Med Dread

In a medical world where 75 percent of all physician office visits result in some form of drug therapy, the potential for mixed drug toxicity is a serious concern.

Ashley Toale, Assistant Professor of pharmacotherapy for UNT System College of Pharmacy

| by Allana Wooley |Larry M., 68, was grocery shopping when he noticed he was sweating profusely. His brain buzzed, and he couldn’t concentrate on his shopping list or focus his eyes on the food-stocked shelves. He clutched the grocery cart to hold his body upright, his muscles suddenly weak all over.

Recording an alarmingly low heart rate, the ER staff identified the problem as a negative reaction to his many heart medications. Larry’s doctors dropped his Coreg dosage of the past 25 years from 25 mg twice a day to 12.5 mg twice a day to 6.25 mg twice a day, finally ending the medication-induced interior assaults. Larry was on a total of eight prescribed medications at the time.

Negative effects of mixing prescribed drugs can occur through a couple of different mechanisms, says Ashley Toale, assistant professor of pharmacotherapy for UNT System College of Pharmacy. Medications have specific pathways through which they are processed by the body — the liver, the kidneys. If a patient is prescribed multiple medications that are fighting to be processed by the same pathway, an increase or decrease of drug levels can result. Additionally, if your prescribed medications carry similar effects — causing sleepiness, lowering blood pressure — they can accumulate and push the body into dangerous territory.

Many drug interactions are unintentional, unpredictable and can lead to potentially life-threatening situations. There are several factors that affect the likelihood that a known interaction will occur: genes, physiology, age, underlying diseases, drug doses, duration of combined therapy and the relative time of administration of the many prescriptions.

“Thankfully, we do not see toxicity very often,” Todd Richwine, D.O., Family Medicine, Family Centered Medical Group, said. “But that has more to do with being a known issue, and we work hard to try to decrease the risk as much as possible. We have to be very careful about this, especially on the more complex or chronically ill patients when they see multiple doctors.”

The increasingly specialized nature of medical care means fragmentation in an individual’s healthcare. Instead of seeing one doctor for all your health concerns, you might see a separate physician for heart disease, diabetes, joint problems and if you catch the common cold. While doctors and pharmacists are carefully trained on the ways drugs interact and do their best to prevent negative reactions, this becomes harder without a full list of a patient’s conditions and medications.

Unintentional drug interactions add millions of dollars to the annual cost of healthcare. With an aging population, these numbers aren’t likely to fall anytime soon. So what can you do?

“The No. 1 way to prevent [interactions], and the best advice I have for patients, is that you need to be completely upfront, open and honest with your physician,” Shaun Kretzschmar  D.O, Family Medicine, Aledo Family Medicine, said. “Bring in all medications, including vitamins, minerals and supplements. And ask questions. Any physician that is a good physician will always answer all of your questions about the medications he or she is prescribing.”