By Joy Stephenson-Laws, JD, Founder

Adverse drug events – harm resulting from medication use – cause more than one million visits to hospital emergency departments each year, according to the Centers for Disease Control and Prevention (CDC).

And if you take medications - prescribed or non-prescribed - you are at risk for adverse drug events or drug interactions. A drug interaction applies to any scenario where “a substance affects the activity of a drug.”

Substances that might affect drug activity include vitamins, certain foods and other drugs. When these substances interact with drugs, the effects of the drugs may be increased or decreased or they may produce an entirely new effect that the drug would not have produced on its own.

Here are some examples of drug interactions:

• Aspirin and blood thinners (like warfarin or Coumadin), which can both be used to help prevent heart attack by stopping blood clots from forming, may cause excessive bleeding if taken together.
• Antacids may prevent antibiotics, blood- thinners and heart medications from being absorbed into the bloodstream.
• Iron supplements may cause antibiotics to not work as well.
• Grapefruit juice may prevent the body from breaking down certain medications, so this means they may stay in your system longer. “Among all fruit juices, grapefruit juice (GFJ) possesses high interaction with almost all types of drugs. The juice modifies the body’s way of metabolizing the medication, affecting the liver’s ability to work the drug through a person’s system, “ according to the National Institutes of Health (NIH).
• Mixing alcohol with drugs, like sleeping pills, sedatives and prescription painkillers, can be very dangerous. This may lead to slow breathing and even complete loss of breathing.

These drug interactions usually occur due to “accidental misuse” or a “lack of knowledge.”

Older people need to especially be proactive about preventing drug interactions, because as we age we tend to take more prescription drugs.

Many older Americans who take prescription drugs may not be proactive about avoiding drug interactions.  

One poll sampled 1,690 adults (ages 50-80) taking one or more prescription drugs. Sixty-three percent of the participants reported taking two or more prescription drugs, and 16% reported taking six or more. And when it comes to filling these prescriptions, 21% have used more than one pharmacy in the prior two years.

“This includes respondents using a combination of mail- order and retail pharmacies, as well as those who filled prescriptions at more than one retail pharmacy,” according to the poll report.

The poll revealed that 90% of the participants felt confident about their personal ability to avoid drug interactions, but the reality was that only 35% had actually talked to someone about drug interactions.

The poll results also discussed varying beliefs about who should be responsible for educating the patient about drug interactions.  

• 11% said the pharmacist is responsible.
• 26% said the doctor is responsible
• 63% said both pharmacist and doctor are responsible.

Notably, no one suggested that the poll participants themselves shared any responsibility for educating themselves.

“Complicating the discussion of possible drug interactions is that respondents often see multiple doctors (69%) and use multiple pharmacies (21%). Only 36% of adults said the pharmacist definitely knows about all their medications when they fill a prescription; another 40% thought the pharmacist probably had that information.”

It is true that many doctors and pharmacists have great tools that make it easier for consumers to be aware of possible drug interactions, including electronic health records (EHRs) and electronic prescribing systems. These systems actually alert healthcare professionals about possible drug interactions. However, it can get tricky when a patient sees multiple doctors and uses more than one pharmacy because not all of these EHR systems are shared.

“In these situations, alert algorithms are less accurate because they may be missing key pieces of information,” according to the poll.

“In addition, many older adults use over-the-counter medications and supplements, some of which may pose a risk of drug interactions; however, information about over-the- counter and supplement use may not be included in electronic drug alert systems.”

So medications require a cohesive, open dialogue and partnership between patient, pharmacist and doctor.

It is also very important for older adults to talk extensively with their healthcare providers about what kind of side effects can occur with the medications they are taking and what to do if they are experiencing any side effects. A common reaction is to just stop taking the medication when they experience side effects, but this is not always the best thing to do.

Some suggestions on how to be proactive about preventing drug interactions?

• Keep your own records. Don’t just leave this up to the healthcare professional. Write down all the medications you take in a notebook or keep an electronic record of both your prescription and over-the-counter medications. If you are very elderly and have trouble with this, ask your children or a capable friend to help you with this.
• Communicate. Never feel like you can over-communicate or as if you are being a pest when it comes to talking about your health. Speak with every healthcare professional you work with (doctors, pharmacists, nutritionists, etc.) about the medications you are taking. Make sure they know specific names and dosages of both prescription and over-the-counter (OTC) drugs. Be sure to also ask about any changes you may need to make to your diet or foods you should avoid. Also discuss possible side effects.
• Watch your alcohol consumption. Alcohol reportedly interacts with more than 150 medications!
• Try to streamline your healthcare. Some people may need to see multiple doctors, but if possible try to use just one pharmacy. This may feel like an inconvenience, but keep in mind how inconvenient it will be if you have drug interactions.
• Test your blood. Some medications require blood testing, in order to ensure you are receiving the right dosage. Over 40% of emergency visits which require patients to be hospitalized are caused by just a few of these prescriptions which require regular monitoring with blood tests, according to CDC. So ask your doctor if you need regular blood testing. Common medications that require blood testing include:
• Blood thinners (e.g., warfarin)
• Diabetes medicines (e.g., insulin)
• Seizure medicines (e.g., phenytoin , carbamazepine)
• Heart medicine (e.g., digoxin)

• Go online. Always speak with your doctor and pharmacist, but you can also do a bit of homework yourself by visiting sites like drugs.com and rxlist.com. These are easy-to-use resources, where all you have to do is enter in the names of the medications and supplements (including vitamins, minerals and herbs) to see if you are at risk for drug interactions by taking them together. But before you take action, always speak with your doctor.

Finally, it is also important to be aware that taking medications generally depletes your body of essential nutrients, such as vitamins and minerals, which may in turn cause certain symptoms or side effects. Talk to your doctor about getting a nutrient test to see if you have any of these imbalances, which may prevent you from being in your healthiest and happiest state.

When it comes to your health, you have to take control and steer yourself in the right direction. And part of knowing the right direction to go, largely depends on you being an informed patient that knows what you are putting into your body and how it may affect you.

Of course, you should listen to your doctor’s orders and take medications when prescribed. But also ask yourself the following: What are the possible side effects? If I am prescribed two or more medications at once, is it safe and effective to take them all together? If I take over-the-counter (OTC) drugs with my prescription drugs, will this make a difference? Have I provided a list of prescribed and OTC medications I am taking, for all of my doctors and healthcare providers? Will my diet have an impact?

If you don’t ask yourselves these questions and communicate with knowledgeable healthcare professionals, you may be at risk of having serious and life-threatening drug interactions.

Enjoy your healthy life!

The pH professional health care team includes recognized experts from a variety of healthcare and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, click here.