The hazards of prescription drugs
When actor Heath Ledger died in January from an accidental drug overdose, the headline “Deadly Cocktail” appeared on Web sites and newspapers around the world.
Ledger didn’t take 85 pills or wash his medicine down with whiskey. He took the wrong combination of prescription medication and his heart essentially fell asleep, according to his autopsy report.
It’s fairly common for people to make mistakes when taking medications, says Mike Kyler, director of inpatient pharmacy at Vail Valley Medical Center. For people with several prescriptions, mixing them up or forgetting how recently a certain pill was taken can be easy to do.
“Unfortunately, people can get confused,” Kyler says. “They forget they’ve taken something already, or maybe they take another one two hours in when they should have waited eight (hours).”
Pharmacists and doctors try their best to make sure this doesn’t happen, but the responsibility isn’t entirely theirs.
Doctors and pharmacists have a role of ensuring medications are taken as prescribed. The first step for a doctor is to learn as thorough a history as possible about a patient, says Dr. Jack Eck, a Vail Valley Medical Center internal medicine specialist.
“Because of the liability with drugs, I do two things: I always write down allergies first for medications, then I write down the medications they’re on, including the dose,” Eck says.
Patients need to be completely honest with their doctors in order for doctors to get these facts right, he says. A good way to make sure you’re not excluding any important information from your doctor is to think of everything way before a doctor’s appointment. That way there’s time to remember things and add them to the list.
Sometimes patients might hold back because they’re ashamed of something personal, but Eck says doctors have seen it all before. From men who take impotence medication to people on anti-depressants, he says there’s no need for shyness.
“What might be awkward for them is not a big deal for (doctors),” he says. “We see it every day. If they let us know, we won’t look down upon them.”
That communication is equally as important for pharmacists and patients too, Kyler says. Since there isn’t one big interconnected computer system among doctors and pharmacists nationwide, talking to one another is often the best way to prevent accidental doses, he says.
“Not every patient wants to be talked to,” Kyler says. “We’re trained and ethically bound to try and do the best we can to protect the safety of the patient.”
Pharmacists can usually see the most information about a patient at any one time, Kyler says. That’s because a patient who is seeing an orthopedic surgeon, a gynecologist and a psychiatrist might fill prescriptions from each doctor at the same pharmacy, giving the pharmacist a chance to see whether those medications interact with each other.
That’s the ideal situation, says John Batson, pharmacist and owner of the Eagle Pharmacy. Batson says one of the best ways to prevent accidental drug interactions is by filling prescriptions at the same pharmacy.
“People need to pick a pharmacy that they trust and stick to it, not just price shop,” Batson says.
Batson says he understands that medications can be expensive, but the benefit of having all of a patient’s records in one place can outweigh the cost of slightly more expensive drugs.
Pharmacists have specialized software that brings up alerts when two medications interact with each other. When that happens, the pharmacist calls the doctor to make sure he knows about the other drugs a patient is on. Sometimes the doctor says yes and that he approved the combination of drugs, other times the doctors could put a hold on that prescription until he talks to his patient.
Doctors also have electronic alerts that pop up when certain medications are added to patients’ records. Doctors can choose to give the patient the medication anyway, “but at least you’re alerted,” Eck says.
The system is sort of a last resort, because doctors and pharmacists alike expect patients to tell them everything about their medical history.
“If the patient would just simply talk to the pharmacist and make sure they know why they’re taking the different medications. … That little bit of communication can be so important.”
In a valley where tourists from around the world flock to ” mostly in seek of the thrills from extreme sports ” it becomes even harder for doctors and pharmacists to keep track of patients’ medical records. Sometimes there are language barriers, other times patients might just want to get in and out of the hospital or doctor’s office and get back to their vacations.
“We have no idea what they’re taking, and in some cases it might be impossible for us to find out,” Kyler says.
Local doctors typically prescribe out-of-towners things like anti-inflammatory drugs or pain medications because of sports injuries. If a person is on blood thinners because of heart problems or some other ailment, anti-inflammatory drugs could have very serious consequences, Eck says.
Patients should be careful with antibiotics also, because they commonly interact with blood thinners and other medications. Viagra, the popular drug for impotent men, could cause blood pressure to drop because of the nitroglycerin in it, Eck says. Doctors also need to know about natural herbs and homeopathic drugs.
Deborah Wiancek, a natural doctor at the Riverwalk Natural Health Clinic in Edwards, says patients might be afraid to mention they’re taking homeopathic drugs to their doctors because they don’t know how their doctor might react to natural products. Those types of products, while they might seem harmless because they’re natural, can have severe interactions with prescription drugs, she says.
“It’s always good to take all of your medications and everything you’re on to the doctor’s office,” Wiancek says. “That’s what I tell my patients when they come here. I want to see everything you’re taking.”
Natural medicines, things like garlic, Omega 3 fatty acids and flaxseed oil, often thin the blood. Green leafy vegetables, vitamin C, Ginkgo biloba and Coenzyme Q10 also thin the blood, which many people might not realize, she says.
The herb St. John’s wort is a popular natural drug, but should be taken with caution. People take the herb for things like depression, anxiety or sleep disorders ” symptoms that are commonly treated with popular prescription drugs like Prozac, Valium and Restoril, respectively.
If a person is taking these types of prescriptions, the St. John’s wort could make symptoms worse. The herb works well for people with low to moderate depression, but not for more severe cases, Wiancek says.
For people who want to try the herbs, they have to wait until they’re completely off the prescriptions. And patients have to gradually wean themselves off such medications.
To stop taking them cold turkey could send someone into a very deep depression, she says. “It is really important to talk to your doctor,” Wiancek says.