Older Adults at High Risk for Drug Interactions; Prescription and OTC Medications Are Commonly Used Together

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Source: University of Chicago Medical Center

Released: Thu 18-Dec-2008, 10:20 ET

Embargo expired: Tue 23-Dec-2008, 16:00 ET

Older Adults at High Risk for Drug Interactions

Description

At least one in 25 older adults, about 2.2 million people in the United

States, take multiple drugs in combinations that can produce a harmful

drug-drug interaction, and half of these interactions involve a

non-prescription medication.

Newswise — At least one in 25 older adults, about 2.2 million people in

the United States, take multiple drugs in combinations that can produce

a harmful drug-drug interaction, and half of these interactions involve

a non-prescription medication, researchers from the University of

Chicago Medical Center report in the Dec. 24/31, 2008, issue of JAMA.

Although the number of people taking medications has remained stable for

the last decade, the number of drugs taken by older people has

significantly increased. This may be because of more intense therapy for

chronic illness, improved access to medications due to Medicare Part D,

and the growth of the generic drug market. More than half of older

adults now take five or more medications or supplements.

" Older adults are the largest consumer of prescription drugs, " said

study author Tessler u, MD, assistant professor of obstetrics

and gynecology and of medicine at the University of Chicago Medical

Center. " We find that they commonly combine these prescription

medications with over-the-counter medications and dietary supplements,

which can increase their vulnerability to medication side-effects and

drug-drug interactions. "

" We were reassured that we did not find combinations of the most

commonly used drugs that were absolutely forbidden, " she added, " one

indication that drug safety systems used by physicians, nurses and

pharmacists are working. "

" However, " she added, " our results probably underestimate total risk. "

Patients using less common drugs and non-prescription medications could

be more at risk for harmful interactions because health care providers

may be less familiar with their safety profile.

The study also found ethnic and gender differences. Older Hispanics were

more likely than other ethnic groups to be taking no medications. Older

women were less likely than older men to take medicines to reduce

cholesterol.

" In our study, men and women were equally likely to report a history of

cardiovascular disease, " said co-author Dima M. Qato, PharmD, MPH,

research associate in obstetrics and gynecology at the University.

Despite efforts to increase awareness in the medical community that

older men and women are equally at risk for a cardiovascular event,

" disparities persist in the use of statin medications, " she said. " Far

fewer women than men were taking these effective cholesterol-lowering

drugs. "

The study used data collected for the National Social Life, Health and

Aging Project, a nationally representative multi-purpose survey of

adults aged 57 to 85 administered between July 2005 and March 2006. The

survey team interviewed 3005 participants in their homes about the

medications they used " on a regular schedule, like every day or every

week. " Ninety-nine percent, 2,976 respondents, completed the interview

and medication log.

Ninety-one percent of all respondents regularly used at least one

medication, a percentage that increased with age. Twenty-nine percent of

older adults took more than five prescription medications.

Sixty-eight percent of the adults who took prescription drugs also used

over-the-counter medications or dietary supplements. Men were more

likely to take over-the-counter medicines. Women were more likely to use

supplements, such as vitamins or herbal remedies.

Nearly half of the drug-drug interactions identified could cause

bleeding problems. One of the most common was taking warfarin, a

prescription drug designed to prevent blood clots, along with an

over-the-counter drug such as aspirin, which also interferes with clotting.

The most common potentially severe medication interactions

Type Medications Risks

Prescription-prescription Lisinopril-potassium Elevated blood-potassium

levels (can disrupt heart rhythm)

Warfarin-simvastatin Bleeding

Prescription-non prescription Warfarin-aspirin Bleeding

Atorvastatin-naicin Muscle weakness, muscle breakdown

Simvastatin-niacin Muscle weakness, muscle breakdown

Non-prescription-non-prescription Ginkgo-aspirin Bleeding

" Physicians and pharmacists need to ask their patients about the use of

nonprescription medications, " said u. " Patients need to inform

their providers about all medications they use--prescription and

nonprescription--and should ask their physician or pharmacist about

interactions any time they start a new drug, on their own or following

the doctor's recommendation. "

Carrying a list of all medications in a wallet might be a good idea, the

authors suggest. So is using the same pharmacy or chain for all

medications, said Qato. The researchers also stressed that health

professionals need to stay on top of drug-safety information and

consider the evidence, where available, for safety in older adults.

The National Institutes of Health and the University of Chicago Program

on Pharmaceutical Policy funded the study. Additional authors include

Caleb , Rena Conti, , and Phil Schumm of the

University of Chicago.

http://www.newswise.com/articles/view/547559/?sc=dwhn

Source: American Medical Association (AMA)

Released: Thu 18-Dec-2008, 17:15 ET

Embargo expired: Tue 23-Dec-2008, 16:00 ET

Among Older Adults, Prescription and OTC Medications Are Commonly Used

Together

Description

A survey suggests that nearly half of older adults in the U.S. use

prescription and over-the-counter medications together, and that about 4

percent of older adults are potentially at risk of an adverse drug

reaction because of an interaction between medications, according to a

study in the December 24/31 issue of JAMA. The researchers also found

that nearly 30 percent use at least 5 prescription medications.

Newswise — A survey suggests that nearly half of older adults in the

U.S. use prescription and over-the-counter medications together, and

that about 4 percent of older adults are potentially at risk of an

adverse drug reaction because of an interaction between medications,

according to a study in the December 24/31 issue of JAMA. The

researchers also found that nearly 30 percent use at least 5

prescription medications.

Rates of prescription medication use have increased considerably over

the last several decades, as have the rates of use of over-the-counter

medications and dietary supplements. Older adults are the largest per

capita consumers of prescription medications and the most at risk for

medication-related adverse events, according to background information

in the article. “Despite concerns about drug safety and new federal

policies to improve older adults’ access to medications, current

information on their concurrent [regular use of at least 2 medications]

use of prescription medications, over-the-counter medications, and

dietary supplements is limited,” the authors write.

Dima M. Qato, Pharm.D., M.P.H., of the University of Chicago, and

colleagues analyzed data from a survey to estimate the prevalence and

patterns of medication use (including concurrent use) and major

drug-drug interactions among older adults, age 57 through 85 years. The

survey included 3,005 community-residing individuals, who were drawn

from a cross-sectional, nationally representative sample of the United

States. In-home interviews, including medication logs, were administered

between June 2005 and March 2006. Medication use was defined as

prescription, over-the-counter, and dietary supplements used “on a

regular schedule, like every day or every week.” The survey response

rate was about 75 percent.

During 2005 to 2006, 91 percent of older adults, corresponding to 50.5

million adults age 57 to 85 years, regularly used at least 1 medication.

Among all medication types, prescription medication use was the most

prevalent, used by 81 percent, or an estimated 44.9 million older

adults. The prevalence of prescription medication use was highest among

the oldest age group, age 75 to 85 years. Nearly one-half of older

adults regularly used at least 1 over-the-counter medication or dietary

supplement. Women were more likely to use prescription medications and

dietary supplements than men, whereas use of over-the counter

medications was similar among women and men.

More than half of older adults used 5 or more prescription medications,

over-the-counter medications or dietary supplements. For prescription

medications, 29 percent of all respondents used more than 5 medications.

The prevalence of the use of 5 or more prescription medications

increased steadily with age for both men and women and was overall

significantly higher among women.

Overall, 68 percent of older adults using prescription medications were

concurrently using over-the-counter medications, dietary supplements, or

both. The researchers also found that 1 in 25 (4 percent) older adults

(approximately 2.2 million) were at risk for a major potential drug-drug

interaction. The rate of any major medication interaction increased with

age for both men and women but was higher among men compared with women

across all age groups. More than half of these major interactions

involved the use of nonprescription therapies. In addition, nearly half

involved the use of anticoagulants (e.g., warfarin) or antiplatelet

agents (e.g., aspirin).

“Several factors have likely contributed to this increase in the rate of

[the use of five or more medications] among older adults over the last

decade. These include intensification of therapy for common chronic

medical conditions (e.g., diabetes, cardiovascular disease), increased

access to medications because of policy changes (e.g., Medicare Part D

and assistance programs), and growth of the generic drug market,” the

authors write.

“One recent report estimated that U.S. adults older than 65 years make

more than 175,000 emergency department visits annually for adverse drug

events; commonly prescribed medications accounted for one-third of these

events,” the researchers note. “Our findings suggest that concurrent use

of prescription and nonprescription medications in older adults remains

a public health problem and could be an important focal point for

further improvements in drug safety for seniors.”

“Medications are a critical modality for prolongation of life and

improved quality of life for many older adults. By establishing patterns

of prescription and nonprescription medication use among older adults,

these data may help support efforts to increase the safety and quality

of pharmacotherapy for older adults,” the authors conclude.

(JAMA. 2008;300[24]:2867-2878. Available pre-embargo to the media at

www.jamamedia.org)

Editor’s Note: Please see the article for additional information,

including other authors, author contributions and affiliations,

financial disclosures, funding and support, etc.

http://www.newswise.com/articles/view/547601/?sc=dwhn

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