By LCDR Jefferson Fredy, Pharm.D.

LCDR Fredy contributed to this article in his personal capacity. The views expressed are his own and do not necessarily represent the views of the Indian Health Service or the United States Government.

Medications are very useful when taken correctly; however, unwanted side effects or adverse events can occur due to interactions with other drugs, food or herbal products. Everything that is swallowed is broken down by your body to be eliminated. Some medications are broken down by the same pathways as food, herbal products or other drugs. Therefore, it is important your doctor and pharmacist know all the medications you take.

Every year, medications are the contributing source of hospitalizations or injuries. A majority of medication errors can be avoided. Medications are often taken incorrectly or taken with interacting drugs that lead to side effects. Pharmacists can determine if there are any drug interactions based on a person’s complete drug list.

In 2005, a National Patient Safety Goal (NPSG) was initiated by the Joint Commission and implemented by hospitals. The purpose of NPSG is to reduce medication errors and adverse outcomes. In summary, this is achieved by healthcare providers gathering a thorough history of a patient’s medication list. This information is crucial, especially in the event of an unexpected hospitalization. The doctor can promptly make decisions about whether to continue a patient’s chronic medications or withhold them.

It is not uncommon for a person to see a number of different doctors. One person may have appointments with a family physician, a kidney doctor, a heart doctor and another doctor for migraine headaches. It is important each doctor knows all the medications that are being taken. This will prevent similar medications from being prescribed. If any drug doses are changed or a drug is discontinued, make sure you properly discard the old drugs. This will prevent any mistakes of taking additional doses.

Drug allergy information is necessary for determining what medications should be avoided. If possible, list the type of reaction you may have to certain medications. It is very important to know what true allergic reactions are. Reactions such as hives, rash or difficulty breathing (anaphylaxis) are considered true allergies. The most common mistake is made when a person reports stomach intolerance as an allergy. Symptoms such as nausea, vomiting and headache are considered adverse drug reactions.

If an antibiotic is misclassified as an allergy, that potentially eliminates the availability of a large number of related antibiotics as a possible drug selection. Sometimes, simple antibiotics are cheaper and effective in treating infections. Thus, making sure that intolerances are not mistaken as allergies is important.

Adverse events can occur if there are drug interactions. Some medications are best taken with food and some on an empty stomach. Certain foods can make some medications ineffective or can increase the drug concentration level in the body. Increased drug concentrations may cause an increase in side effects. Your doctor or pharmacist can provide you with that information.

Some people don’t report taking vitamins, herbal products and other over-the-counter (OTC) medications to their doctors. Like certain foods or prescription drugs, these products can possibly interact with other drugs. Some common OTC drugs are pain relievers like acetaminophen (Tylenol®), aspirin, ibuprofen (Motrin®) and naproxen (Aleve®). These medications are often found in certain prescription pain medications. Taking too much can cause side effects or drug interactions.

Herbal products and vitamins are considered “natural.” That’s often mistaken as not having any drug interactions. Some can cause certain medications to be eliminated by the body faster. This causes the medication to work less effectively. Others can cause a drug level to increase, which may lead to side effects. The more medications a person has to take usually leads to a greater potential for drug interactions. It is important for your healthcare providers to know all the prescription medications and OTC medications you take. It is also important to let your doctor know the type of foods you eat. The next columns provides some pointers to help you reduce some of the drug interactions and make medications more effective.
What can you do to help?
1. Keep an updated list of medications with you and also your allergies. (This service is available on AAKP My Health™ .)
2. Bring your medication bottles to doctor visits.
3. Get rid of old medications not currently being used.
4. Keep a list of over-the-counter products (including herbal products) you take on a regular basis.
5. Use pill boxes to help remind you to take your medications.
6. Have a general idea of what each medication treats.

Side effects or drug allergies may result with any drug. You can do your part to minimize the risks of drug interactions by keeping your medication list up to date. Also, properly disposing of old medications that are no longer being taken will prevent someone from taking them by accident.

Jefferson Fredy is a Lieutenant Commander in the United States Public Health Service. He is a pharmacist with chronic kidney disease training. LCDR Fredy has provided periodic medication in-services to Native American tribes in the Phoenix, Ariz., area.

This article originally appeared in the July 2008 issue of aakpRENALIFE.

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