Mixing Meds Celebrity Death Highlights the Dangers of Combining Different Medications

By Jamie Sotonoff Daily Herald Staff Writer

Anna Nicole Smith was taking at least four different prescription medications when she died last month, according to court testimony: Topamax (for migraines), Methadone (for pain or narcotic addiction), Dilaudid (for severe pain) and an unspecified anti-depression medication.

Toxicology reports, expected any day now, will determine if this drug cocktail caused the Playboy centerfold’s death. Regardless, it sheds light on a growing problem in the U.S.: dangerous side effects from mixing medications.

Prescription medication mixed with other prescribed drugs, over- the-counter medicines, herbal supplements – even alcohol, nicotine or caffeine – can cause a wide range of health problems, from a dry throat to sudden death.

While the danger of mixing drugs might seem obvious, people are increasingly ignorant or oblivious to it.

The problem doesn’t only plague heavy-duty drug users, but average Joes who take medicine for common ailments like depression, diabetes or heart conditions.

“It seems so easy and so simple to take a pill, that sometimes we forget that we’re putting actual chemicals in our body,” says Northwestern University professor Michael Wolf, who studies the topic.

Last year, 700,000 people ended up in the emergency room because of drug-related side effects, reports the Journal of the American Medical Association. Not all are the result of combining drugs, yet with half of all Americans now using prescription medicines, the chance of drug interactions is growing rapidly.

Senior citizens, who typically take more medication, were twice as likely to experience problems.

In a recent New York Times article, a physician called this escalating problem a “full-scale epidemic.” Local pharmacology experts agree.

“It’s a huge problem that doesn’t have a solution in sight,” Wolf says.

Why it happens

Americans are popping pills in record numbers.

An all-time-high 3.6 billion prescriptions were filled in 2005, the Kaiser Family Foundation reports. Sales of over-the-counter medicine and herbal supplements are also surging.

As more people take more drugs, sheer odds lead to medication errors.

But another major cause is our busy lifestyles and complicated health insurance plans, which together create a communication breakdown.

Let’s say you go to the doctor because you have a cough. The behind-schedule doctor quickly writes you a prescription for an antibiotic without asking many questions or checking your chart’s drug history.

You take the prescription to a pharmacy, where the overloaded pharmacist fills it, but it’s the tech who asks, “Any questions?” Not wanting to bother the pharmacist, you simply answer, “no.” When you get home, you tear open the package without reading the warning labels or attached papers and pop a pill.

If the antibiotic adversely mixes with something else you’re taking, you are at risk for getting sick.

Because they’re so overloaded, health care providers sometimes fail to double-check or communicate instructions for the medicine.

“Sadly, the insurance system forces us (pharmacists) to hurry up and fill as many prescriptions as we can. We spend too much time with insurance issues, or finding the cheapest medication that they’re willing to pay for,” says pharmacist Luke Vander Bleek, president of the Illinois Pharmacists Association board. “We struggle every day to keep service up.”

We consumers are partly to blame, too, because two-thirds of us throw away the paperwork that comes with our prescriptions, Wolf says. We just want to pop a pill to quickly solve our health problem and get on with the day.

Others are embarrassed to tell their doctor or pharmacist they’re taking certain medications, like Viagra, or that they smoke and drink heavily. That silence puts them at greater risk.

“I’ve tried to talk to some patients, and they don’t want to talk. They’ll say, ‘I just want my medicine so I can get out of here,’ ” says Vander Bleek, who runs a pharmacy in downstate Morrison.

With warning and informational labels so difficult to read and understand, it’s no surprise people don’t bother with them.

“I got some cold medicine for my children the other day, and to read through it all took a lot. And I know what I’m doing,” said pharmacist Jan Engle, a teacher at the University of Illinois at Chicago and past president of the American Pharmacy Association.

Consumers sometimes create more problems for themselves by failing to “use as directed.” Either they’ll skip dosages, won’t follow the instructions, or decide to double the dosage for faster or better results. That can throw off the delicate balance of chemicals in the body.

“Noncompliance is a very, very, very big issue,” says pharmacist Mark Mandel, owner of Mark Drugs in Roselle.

Another issue is money. Whether because of the high cost of drugs or cost-conscious insurance providers, people often get their medicine from different sources, including mail-order pharmacies or out-of-country sources. Anna Nicole Smith reportedly obtained her medications through different doctors and pharmacies, although privacy, not money, was likely her motivation.

While most pharmacies are equipped with software to red flag dangerous drug combinations, it does little good when prescriptions are being purchased in different places.

Sometimes, it’s over-the-counter drugs that don’t mix with prescription medications. Blood thinners mixed with ibuprofen, for example, can cause hemorrhaging. So someone taking a seemingly harmless headache pill can end up seriously ill.

“I once had a customer taking Allegra for allergies. It wasn’t working well, so she was going to buy Claritin to add in to it. That’s two antihistamines. That’s double dosing, and you can start seeing side effects, like dry mouth and dizziness. I had to say to her, ‘You’re overmedicating.’ She just didn’t realize,” Engle said.

Even over-the-counter medicines sometimes clash. Let’s say you take a daily aspirin for your heart. Then you get a headache, so you pop an Advil. It’s one of many examples where two rights can make a wrong.

“You counter the effects (of those two drugs) because they interact,” Engle says. “It can also give you stomach upset and cause bleeding.”

Herbal medicines aren’t always safe, either. Garlic, for example, which is good for your immune system or heart, can cause hemorrhaging when mixed with certain blood thinners.

What makes this tricky for doctors and pharmacists is that it’s not always black and white. One person taking two drugs might experience no symptoms while another has an extreme reaction.

That leaves it up to the doctor or the pharmacist to make a judgment call. They do their best, but they’re not perfect.

“There are multiple checks in this business of medicine, but sometimes things get by,” Vander Bleek said.

Working on solutions

Pharmacies are trying to do more to warn people about the dangers of mixing medicines. Target, for example, is leading the industry with its “Clear Rx” program that includes large type on the labels with easy-to-understand instructions and warnings.

Walgreens has pharmacists who can explain instructions or labels in 14 languages.

“As we identify where the problems are, I think the industry is moving in the right direction,” Engle says.

In the meantime, it’s up to the consumers to take responsibility for what they ingest.

“Your best defense is to read the label. Make sure the drugs don’t have the same ingredients,” Engle says.

Equally as important is to be honest with your doctor or pharmacist about what you’re taking and ask questions about drug interactions.

“As much as they want to rush you through it, you have a right to get counseling from your pharmacist and your doctor. You should make it a routine habit as much as you can to ask questions,” Wolf says.

It may not always look like it, but counseling patients and talking about medication is what pharmacists like to do best. It’s not counting pills and calling insurance companies.

“I love talking to people about their medicine. And I love problem solving. Most retail pharmacists do,” Mandel says. “Even though we’re really, really busy, we’re extremely accessible. I’ve been in pharmacy for 28 years. I have never yet said, ‘I’m sorry, I can’t talk to you.’ “

How to prevent medication errors

– Be honest with your doctor or pharmacist. You might be embarrassed to be taking medicine for erectile dysfunction or reluctant to admit you smoke or drink six cups of coffee a day, but your doctor or pharmacist needs to know. They can then prescribe a safe medication that doesn’t negatively interact with what you’re already taking.

– Make a list of everything you take. If you’re too embarrassed to talk about it or have difficulty keeping track, write down all of the prescription, over-the-counter and herbal medicines you take, along with dosages. Then you can just hand it to your doctor or pharmacist, or if need be, a paramedic.

– Establish a relationship with your pharmacist. Choosing a pharmacist is almost as important as choosing a doctor. If you feel your pharmacist doesn’t take time to answer your questions, go elsewhere.

– Slow down the rushed process. Listen to your doctor and pharmacist. Ask questions. Read the warning labels and written materials. Yes, your pharmacist or doctor is probably busy. But it’s critical to make sure all your questions are answered.

– If possible, get all your medications from the same pharmacy. That way, there is a record of what you’re taking. Most pharmacies have software to alert the pharmacist of potential interactions.

– Jamie Sotonoff

(c) 2007 Daily Herald; Arlington Heights, Ill.. Provided by ProQuest Information and Learning. All rights Reserved.