Posts Tagged drug interactions
Many patients take too many medications which leads to unnecessary side effects, drug interactions and high cost. Yet physicians sometimes fight just to get patients to take necessary medications. Two examples:
- Provider: How many medications are you taking?
Patient: Including vitamins I think fifteen.
Provider: What? I only have two medications on my list.
Patient: I restarted all the medications I was taking before you hospitalized me plus all the new prescriptions from when I left the hospital and I added some vitamins.
- Patient: I stopped that medication because I thought it was causing my hair to fall out.
Provider: Your heart medication does not cause hair to fall out. And, even if it did you could die without it.
The medications you take should be reviewed at each visit so you and the provider consider which are truly needed and why. The provider who gives the patient a prescription is responsible to make sure there is no interaction or duplication with ongoing treatment. Yes, that means cardiologists and dentists also. A proactive patient should simply ask, “Is that new medication compatible with all of my existing medications and does it replace one of the existing medications?”
The highest risk situation for evaluation of medications happens when alternate providers become involved. Like a hospital doctor, an ER doctor or a specialist. They tend to add medications without fully considering the existing medications, often thinking the primary provider will resolve any drug issues — too bad when a fill-in primary provider steps into the mix.
An article in the Washington Post January 28, 2017 by Dr. Ranit Mishori advises the following questions for providers and patients to consider together about medications:
● What is this medication, and why am I taking it?
● Are there non-pharmacologic options to treat this condition?
● How long do I need to be on it?
● What are the benefits of continuing to take it?
● What are the possible harms of using that medication?
● Do any of my medications interact with any another?
● Can I lower the doses of any of these medications?
● Which of my medications are more likely to be nonbeneficial considering my age, my other medical conditions and my life expectancy?
● Are there any medications I can get off completely?
The physician who does not carry a smart phone to look up drug side effects is a dinosaur soon to be extinct.
Drug side effects can be common, rare, severe or mild. But, the number of reported drug side effects is so large the human brain can not remember them all. When a patient has a symptom or abnormal lab finding it is imperative to answer the question “could it be the medication?” An additional step is to check for drug interactions between all the medications a patient takes — easy on a smart phone or computer.
Prescribers may recall the side effects that were listed when a drug first went on the market — but quietly pharmaceutical companies discover more side effects which are later added to the product literature in fine print.
Here are some real life examples:
- A patient who takes several blood pressure medications is hospitalized with another episode of abdominal pain due to pancreatitis. $10,000 worth of tests find no cause. The patient is sent home and told it must have been due to a gall stone that passed undetected. WRONG — it was due to the side effects of the blood pressure medications. Medications changed, problem solved.
- A patient takes a new oral anticoagulant and needs a heart procedure. The blood test shows a low platelet count. $10,000 worth of tests give no clue. A bone marrow biopsy is proposed. WRONG –The patient finds an internet site shows the new drug may cause a low platelet count. No bone marrow test is needed. Medication changed, problem solved.
- A patient gets sunburned easily and friends comment on a suntan even in the winter. The medical diagnosis: fair skin. WRONG — the blood pressure medication causes photosensitivity. Medication changed, problem solved.
No matter whether the drug side effect is rare or common, if it happens to you it is 100%. Pharmaceutical companies rate the frequency of certain side effects. Indeed, this is helpful to health care providers — they figure out a diagnosis by mentally sifting through possibilities based on likelihood. Right lower abdominal pain is most likely appendicitis but surgeons well know there are other causes.
From a patient standpoint sometimes it is enough just to know that a drug could possibly be the cause of symptoms. If those symptoms start right after a drug was prescribed it does not take a rocket surgeon to figure out the problem.
Drug side effects are not behind every symptom. Such thinking could be very dangerous. To hesitate to see a doctor about chest pain because it could just be a drug side effect would be crazy. Also, there are unavoidable side effects — you might not like the side effects of a medication but sometimes there is no alternative (like medications to prevent organ transplant rejection).
The proactive patient should always check for possible side effects of their medications and discuss the findings that match symptoms with a health care provider. Just searching the drug name and “side effects” almost always gets the list you need. Another source is patient reported side effects. Several web sites are available — this one is sometimes helpful eHealth.me