February 7, 2008

Actor’s Legacy: Mixing Meds Can Kill You

A medical examiner's report that actor Heath Ledger died of an accidental overdose of several prescription drugs is a warning not to mix medications, doctors in North Jersey said Wednesday.

Ledger, the 28-year-old Australian star of "Brokeback Mountain," died from a lethal combination of prescription painkillers, sleeping pills and anti-anxiety drugs, the New York City medical examiner said.

The findings came two weeks after Ledger was found dead in the bed of his rented SoHo apartment. Police found bottles of six types of prescription drugs in his bedroom and bathroom, raising speculation of an accidental drug overdose.

Most patients are not aware of the cumulative effect of mixing medications prescribed for different purposes, said Dr. Anthony Laneve of St. Joseph's Regional Medical Center in Paterson.

"They think, 'A sleeping pill is just for sleep and Valium is for my nerves, then I'll also take a pain pill,' " said Laneve, chief of internal medicine at St. Joseph's.

"They're taking pills for specific reasons, not realizing they're interacting in their system," he said.

The toxicity of mixing drugs goes up more quickly and more intensely in patients who have medical conditions, such as liver or kidney problems, he said.

"It affects the breakdown and excretion of these products, so they stay in your system a longer time," Laneve said.

Ledger died of "acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," the medical examiner's spokeswoman Ellen Borakove said in a news release.

Oxycodone is the generic name for the powerful painkiller OxyContin, while diazepam and temazepam are generic names of Valium and Xanax, respectively. Alprazolam and doxylamine are sold as the sleep aids Restoril and Unisom, and hydrocodone is a widely used painkiller marketed under numerous brand names, including Vicodin.

Prescription drug overdose is now the second leading cause of accidental deaths in the United States, after auto accidents, according to federal officials. About 9 million people use prescription drugs for non-medical purposes; 3 million of them are between ages 12 and 17. Prescription drugs figure in 25 percent of all overdose deaths.

People also often don't realize that prescription drugs and over- the-counter medications can have a cumulative effect when mixed, Laneve said.

It is hard to imagine a doctor prescribing one patient so many overlapping medications, such as the anti-anxiety drugs Valium and Xanax, at the same time, said Laneve.

Often this is a case of drug swapping among patients, or of patients obtaining medications through the Internet, he said.

Dr. Diego Coira, who is chairman of psychiatry at Hackensack University Medical Center, said he tries to prescribe a minimum amount of drugs.

"What happens with these medications is patients build up a tolerance for them," Coira said. "The more you take, the more you need."

People often have a false sense of security that prescription drugs can't have dangerous side effects if used incorrectly, said Dr. Asghar S. Hossain, medical director and chief of geriatric psychiatry at Bergen Regional Medical Center in Paramus.

"There seems to be a growing misconception that prescription drugs can be used without considering the dangers of combining them with other prescribed medications ... and even nutritional supplements," Hossain said.

Patients should stick to one physician so computer records can keep track of their prescriptions, said Bob Zadra, pharmacist at Town and Country Apothecary & Fine Cosmetics in Ridgewood.

"That's the reason patients shouldn't hop from doctor to doctor and pharmacist to pharmacist," Zadra said.

"There's drug interaction, and the computer will pick it up that much easier" if the patient stays with the same health providers, he said.

A pharmacist can spot whether the patient has a prescription for a drug that's the same or similar to one he is already on, and check with the doctor before dispensing it, Zadra said.


Lethal combination

Actor Heath Ledger died of an accidental overdose of prescription drugs, including:

* Painkillers: Oxycodone, hydrocodone

* Anti-anxiety medication: diazepam, alprazolam

* Sleeping pills: temazepam, doxylamine


This article contains material from the Associated Press. E- mail: [email protected]