The Dangers Associated with Combining Prescription Medications
Written by: Richelle Cox, Pharmacist In-Charge, HPS Pharmacies - Sunnybank
The untimely death of Heath Ledger has cast a spotlight on the dangers associated with combining prescription medications. Toxicology reports indicated Heath Ledger's death was caused by mixing oxycodone, hydrocodone (marketed in the US as a combination product with paracetamol known as 'Vicodin'), diazepam, temazepam, alprazolam, and doxylamine.
This is a tragic example of the result of additive side effects of pain relievers, anti-anxiety and sleep inducing drugs. Health professionals would recognise that some of these drugs belong to the same class of medications. Ledger's unfortunate death serves as a warning about the potential hazards of combining medication, just one kind of medication error occurring in a society where prescription drugs are common place.
In Australia alone, the Pharmacy Guild estimates that more than 140,000 hospital admissions are due to problems related to medication. Of these, 69% were deemed to have been avoidable.
Multiple medication regimens are ubiquitous, particularly amongst the elderly. The aging population and an ever increasing artillery of drugs used to combat their multiple health conditions have resulted in a large number of people at risk of mixing up their medication. Furthermore, the explosion of generic companies and brands on the market contributes to confusion amongst those with already complex regimens.
The number of available tablets is exponentially increased when one considers the abundance of complementary therapies available from pharmacies, health food stores and nutritionist services. Many patients believe that because these products are 'natural', that they are 'safe', and therefore exempt from the caution they exercise with prescription medication.
The culture of drug 'hoarding' could also have contributed to drug related mishaps with patients having significant caches of medicines that they may not even be prescribed any more. This has been partially quashed by Medicare Australia's introduction of the 21 day rule (which is not without its drawbacks, but that's another issue). Nonetheless, medication mix-ups remain a serious and preventable problem.
The key to minimising medication errors by patients is education. Patients are less likely to inadvertently cause themselves harm if they are fully aware of all aspects of their medication. The National Prescribing Service (NPS) is dedicated to providing patients with tools and resources to promote quality use of medicines. NPS activities for consumers range from public information sessions on topics such as generic medicines, to 'medimate' - a resource providing useful tips to patients on how to gather information and make decisions about their medication. The website www.nps.org.au has many other useful links to aid patients in understanding their medications, and to promote their safe and effective use.
At an individual level, pharmacists are ideally placed to aid patients in their medication management and knowledge. Aside from patient education, pharmacists are able to provide other services to prevent medication errors at home. Consumer Medication Information educates on each drug, while medication profiles provide patients with a comprehensive list of current therapy. For patients struggling to manage medication, dose administration aids such as Webster packs or mediSACHetm are a convenient alternative. For a complete assessment of medications, AACP pharmacists are able to provide Home Medicines Reviews.
In a time when many people are on complex medication regimens involving a mixture of prescription items, over the counter medications and complementary therapies, the risk of medication error is high. By facilitating an environment of open discussion, pharmacists can encourage patient involvement and understanding of their medication. If consumers are informed on how to use their medications, and aware of services available to assist in medication management, errors should be less likely to occur. Recent media coverage has highlighted the risks involved in mixing medication and promoted positive steps towards preventing patient harm in the future.