Taking multiple medications can put you at risk for interactions
The CDC estimates that about one in five American adults between the ages of 40 and 70 take five or more prescription drugs, a phenomenon called polypharmacy. That medication number increases with age. The same CDC report estimates that about one-third of adults in their 60s and 70s take five or more medications.
In addition to costing seniors a lot of money, polypharmacy increases the risk of severe side effects and drug interactions, according to the National Institute on Aging. It also increases the risks of falls and cognitive impairment.
“All medications have the potential for side effects,” said James Mangan, RPh., MBA, CPEL director of Hospital and Ambulatory Pharmacy at Cape Cod Healthcare.
Certain combinations of medications increase the risk for negative interactions.
“When you take each medication on their own, you might not notice a side effect, but some combinations can lead to excessive sedation, dizziness and drowsiness,” Mangan said.
One of the other problems that can occur with polypharmacy is “prescription cascading,” where you take one medication to treat a medical condition but then you need to take one or more other medications to treat the side effects from the first medication, he said.
Mangan recommends keeping an updated list of all the medications and supplements you take and then bringing that list with you to every medical visit. That way you can review any possible medication interactions or discuss medications you might not need any longer. For example, a patient who loses a lot of weight might need to reduce the dose of their blood pressure medication, possibly eliminating it altogether- always after a collaborative discussion with their healthcare provider.
Mangan recommends listing each medication to the doctor or nurse at each visit rather than just answering the question, “Are you taking the same medications as last time?” That ensures your medical provider has the most accurate list.
Epic Has Improved Things
Another mistake that can occur is that doctors might not know what other doctors are prescribing for you. A shared electronic record system like Epic (which is used by all Cape Cod Healthcare providers) has helped minimize this problem.
“It is greatly improved with Epic, where before, every physician’s office was kind of a silo and now, with one common electronic health record, they are all working off the same list. It’s much easier for changes to be communicated,” Mangan said.
While other healthcare organizations in Massachusetts and throughout the U.S. have separate instances of Epic, a robust feature within Epic, called CareEverywhere, allows patient data to be shared between organizations, including patients’ medications, for transparency between care providers.
Patients should also leverage CCHC’s MyChart patient portal and keep it updated to ensure accuracy of medications between caregivers, both internal to CCHC and externally.
“So, make sure you have an updated med list, ideally all from the same pharmacy, so the pharmacist has the full picture as they’re processing that new prescription for you. Then they have a good picture of what your interaction profile looks like,” he said.
Ask the Pharmacist
Your pharmacist is also a good source of information about food interactions. For example, you need to avoid grapefruit juice with many different medications, including statins. Cranberry juice should be avoided with the blood thinner warfarin (Coumadin). Pharmacists also know which over-the-counter medications and supplements shouldn’t be taken together with certain prescriptions. For example, blood pressure meds and decongestants don’t mix.
It's also important to know the specific directions for taking the medications, Mangan said. Some medications need to be taken in the morning. Others are better taken at night. You need to take some medications with food and others on an empty stomach. There are medications that cause rashes in sunlight or render another necessary medication ineffective.
“The pharmacist is the expert on all of those things, so take the time to ask the questions,” Mangan said.
