A study shows dangerous combinations of drugs are prescribed and dispensed. You need to know how to protect yourself.
A recent investigation by the Chicago Tribune warns of the danger of adverse drug reactions (ADR’s) from combinations of medicines, because doctors and pharmacists ignore warnings.
You, the patient, need to know how to avoid harm from these dangerous cocktails that doctors prescribe and pharmacists dispense.
Worrisome – But Easy To Do
After consulting two leading experts in the field of drug interactions, the Tribune sent reporters out to 255 pharmacies with prescriptions for combinations of medicines that could cause strokes, muscle damage, potentially lethal kidney and organ failure or unintended pregnancy.
Overall, 52 per cent of the time the medicine combination was dispensed without any mention of the potential interaction. In a breakdown, independent pharmacies fared worst with 72% failure rate. Next came CVS with 63%. Best was Walgreens with 30%.
You hope that your doctor is sufficiently well informed and alert to not prescribe such combinations, but I know from experience it’s all too easy to overlook adverse drug warnings.
In Managing Your Doctor I tell of how I got in to trouble when I overlooked a black box warning.
The difficulty of keeping up with ADRs and interactions and warnings was brought home for me when I had to give a deposition about a patient wanting to sue the manufacturer of Chantix, which he took to stop smoking and claimed it caused neuro-psychiatric problems.
It was a joke. This guy had been my patient for years, and his neuro-psychiatric status was a disaster long before the Chantix. He was the most noncompliant, recalcitrant, alcoholic, pot-smoking, curmudgeonly old bastards you are ever likely to meet. He looked like the Unabomber, with his wild hair and unkempt beard, and he apparently even took a swing at the judge at one of his many court appearances.
In the course of the deposition, I was forced to deny any knowledge of receiving a letter about the new black box warning Pfizer issued when after-market surveillance noted certain neuro-psychiatric side effects of Chantix. With great gusto, the patient’s attorney waved under my nose a copy of a receipt for the Dear Doctor letter with my signature on it.
My excuse for not remembering was simply that we get Dear Doctor letters every day, which is just one example of the problem of “overwarning,” which the Archives of Internal Medicine defines as an “exhaustive list of every reported adverse event, no matter how infrequent or minor.”
The Tribune report lays a lot of the blame on the pharmacy chains pressuring their stores to provide fast service, at the expense of being alert to ADR’s.
Much of the prescribing and dispensing of medicines is done using computers. A computer, with its infallible memory, immunity from fatigue or distraction, and ability to be fast and ever vigilant - unlike the befuddled brain of your time pressured doctor or pharmacist - should be the ideal safeguard. They have built in interaction alerts, that tell you about hazardous drug/drug interactions, as well as drug/ foods, and drug/supplement interactions.
But it’s like Aesop’s “wolf wolf” fable, computer programs are a classic example of overwarning.
About every prescription for someone on several drugs comes up with some kind of interaction alert. A lot of them not really serious. Things like “efficacy may be diminished if taken with grapefruit juice” when prescribing a statin for example.
So doctors get in the way of not really taking note and just hitting the “OK” button.
Given that the doctor are likely to prescribe, and pharmacist dispense these dangerous combo’s you need to be your own advocate and know the strategies to avoid ADL’s and dangerous combinations. You need to :
- Know your medicines – know the brand and the generic name - so you will spot when you get Actonel (generic name risedronate) instead of Actos (generic name pioglitazone) for example. Also know the dose, and what it’s for.
- Bring a list of all your medicines (including over-the-counter) and supplements. Or better still bring the actual bottles as these have all the information on them.
- Ask your doctor when he or she is prescribing if there are any adverse effect or interactions with medicines you are on – which may be enough to get their attention to realize they are prescribing a dangerous medicine or combination of medicines.
- If you go to multiple specialists they may not know what other medicines you are on, or what effects their medicines might have outside their field of expertise, so having a primary care doctor to act as “conductor of the orchestra” and provide an overview of all your medicines is a good idea.
- Also ask the pharmacist if there could be any bad interactions or ADR’s - don’t be afraid to use the consultation window may prompt them to realize they are making a snafu.
- Read the printout that is supplied with your prescription. Although these tend to be voluminous, and may seem to be another case of “overwarning” it can keep you safe.
- Finally, check for yourself by going to a site like Drugs.com and look up about ADR’s or interactions
One other point is that many people come to grief by not remembering whether they have taken a their medicine or not, so either “double dipping” and taking too much. Or miss a dose and don’t get enough. A pill dispenser with compartments for the medicines you take at different times of day is very helpful for avoiding this.