Your Weekly Checkup: How Well Do Your Medications Mix?

We are pleased to bring you “Your Weekly Checkup,” a regular online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.
                                                                                                                                                         —William Osler

We live in an era of polypharmacy. Many people, particularly the elderly, ingest five or more drugs daily for a multitude of common problems such as high blood pressure, arthritis pain, depression, diabetes, and so on. Most of these drugs, when prescribed and carefully monitored by a physician, help relieve symptoms, and some are even lifesaving. However, unintended consequences can cause important side effects.

The greatest risk factor for adverse drug-related events is the number of drugs prescribed. For example, the risk of an adverse drug effect is 50 to 60 percent if four drugs are taken chronically, and almost 100 percent with eight or nine drugs.

It is critical that patients review their entire drug list, including dietary supplements, at each visit with their physician or pharmacist. Often, a physician’s role is to educate patients about what drugs not to take, and to de-prescribe drugs rather than add more. A general recommendation for the patient is to take a drug for the shortest time possible and at the lowest effective dose.

Here are a few common drugs and their side effects to watch for:

• Proton pump inhibitors (for example, Prilosec): loss of electrolytes such as potassium, magnesium, calcium; bone loss and fractures; perhaps dementia and kidney disease
• Statins (for example, Lipitor): muscle pain; type 2 diabetes
• Hypnotics (for example, Ambien): delirium, falls, bone fractures, and motor vehicle crashes
• Selective serotonin reuptake inhibitors (for example, Prozac): falls, loss of sodium
• Fluoroquinolone antibiotics (for example, Cipro): Achilles tendon rupture
• Sulfamethoxazole/trimethoprim antibiotic (for example, Bactrim): elevated potassium
• Opioids (for example, OxyContin): addiction, constipation, nausea, dizziness, somnolence

Drug-drug interactions are of significant concern. Alcohol, statins, warfarin, calcium channel blockers, and many additional drugs can affect the metabolism and/or action of other drugs, which can increase or decrease the drug’s effects. The presence of medical issues such as obesity, kidney, liver or heart disease can impact a drug’s action. When in doubt, check with your physician, and never start or stop a drug without his or her knowledge.