Senior Man, arms crossed, looks down at large assortment of prescription pill bottles, wrong medicines

Americans are swallowing more medications than ever before. A recent nationwide study showed that one in three older people take at least five different prescription drugs (JAMA Internal Medicine, April 1, 2016).

That doesn’t include over-the-counter medicines or dietary supplements: more than two-thirds of those between 62 and 85 years old take medications their doctors prescribed along with vitamins, minerals, herbs and a vast array of drugstore remedies for heartburn, arthritis, insomnia and other common ailments.

Russian Roulette with A Deadly Drug Combination?

Such mixing and matching represents a gigantic chemical experiment being played out inside the bodies of tens of millions of Americans. Nearly 15 percent of older people are taking a potentially dangerous combination of compounds, double the proportion from five years earlier.

When incompatible medications are taken together, the result can be terrifying. One reader narrowly escaped death:

“I take an ACE inhibitor for hypertension and was prescribed the antibiotic Bactrim for an infection. Within a week I was close to passing out from super low blood pressure. When I went to my doctor to report a bad reaction to the drug, I was literally told that Bactrim has no serious side effects.

“But an exam showed that my liver was failing, my kidneys were failing and I was suddenly diabetic. Luckily, I was then told to throw away the rest of the prescription. Within a week all the problems had disappeared.

“The interaction between Bactrim and common medicines like ACE inhibitors needs to be further highlighted. Those were severe failures.”

Antibiotic Plus Blood Pressure Drug = A Deadly Drug Combination!

Co-trimoxazole (Bactrim, Septra) interacts with dozens of blood pressure medicines (ACE inhibitors and ARBs) to raise potassium and increase the possibility of sudden death (BMJ, Oct. 30, 2014). This deadly drug combination is frequently ignored. Here are just a few ACE inhibitors or ARBs that could interact with co-trimoxazole to raise potassium levels into the danger zone:

Some Popular ACE Inhibitor Drugs

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Lisinopril (Prinivil, Zestril)
  • Quinapril (Accupril)
  • Ramipril (Altace)

Some Popular ARBs (Angiotensin Receptor Blockers)

  • Azilsartan (Edarbi)
  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

How Can Prescribers Miss A Deadly Drug Combination?

Why don’t doctors notice these looming catastrophes and ward them off? Part of the explanation is in the way medicine is practiced in the 21st century. While people may have a primary care provider, they also see a lot of specialized health professionals: a gastroenterologist for reflux, an internist for hypertension, a cardiologist for an irregular heart rhythm and a neurologist for migraines, for example.

Specialists live in silos and prescribe medicines for the particular problem they are treating. They may not pay much attention to other health issues and drugs. Although patients are often asked to fill out a questionnaire regarding all their medications, it is rare that anyone actually checks the list for incompatibility.

The other problem is that when doctors are notified of a possible drug interaction through their computers or electronic devices, they frequently ignore the warning. Researchers have found that this happens between 49 and 96 percent of the time (Journal of the American Medical Informatics Association, March-April, 2006).

“Alert Fatigue” Can Have Deadly Consequences:

Are you surprised? Shocked? What would happen if you ignored a red light signal and went speeding through intersections without paying heed to the admonition to stop? At best, you might get a ticket from a policeman. At worst, you could end up in a terrible accident.

Sadly, health professionals frequently override the warnings they receive when they prescribe a medication that could interact with something else a patient is taking. There is even an official name for this: “alert fatigue.” Prescribers get so many computerized warnings about drug interactions that they frequently override such notifications.

What Can Patients Do To Protect Themselves from A Deadly Drug Combination?

Because physicians and pharmacists are so busy these days, they often do not take time to double check for dangerous drug interactions. That means patients may need to do this for themselves. You will find information on this complex problem at this link.

Drug interaction checkers, such as MediGuard.org, can also be helpful. Always ask the prescriber and pharmacist about potential interactions with all the pills you are taking. In our chapter “Drug Interactions Can Be Deadly,” we also provide our “Top 11 Tips for Preventing Dangerous Drug Interactions.” Here are the highlights:

  1. Take a list of all your medicines to your appointment
  2. Make sure someone actually checks for a deadly drug combination
  3. Find out how to take your medicine
  4. Check about whether any foods or beverages should be avoided
  5. Ask your doctor to check for interactions
  6. Ask your pharmacist to check for interactions
  7. Inquire about over-counter drugs
  8. Go to the Web to check on interactions yourself
  9. Beware drug-alcohol interactions
  10. Inquire about drug-disease interactions
  11. Check for prescription drug effects on laboratory test results

To learn more about how to protect yourself or someone you love from a deadly drug combination check out our book, Top Screwups Doctors Make and How to Avoid Them for far more details about proactive steps you can take.

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  1. HelenM
    Modesto
    Reply

    Many conditions are self limiting; however, we are rarely told that when we present with something acute going on. What does happen is that we are given a script with three refills and told to come back in four months. Healthcare in this country is in terrible disarray where greed has become rampant. Doctors have several organizations, like the AMA, that have a lot of clout. Instead of always protecting and increasing income, their new thrust needs to be on either repairing the system, or building a new one. After all, isn’t the patient supposed to be the first consideration? Also, the artificial limitation on medical schools/students needs to stop. Either school costs need to be lowered or student loans need to be restructured. Or new schools created; something that should have happened a hundred years ago. And just why does a medical education cost so much? What are we really financing with the high tuition costs at a school like Harvard vs. a state university?

  2. Linda
    Aiken, SC
    Reply

    My husband is on Eliquis and I was told this week by his Doctor that he could take Motrin 400 mg for pain in his hand and arm. I gave him one dose then decided maybe I should check Drugs.com to see if there might be a problem as he is also on a number of other RX’s also. It came up as a major interaction that could possibly cause massive bleeding. I then talked to two pharmacists who said that was correct. They said he could take Tylenol instead. My Doctor doesn’t know this????

  3. Louise
    Texas
    Reply

    Every pharmacist we’ve ever had counsels us on our medication when it is prescribed, based on other drugs we take. When you read all the literature that comes with a drug, you dread taking it.

    Every person metabolizes drugs differently. One Tylenol handles common pain for me – not my grown children who take 2 or more.

    Doctors tend to treat everything with a prescription when they can’t fix a problem – rather than offer other suggestions. When I told my doctor I was very anxious about taking so many drugs, he prescribed a medication for that!

    You have to be your own advocate and find someone you trust to make decisions for you when you can’t. My husband is a pill popper and wouldn’t discourage that should I become too ill to decide. It’s a scary world.

  4. Michael
    Reply

    “Although patients are often asked to fill out a questionnaire regarding all their medications, it is rare that anyone actually checks the list for incompatibility” is a huge understatement. I keep a fairly detailed medical history, in spite of the medical industry’s efforts to keep all my data secret, and give it to health care providers when they ask me to fill out their patient questionnaire (which universally does not have enough room to answer all the questions asked). I’ve only seen one practitioner actually read it, and he treated it as a curiosity. Of greatest concern, perhaps, is my radiation exposure history — now fairly extensive. When I present for any such procedure, I’m always asked for my history but I have never seen it acknowledged.

  5. susan
    Chapel Hill, NC
    Reply

    Joe and Terry Graedons book, Top Screw ups Doctors Make and How to Avoid them is a great place to start. Next for me I got a phone app Drugs.com. This app list the drug reactions from mild to severe, also food reactions, and inter reactions with other medications, how to properly take a medication and the many different effects the medication can have. It was a real wake up call to me to be able to see that for myself and how much doctors and myself have ignored.
    I have taken many different medications over the years for hypertension, but after this awareness of so many possible dangerous other effects, I slowly got off pharmaceuticals and now take Hawthorn and Magnesium Citrate with very good blood pressure control.

  6. Steve
    Reply

    Thanks for doing this article. I work in Group Homes where many of the clients cannot complain about the effects drug interactions. So many of my consumers take mountains of pills. Their pharmacists and physicians almost never check for interactions.

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