Prescription Drug Interactions Are Killing Our Seniors
Since I am a retired pharmacist, many of my customers make appointments with me to discuss their prescribed medications, how they interact with each other and how they interact with supplements and foods. Although there are some very rare marginal interactions between grapefruit and statin drugs, licorice and digoxin and St.John’s Wort with Coumadin, 99% of the serious drug reactions are between the drugs prescribed by physicians.
Last year in Canada 3300 seniors over the age of 65 died from drugs prescribed for them that interacted with medications they were already taking. Almost 200,000 patients were hospitalized in Canada due to drug reactions that could have been avoided and the extra cost to taxpayers to stabilize these patients and allow them to recover from the drugs cost us almost one billion dollars in 2006. Among senior citizens 75% of all Canadians over the age of 65 averaged 4 prescriptions a day in 2006; the average 75 year old swallowed eight different prescriptions drugs each day. People over 65 were more than twice as likely to be admitted to emergency than those under 65 and seven times more likely to be hospitalized due to unintentional doses and toxic drug reactions between prescription drugs.
Most interactions occur when a patient who was getting medication from a family practitioner is treated by a specialist and prescribed other drugs. Less than 40% of the doctors communicate with each other and none of the doctors in private practice use any type of computer program that could keep track of a patient’s medications. All your information is scribbled on paper files stacked to the ceiling in various physicians’ offices. If you go to more than one pharmacy there is no communication between the different pharmacies with regard to drug interactions. Of course if you are a senior and get your sleeping pills at one pharmacy and then get a second prescription that month for that same drug and take it to another pharmacy, the second pharmacy will have the claim rejected and this saves the government money. But if you were prescribed a different sleeping pill, the computer would miss it entirely and you could die from an overdose. If you get all your prescriptions at the same pharmacy, the computer will warn the pharmacist about any possible drug interactions. The problem with this computer program is that it alerts so many trivial and meaningless interactions; the pharmacist is constantly overriding the program and may miss a very serious drug interaction.
Prescription Drugs That Commonly Cause Interactions
Although I cannot list every possible side-effect and interaction, the following is a list of drugs that are among the worst offenders and a list of some of the substances that can cause serious problems when taken with these drugs.
This drug also known as warfarin sodium or in some circles as “rat poison” is usually prescribed for people who have had a heart attack, stroke or recent surgery to prevent the blood from clotting. This is one of the most difficult drugs for your liver to detoxify and as a result it causes all other drugs taken with it to act in your body longer than they should. If you look up the pharmacology of this drug, it is contraindicated with almost every other drug. It is contraindicated with other blood thinners and yet physicians prescribe Aspirin and Plavix to be taken with Coumadin. It causes drugs for cholesterol and blood pressure to stay in your blood stream longer because they have to wait while your liver detoxifies the Coumadin. This can cause low blood pressure leading to fainting and serious falls and horrible muscle pain caused by an overdose of cholesterol lowering drugs. If you take acetaminophen or alcohol or both with your coumadin, you may develop liver disease. Thousands of patients who were prescribed the antibiotic erythromycin while they were taking coumadin died because both drugs were so difficult to detoxify the liver shut down and stopped. The antifungal drug Lamisil used to treat fungal infections of the nails may very easily cause the death of a patient on Coumadin. In fact, no drug can be safely taken with Coumadin but if you ask your doctor, in most cases he will insist you take it for the rest of your life. And, by the way, do not worry about the drug interactions but avoid leafy green vegetables because they contain vitamin K which may interfere with the activity of Coumadin.
Cholesterol Lowering Drugs Atorvastatin (Lipitor) Pravastatin (Pravachol) Rosuvastatin (Crestor), Lovastatin (Mevacor) Simvastatin (Zocor)
All of these drugs block cholesterol production in your liver. The most common side-effect is muscle pain but this pain is caused by a breakdown of the fibers that form the muscle, a condition known as Rhabdomyolysis. Hundreds of people taking Amiodorone (a blood pressure-lowering drug) along with cholesterol-lowering drugs died from this interaction in which their muscles virtually fell apart including their heart muscle. If you are taking Synthroid or Levothyroxin for an underactive thyroid gland, you may need a higher dose if you are taking any of the statins because cholesterol-lowering statins reduce the activity of your thyroid medications. Just like Coumadin, Erythromycin and Lamisil when taken with statin drugs can cause the muscle deteriorating condition known as Rhabdomyolysis. Many people who take digoxin for their heart will also be prescribed statin drugs but the digoxin levels could go so high they might become toxic. Statin drugs that lower cholesterol also interfere with your liver’s ability to produce coenzyme Q10 and reduce the output by almost 50%. This is the most important antioxidant produced naturally in our bodies and anyone taking statin drugs must take a Co Q10 supplement to prevent premature aging and dementia. The most recent medical study published in the British Medical Journal “The Lancet” showed that cholesterol-lowering statins taken for a five year period reduced the risk of having a heart attack or stroke by ONLY 1.5%. If you measure benefits versus risks, the answer is simply to stop taking the statin drug.
Blood Pressure Lowering Drugs
Most people who have had an incident with high blood pressure or a heart attack or stroke are usually prescribed up to 5 different drugs to lower their blood pressure. A beta blocker, a calcium channel blocker, an Ace inhibitor and possible two diuretics, furosemide and hydrochlorothiazide. These drugs can lower your blood pressure so much that you could faint, hit your head and die from a brain injury. In males they lower blood pressure so much they are the number one cause of erectile dysfunction and if you are a male with prostate problems, you will be prescribed an alpha blocker to shrink the size of the prostate. The main side effect is a severe lowering of your blood pressure and if you are taking other blood pressure medication you could lose consciousness. What if that happened while you were driving?
Since all of these drugs are detoxified in your liver, they are contraindicated with other drugs such as coumadin, cholesterol lowering drugs, alcohol and acetaminophen. Taking these drugs for life may not be a problem because the interaction could end your life very quickly. Losing 10 to 20 pounds along with a daily exercise regimen is sufficient to get most people totally off their blood pressure medication.
Antidepressants (Selective Serotonin Reuptake Inhibitors) SSRI’s Paxil, Zoloft, Effexor, Celexa, Lexapro and Luvox
Most of the physicians who prescribe these drugs know absolutely nothing about their highly addictive nature and their serious contraindications with other drugs. They should never be prescribed by a family physician, only by a highly trained psychiatrist and only if absolutely necessary. The two principle side-effects of these drugs are insomnia and sexual dysfunction. Not a good combination for a person who is already depressed. The second most common side-effect is suicide. That will certainly put an end to your depression. Of course these drugs interfere with other drugs such as drugs for anxiety like diazepam (Valium) clonazepam (rivotril), Lorazepam (Ativan) and Xanax (alprazolam). Combining any of these drugs with SSRI’s can produce a state of stupor and severe drowsiness which can easily be enhanced by even one glass of wine or beer. These drugs also raise digoxin levels in the heart patient and interact with all the above mentioned drugs such as Coumadin, statin drugs and drugs for high blood pressure. If these drugs are taken with aspirin, coumadin or non steroidal ant-inflammatory drugs, the result could be excessive internal bleeding. Prescription
Opiates Morphine, Codeine, Hydrocodone, Vicodin, Percocet, Percodan, Oxycontin
These drugs by themselves may cause stomach upset or bleeding. When combined with aspirin or NSAIDS the risk for internal bleeding becomes much greater. Besides relieving pain, the main side-effects are dizziness, imbalance and reduced coordination. If combined with tranquilizers such as lorazepam, SSRI’s like Paxil or even just alcohol the person may not be able to drive, walk or even crawl. High doses can cause liver damage but even low doses with other drugs that are hard on the liver can lead to very severe liver problems. If you are taking drugs that thin your blood and you develop internal bleeding, you could easily bleed to death. Narcotics are drugs that should only be taken for a very short time immediately following a traumatic event that caused severe pain. After that they must be stopped. Many people with rheumatoid arthritis and fibromyalgia are prescribed narcotics to alleviate their pain but have no idea of the dangers of taking this medication. These drugs are extremely addicting and it takes a great amount of strength to get off these drugs but it must be done.
Non-Steroidal Anti-Inflammatory (NSAID) drugs Naprosyn (naproxen) Motrin (ibuprofen) Voltaren (diclofenac)
These drugs by themselves may cause stomach ulcers and heavy bleeding. If combined with Aspirin or Coumadin or Plavix which thin the blood the result could be internal bleeding causing death. They block the daily effects of most hypertensive drugs if taken at the same time. That is why you take your blood pressure meds early in the morning and your NSAIDS later on after a meal. Not only can they upset your stomach but they can cause your esophagus to bleed out. Most physicians when confronted with these side-effects simply prescribe proton pump inhibitors like Losec, Nexium Prilosec or Prevacid which stops acid secretion. This whole class of drugs interferes with the absorption of most medications and forces the physician to prescribe even higher doses. They also interfere with your body’s ability to absorb calcium and the newest medical studies show that proton pump inhibitors are one of their main causes of osteoporosis because of this side-effect.
It would be virtually impossible for a patient to understand all the possible side-effects and interactions of drugs in their body. That is why it is absolutely imperative that our federal government insist that all physicians in private practice, in clinics and in hospitals be connected to a secure health network that would monitor the drugs and dose of every person in Canada taking prescription medication. If you were on vacation in Vancouver and developed a severe respiratory infection that resulted in a prescription for erythromycin, it would instantly be flagged in the computer because you were on coumadin. Physicians complain they do not want to spend the money to computerize their offices and join the government network. They should be allowed to deduct the cost as an office expense and that would not only save Canadian taxpayers about a billion dollars but it would also save over 3000 lives a year.