by Dennis Thompson
the new york times
Barely a week goes by, it seems, without some company announcing a new pill designed to help you live a longer, healthier life.
Medication can, indeed, do a lot toward curing, preventing or easing many ills. But taking a fistful of pills each day creates its own set of medical risks, prompting concern among a growing number of physicians and pharmacists that people are simply taking too many medications for their own good.
“As you keep increasing the amount of prescriptions, that increases the chance of having a drug interaction or major side effect,” said Sophia De Monte, a pharmacist in Nesconset, N.Y., and a spokeswoman for the American Pharmacists Association. “It’s exponential. The more you add on, the more chance you’ll have something bad happen.”
It’s a concept called polypharmacy, the use of more medications than someone actually needs. And that means not just prescription drugs but also over-the-counter medications and dietary supplements.
The average American is prescribed medication about 13 times a year, according to a report last year by the Kaiser Family Foundation. But the likelihood of polypharmacy increases as people age. Studies have found that seniors make up 13 percent of the population but account for 30 percent of all drug prescriptions. When elderly patients transfer from hospitals to nursing homes for rehabilitation, it is common for caregivers to have to keep track of nine or more prescribed medications for each person, according to a long-term care report.
The more medications people take, the more likely it is that they’ll experience a problem in three key areas, said De Monte and Norman P. Tomaka, a pharmacist in Melbourne, Fla., including:
Drug interactions. Drugs can work against each other in strange ways, and the more medications added to a daily regimen, the greater the risk for an interaction that could affect the person’s health.
Drug compliance. Trying to keep track of multiple medications can become too much of a burden, causing people to give up trying to comply with the directions for medication use. “We’ve found that compliance drops 40 percent when you add a second drug to a patient’s regimen, even if they are both once a day,” Tomaka said. A lack of compliance to prescription directions can create a serious health risk. “For example, if you use blood pressure medication sporadically, you may set your blood pressure up to become drug resistant,” he said. Sporadic use of antibiotics can cause infectious bacteria to develop immunity to medications.
Side effects. Every medication a person takes comes with its own risk for side effects. Multiple prescriptions and remedies mean a multiplied risk. And once side effects occur, it can be more difficult to track down the problem. “Sometimes those drugs can mask each others’ symptoms,” Tomaka said. “If you get an adverse reaction, you don’t know which one caused it. Then you have a quandary.”
But though the trend has been toward more prescriptions, steps are being taken to safeguard patients’ health.
Doctors and pharmacists are working together to create systems by which patients’ prescription lists are reviewed, with an eye toward minimizing the medications they take, De Monte said.
“The whole goal is to try to fine-tune it,” she said, “working with the patient to get the best medication with the best effects at the minimal amount.”
Researchers also are working on ways to combine drugs that work well together into a single dose, reducing the number of pills people have to keep track of as well as the risk for drug interactions, Tomaka said.
“The history of HIV treatment is a good lesson in this,” he said. “In the 1990s, most HIV patients took anywhere from six to 24 medication tablets. Sometimes there would be as many as 65. Today, it’s thoroughly realistic that a patient will only have to take two pills a day.”
In the meantime, De Monte and Tomaka suggested a few steps people can take to make sure the multiple medications they are on don’t cause more problems than they cure:
Take each medication with water. If you add an acidic beverage, like fruit juice or soda, to the mix, it’s just one more thing for your medication to interact with.
Read all the information provided about any medication, either prescription or over-the-counter, looking for potential problems that might crop up for you.
Review your medication list with your doctor and pharmacist.
Report symptoms that occur once you begin taking a new medication.
In the end, dealing with polypharmacy entails some work on the part of patients because only they know about their specific health condition and how each medication makes them feel.
“Medications are tools,” Tomaka said. “We have to get away from looking at drugs as anything other than a tool used to help repair a patient’s body. The key is working with your physician on your specific condition and realizing that one size does not fit all.”
by Dennis Thompson