Preventing adverse interactions from multiple medications

More than half of adults 65 and older take four or more prescription drugs, with some studies showing that more than 40% take five or more.

Keeping track of dosages, duration, and potential interactions adds another layer of complexity to managing multiple medications.

“It’s not easy getting old, especially with so many medical issues and specialists involved,” said Dr. Rajarajeswari Majety, medical director with the Franciscan PACE program. “Especially in this part of the state, we have so many hospital systems, so it’s very difficult to navigate, not only for seniors, but also for providers and practitioners.”

Researchers at the Harvard TH Chan School of Public Health in Boston found that while Medicare recipients see an average of two specialists, up to 30% see five or more doctors.

When specialists are spread across multiple hospital systems, it can be difficult to coordinate care and ensure all providers are informed about a patient’s complete medication regimen, said Whitney Lee, co-owner and pharmacy manager at Tinley Park Apothecary. .

“This happened to my mom when she was in New York and saw a specialist who gave her one medication, but her primary doctor prescribed another medication and the interaction caused her to almost pass out,” Lee said.

Filling prescriptions at pharmacies that are not in the same network can present the same problems.

“It’s easier if patients can go to practices within the same group so that their information is shared within the same medical system,” Lee said.

However, when patients seek specialty care or face insurance limitations, that’s not always possible, she says. This makes open communication crucial.

“No matter which doctor they go to, they should bring all their medications,” Lee said.

Nathan Damasius, pharmacist and owner of Vyto’s Pharmacy at Hammond and Highland, says taking multiple medications can be difficult when it comes to remembering when to take them and what conditions they address.

“Having two pills that look similar and mixing them up, or mixing a once-a-day pill with a twice-a-day pill is a risk,” Damasius said.

Adding a temporary drug to the mix can increase the risk of drug interactions, especially if the prescriptions come from different doctors, he said. For example, some antibiotics such as ciprofloxacin can cause bleeding more easily. So prescribing it to a patient on a medication to prevent blood clotting like warfarin can lead to complications.

“It’s important to fill all medications at a pharmacy,” Damasius said. “If a patient accesses other pharmacies, checks for drug interactions between medications may not occur. If an allergy is present, it can also be absent.â€

Research shows that the use of dietary supplements among older populations has increased over the years, with the US Centers for Disease Control and Prevention reporting that nearly 3 in 4 patients 60 and older take a dietary supplement.

Some supplements can change the way the body absorbs or metabolizes medications. Over-the-counter medications can also interact with prescription medications, Majety says.

“Always bring all medications to the doctor’s office, including over-the-counter medications,” she said. “There may be some overdoses or drug interactions that occur.”

A common OTC medication, Tylenol PM, includes an antihistamine called diphenhydramine, which is found in Benadryl. Studies have shown that diphenhydramine can worsen dementia symptoms, such as confusion, Majety said.

If a patient has Alzheimer’s or is unable to manage medications, family members may need to help, she said.

“I usually recommend planners like weekday planners, so if there’s a missed dose, it’s easy to catch,” Majety said. “Another tip that works for some of my patients is pill packs where all the morning after pills are in one pack so all you have to do is open the pack and throw them away. A pill box that has AM/PM on it. might work too.â€

Patients can also talk to their doctors if managing too many medications becomes too difficult, she said.

“As a physician, I recommend that seniors ask if they can summarize the number of times they take a medication,” Majety said. “There are some medications where you may need to take them three to four times a day, so you might ask if they can be taken once or twice a day. Some situations there is no solution, but if possible, if you can change it to two or three times a day at most, it can make it easier to remember.

Patients should also routinely review their medications with their entire health care team, Damasius said.

“This is very important because if the patient has a reaction to one medication, the doctor will change to another medication,” he said. “If the pharmacy is not aware and the patient is on auto-refill, the medication that the doctor stopped can be refilled, and if the patient does not review their medication with the doctor, the discontinued medication can be taken again.”

It’s also important to see a doctor within a week to 14 days after leaving the hospital, Majety said.

“It’s a good opportunity for us doctors to make sure everyone is on the same page and reconcile patients’ drug lists to catch any holes and clarify any dosages,” she said.