Taking Multiple Meds Can Trigger Dangerous Drug Interactions
Find out how to safeguard yourself
Lugging every pill you take to your next doctor’s appointment or trip to the pharmacist might seem like overkill, but it could save your life—especially if you take multiple drugs or supplements.
In fact, regularly taking five or more medications—something many Americans do—often does more harm than good, especially if you’re not closely monitored by a healthcare provider.
“The chances of drug interactions and side effects increase dramatically as the number of medications you take goes up,” says Michael A. Steinman, M.D., a geriatrician at the University of California, San Francisco, Medical Center.
Sometimes those drug interactions magnify a drug’s potency, sometimes they diminish its effectiveness, and sometimes they trigger dangerous side effects.
And they’re becoming much more common, says Dima M. Qato, Pharm.D., a pharmacist at the University of Illinois at Chicago. An April 2016 JAMA Internal Medicine study she coauthored found that two-thirds of older adults take five or more medications and supplements daily, up 14 percent since 2006. And one in six use medications, supplements, or both that shouldn’t be combined.
Here’s how to stay safe when taking multiple medications.
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Have a ‘Brown-Bag’ Checkup
At least once yearly, gather every prescription and over-the-counter drug you take, including drops and ointments, as well as every dietary supplement, vitamin, mineral, or herbal remedy you use, and bring them all to your doctor or pharmacist.
During that review, often called a “brown-bag checkup,” the doctor or pharmacist should check to see whether any interact with each other or whether you’re unnecessarily taking different drugs to treat the same problem. If so, you might be able to eliminate one of the drugs. Also ask whether the dosage of each medication you take can be lowered, or possibly even eliminated.
After your brown-bag review, create a list of all of the prescription and OTC products you take. Include the dosage, the reason you take the drug, and the name of the prescribing doctor. Then give that list to every pharmacist and doctor you see. Review your list every four to six months and any time you add a new medication.
Fill all of your prescriptions at one pharmacy or pharmacy chain if possible. They usually share the same electronic record-keeping system, so a pharmacist will always know which medications you take and can more easily spot potential problems.
6 Key Questions to Ask
You can reduce the chance of taking more medications than you need by asking the following questions each time you get a new prescription or your doctor recommends an OTC product:
1. What Is the Medication For?
It might seem obvious, but asking that basic question reduces the risk of taking an inappropriately prescribed drug—something that happens surprisingly often.
For example, a study of older veterans who took five or more prescription drugs found that 65 percent were told to take at least one drug that was unnecessary—medications that were ineffective, were not indicated for their condition, or duplicated the therapeutic benefits and actions of other drugs. One common example: The OTC drug ibuprofen (Advil and generic) and prescription drug celecoxib (Celebrex and generic) have similar pain-relieving actions, so they shouldn’t be taken together.
2. How Long Should I Take It?
Asking this can help spot medications you regularly take that should be used only short-term. For example, proton pump inhibitors such as omeprazole (Prilosec and generic), taken for severe heartburn, should not be taken for more than about six months because longer use increases the risk of bone fractures and can cause low blood levels of magnesium, which can trigger muscle spasms, irregular heartbeat, and seizures. And sleep aids should be used for only very brief periods because they can cause side effects such as next-day drowsiness and impaired coordination and balance, and they can lead to dependence.
3. Is This Similar to Another Drug I Already Take?
If you see several healthcare providers, some might be unaware of what others have prescribed—and could prescribe drugs similar to one you already take. For example, your primary-care physician might prescribe a diuretic (a “water pill”) to lower high blood pressure. But your neurologist might prescribe a beta-blocker, which also reduces blood pressure, to prevent migraines. In that case, you might be better off with just the beta-blocker because it treats both conditions.
4. Can Nondrug Alternatives Help Me?
In some cases you might be able to eliminate or reduce your need for drugs by making certain lifestyle changes. For conditions such as high blood pressure, high cholesterol, and type 2 diabetes, for example, losing excess weight, exercising regularly, and consuming a healthy diet can sometimes be as effective as drugs. And exercise and physical therapy can often help ease arthritis as well as back, shoulder, and neck pain, allowing you to cut back on drugs such as ibuprofen (Advil and generic) and naproxen (Aleve and generic).
5. Will This Medication Interact Dangerously With Other Prescription Drugs or OTC Products I Take?
The more medications you use, the greater the likelihood of drug interactions. For example, taking the cholesterol-lowering drug simvastatin (Zocor and generic) with the blood pressure drug amlodipine or the blood thinner warfarin (Coumadin and generic) could trigger potential deadly bleeding. The same could happen by combining aspirin with the blood thinner clopidogrel (Plavix and generic) or OTC pain drugs such as ibuprofen or naproxen.
6. What Side Effects Could This Medication Cause?
Being aware of possible side effects can help you spot them before they cause serious harm. For example, muscle aches might be due to a cholesterol-lowering statin you take—and if allowed to continue, could progress to severe kidney damage. Knowing what to expect can also help you recognize new symptoms as drug side effects, not new health problems.
For instance, if you develop confusion after taking the urinary incontinence drug oxybutynin (Ditropan XL and generic), you’ll be less likely to worry about it as an early sign of dementia if you were warned that confusion is a possible side effect of the drug.
Recognizing side effects can also help you avoid “prescribing cascade,” says Jerry H. Gurwitz, M.D., chief of the division of geriatric medicine at the University of Massachusetts Medical School in Worcester. That happens when, instead of stopping the drug that is causing the problem, your doctor mistakenly prescribes yet another medication to treat the drug side effect—which can lead to additional side effects or drug interactions. “This is a huge issue that is underappreciated,” Gurwitz says.
Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).