995; 155:1949-1956.] It has been estimated that the drugs that are supposed to relieve our symptoms or cure us, may be responsible for as many as 300,000 deaths annually.
Given that medicines are one of the leading causes of death in America, it becomes imperative for physicians, pharmacists and patients to be aware of those drugs that are most likely to cause mischief. A new article in the New England Journal of Medicine [“Emergency Hospitalizations for Adverse Drug Events in Older Americans”] throws some light on this problem.
Dr. Daniel Budnitz and his colleagues at the Centers for Disease Control and Prevention (CDC) analyzed data from 58 hospitals that participated in an adverse drug-event surveillance project. The researchers were looking for medications that led to emergency hospitalizations. They found that blood thinners were especially problematic. Roughly one-third of all the admissions were from warfarin (Coumadin). Oral anti-platelet drugs (such as aspirin, clopidogrel [Plavix], dipyridamole, prasugrel [Effient], and ticlopidine [Ticlid]) added another 14%. Insulin and oral diabetes medications were also high on the list. Of course no one should ever stop a medication without discussing the ramifications with the prescriber. Sometimes a medication is so essential it has to be taken regardless of the risks. When that happens, though, it is essential to know the symptoms and side effects of problems and be extra vigilant so you can catch them before they lead to hospitalization.
High-risk drugs that should rarely, if ever, be prescribed to older people also contributed substantially to hospitalizations. It astonishes us that these drugs, found on a list called the “Beers-criteria of potentially inappropriate medications,” are prescribed at all to senior citizens. Sadly, many primary care physicians are unaware of the Beers list or problem drugs.
We have prepared a Top 10 List of Potentially Problematic Pills in our new book, Top Screwups Doctors Make and How to Avoid Them. Here is our list:
• Anti-inflammatory drugs (NSAIDs)
• Narcotic analgesics
• Atypical Antipsychotics
• Quinolone-type antibiotics
To learn which drugs are on the Beers list and for more details, brand names and a list of other problem pills, check out book, Top Screwups Doctors Make and How to Avoid Them.