Dr. Winni Loesch: Drugs can hurt more than they help
How drugs react with each other sometimes can be a case of the cure being worse than the bite.
The average number of prescription medications taken by older adults is 4.5, plus two non-prescription medicines or supplements, according to a 1996 report by the U.S. General Accounting office.
Another study reported 17 percent of hospitalizations of people older than 65 were due to medication reactions ” though this is a serious issue affecting people of all ages.
Some of the reasons for these admissions were health problems associated with the medicine causing an adverse reaction. Others were due to drug interactions when they were taken with other drugs, supplements and foods.
Before you take
that next pill
Medications and supplements are intended to provide the same type of positive results to all who take them, but circumstances can reduce or prevent the effect. Each person is unique, and a percentage of people can take the same drug and dosage yet have very different outcomes. That’s why health- care professionals gather detailed information about a patient and family members’ history with medication.
Sometimes, drugs interact directly.
For example, taking a calcium supplement about the same time as thyroid medicine causes the calcium to bind to the thyroid in the gut and interferes with its absorption. The person’s blood thyroid hormone level drops, and hypothyroid symptoms continue, even though the person is taking thyroid medicine.
Instead, take thyroid pills on an empty stomach. I suggest to patients they place the pill by their bedside with a glass of water.
Sometimes, a drug’s effect or side-effect may oppose the intended effect of another drug.
For instance, an anti-inflammatory pain medication like ibuprofen may cause the body to retain salt and water; a diuretic or “water pill” (like furosemide or hydrochlorothiazide) helps the body get rid of salt and water.
If someone has asthma or chronic obstructive lung disease, they may be prescribed an inhaled medicine like albuterol, which helps open up the airways. If this person also has hypertension, certain medications such as beta-blockers (like propranolol) have an opposite effect on the airways and can make breathing more difficult. The addition of the glaucoma medication timolol, which is also a beta-blocker, can worsen breathing in patients who have significant lung disease.
Role of liver and kidneys
Nearly all medicines taken by mouth are absorbed through the intestinal wall and processed through the liver, where blood from the intestine first travels. For some drugs, this creates breakdown products, or metabolites, that also have effects in the body. Other drugs may cause changes in certain proteins that the liver normally makes.
Estrogens taken orally can do this. The liver may generate more blood-clotting proteins, which can increase the chances of stroke, blood clots in the leg veins, and so on. This is one of the reasons why estrogen also has also formulated to be applied topically and absorbed through the skin into the blood vessels, bypassing the effects in the liver.
People who take warfarin (Coumadin) should always monitor their intake of vitamin K-containing foods. The (oversimplified) reason is that warfarin causes the liver to make fewer blood clotting proteins and vitamin K interferes with this action of warfarin in the liver.
So people taking warfarin should not to avoid vitamin K foods (“greens”), but eat a consistent amount so that the dosage of warfarin can be adjusted against the average amount of vitamin K that is consumed.
Eliminating drugs from the body also may become a problem.
After medicines get into the body, they are cleared out of the body usually through the liver and the kidneys. If these organs don’t work well, they will have some difficulty eliminating drugs. People with compromised liver or kidney function may need their dosage adjusted to lower amounts, or with longer intervals between doses, or both.
Talk about it
With new drugs being developed all the time, there is potential for unknown interactions. Foods and supplements also interact with drugs. Careful medical judgment must be used to decide whether to prescribe a medication. So computer programs are no substitute for careful assessment by a physician or pharmacist. All members of one’s healthcare team must know about any medical conditions that can influence drug effects and interactions.
Patients must communicate what medicines and supplements they’re taking each and every time they see their doctor or any healthcare professional. Keep an updated list of medications and supplements you are taking in your wallet or purse.
Winni Loesch, MD, FAAFP, has practiced in the region since 1987. She works with Amethyst Medical Group Inc. in Grass Valley, 271-2333.
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