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:
- Take a list of all your medicines to your appointment
- Make sure someone actually checks for a deadly drug combination
- Find out how to take your medicine
- Check about whether any foods or beverages should be avoided
- Ask your doctor to check for interactions
- Ask your pharmacist to check for interactions
- Inquire about over-counter drugs
- Go to the Web to check on interactions yourself
- Beware drug-alcohol interactions
- Inquire about drug-disease interactions
- 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.