Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
"Better things for Better Living... through Chemistry" worked well as a slogan for DuPont, but mixing chemicals in the body can lead to disaster. The world has become healthier because of medications that are available to treat and control disease and illness. But a problem exists when the medications interact with each other, causing complications, or are abused.
Some drug interactions are easy to predict. Take a narcotic pain pill, add a few drinks after dinner, and toss in a sleeping pill. The combination of three sedative medications may cause problems with the brain forgetting to tell the body to breathe. Other interactions are tougher to predict. For example, warfarin (Coumadin), a blood thinner, will become too active in the body and cause significant bleeding if almost any antibiotic is added. The healthcare provider needs to predict the problem and take action to avoid possible deadly complications.
The body is a breeding ground for drug interactions. Whether the drug is an over-the-counter (OTC) medication, a prescription drug, a holistic compound, a dietary supplement, a food, or an illegal drug, the potential for interaction exists. The problem occurs when people forget - or choose not to divulge - what they put in their body.
Medical care has become fragmented in recent years. The family doctor of old no longer acts as a gatekeeper to coordinate the medications patients are prescribed. A gynecologist may prescribe a birth control pill to a patient, and then the patient goes to a walk-in clinic who then prescribes an antibiotic. How can a healthcare provider inform the patient that antibiotics decrease the effectiveness of birth control pills, if full disclosures of medications, supplements, or OTC medications are not provided to all providers the patient visits? You could argue that the patient is responsible for letting people know, but in reality, the patient doesn't have the expertise to figure out the complications and interactions of medications.
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Further, the safeguard of the family pharmacist has been lost to mail-order pharmacies and overworked pharmacists. With increasing numbers of prescription and OTC medications, doctors and pharmacists are using computer programs to help figure out what is safe and what isn't. But to do so, they have to know what medications are in the patient's body.
Take the example of a celebrity who dies with a combination of different pain medications and sleeping pills in their body - and it's called an accidental poisoning; accidental but not unforeseeable, and certainly preventable. Consider that there may have been multiple drugs from multiple doctors that were presumably filled in multiple pharmacies, and it's easy to understand the dangers of mixing and matching.
So what is the risk of a medication interaction? It all depends on how many medications you take. Two medications have a 5% potential of an adverse drug reaction, five medications have a 50% chance, and eight medications gives almost a 100% chance that something will go wrong. But who takes eight medications? As it turns out, plenty of people do; many of them are elderly and have a variety of medical illnesses. A couple of blood pressure medications, another couple for diabetes, one for gout, an aspirin a day; then add an antibiotic, and the potential for problems is there. It just needs to be recognized.
So what to do? Make a list and check it twice. Give it to your healthcare provider before the prescription is written, and provide your medication list to the pharmacist as well. Make certain it contains the herbal medications and OTC medications you're taking, since these may react with the prescription medications. Throw away old medications, and always keep medications in their original container. Living better through chemistry is a good thing; it just takes some effort.