BE
Healthy ™
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Boston Public Health Commission
VOL. 5 • NO. 1
© October 2010
MEDICATION SAFETY: The dos and don’ts of prescription drugs Timothy Velasquez, 67, is like a lot of people — rarely, prescription drug, almost 90 percent of those 65 years if ever, did he extensively question the details of his and older reported the same. prescription drugs. Multiply the drugs and the gap further widens: 63 If questions were few to his doctor, they were even percent of elderly people versus 11 percent of those 18 less to his pharmacist. “I trusted those guys,” he said. to 44 use three or more prescription drugs. “They put [the drugs] in a bag and I walked out.” Fortunately, Velasquez didn’t become another Velasquez can only shake his head at his past irmajor statistic for a medication mishap. But Velasquez responsible attitude. Especially in light of the fact that he did receive a recent wake-up call. He was prescribed a is on 10 different drugs for heart disease, diabetes, high liquid medication to reduce the potassium levels in his blood pressure and other medical complications. He blood and was given two bottles at his pharmacy. considers himself fortunate. There was only one problem. The plastic cup to Fortunate is right. According to a study published help measure exact dosages was missing. Reading the in the Journal of the American Medical Association in label was of little help. And measurements like “CCs” 2006, more than 700,000 visits to the emergency departfor cubic centimeters merely added to the confusion. ment occur every year due to medication mishaps. And He had no idea what that meant, let alone how to 120,000 of these visits result in hospitalization. Part of calculate it, and that led to the next problem. Velasquez the reason is attributable to the virtual explosion in drug developed his own regimen. usage across America. In fairness, Velasquez was right that he needed to Prescription drugs alone constitute the third hightake the medicine twice a day. But without knowing est national health expenditure in this country, trailing the exact amount, he drank half of the first bottle after only costs for hospital and physician services. The Nabreakfast and the remainder before bed. tional Council on Patient Information and Education, He repeated this regimen the following day. “The a Rockville, Maryland-based nonprofit organization, medicine tasted pleasant,” he explained, “so I did not estimates that more than 3.5 billion prescriptions were make a big deal of it.” written in 2007. But it was a big deal. He wound up taking more Timothy Velasquez took four times the amount of his prescribed medication Some medications in particular have escalated in than four times the recommended dosage — a mishap — fortunately, with no side effects. Velasquez says he now asks questions demand. For instance, the use of antidepressants and about his medication before he leaves the pharmacy. (Ernesto Arroyo photo) that could have resulted in kidney damage, according to antiasthmatic drugs has doubled in the past nine years, Dr. Donney John, the clinical pharmacist at South End while certain medications for high blood pressure and high preceding month, while roughly one-fourth used three or Community Health Center. cholesterol have experienced a five-fold increase. more prescription drugs. Velasquez realized his error when he spoke to his It’s no wonder then that almost half the population The elderly are particularly vulnerable. While only 38 pharmacist. Alarmed, the pharmacist immediately called his reported using at least one prescription drug during the percent of those between the ages of 18 and 44 used one Velasquez, continued to page 4
Easy access belies over-the-counter drugs’ health risks
Over-the-counter (OTC) drugs can interact with prescription medications, food, alcohol and other OTC drugs. Read the drug labels carefully before using.
Stephanie Andrews learned her lesson the hard way. Like most people, the 36-year-old mother of two, who asked that her real name not be used, underestimated the potency and impact of the over-the-counter (OTC) drugs she was taking to relieve her abdominal cramps. Instead of reducing the pain, the extra doses of pain relievers actually added to her misery. Her story starts a few years ago when she suffered a miscarriage. Her doctor offered her two treatment options. One was a surgical procedure; the other allowed nature to take its course
and dispel the tissue. She chose the latter, but that meant a few days of discomfort. Andrews’ doctor recommended 800 milligrams (mg) of ibuprofen every four hours. But Andrews had another idea after her cramps subsided with the help of the first round of ibuprofen pills. She decided to get a head start on her next bout of pain by taking more pills. “I tried to head it off at the pass,” she said. “I was trying to beat the pain.” She decided not to wait for four hours as instructed; she took another 800 mg in two hours — double the recommended dose. She continued her “treatment” for two days. Though she said “it felt good to be without pain,” the plan backfired. What she didn’t know is that stomach and kidney problems are the two main side effects associated with excessive use of ibuprofen. She knows now. “My stomach was cramping even more,” she said. Her doctor was a tad furious and had a few choice words after Andrews confessed. “You’re taking way too much,” her doctor warned. “Stop taking it immediately.” The doctor instead advised her to take acetaminophen, another pain reducer. “But take it as prescribed,” she said. Andrews says she has learned her lesson. “I still take ibuprofen as needed,” she said. “But I definitely watch how I take it.” Misuse of OTC drugs has not received the amount of at-
tention as prescription drugs but they are far from harmless. Part of the problem is that doctors are taken out of the process. Consumers instead diagnose their own problems, and then selfmedicate — all without the benefit of any medical education. Indeed, OTC drugs are readily available for all to use, but that does not mean that all should readily use them. It is a common misperception that OTC drugs are not powerful and do not require the same attention to detail as prescription medications. Not so. Many OTC drugs were at one time available only through a provider’s orders. The Food and Drug Administration (FDA) regularly evaluates the safety of prescription drugs and their ability to transition from prescription-only to OTC status. Between 2001 and 2009 the FDA approved that transition for almost 30 medications. Some drugs that have made the switch are well known: the antihistamines Claritin-D and Zyrtec and the acid reducer Prevacid 24 HR. Ibuprofen, a common pain killer, got its walking papers about 20 years ago. There’s one catch though. That switch and the resultant ease of access did not reduce their potency. A practical way of viewing all OTC drugs, including vitamins and herbal supplements, is that any product that changes the way your body works or treats a condition is a drug. But how can an untrained person make such an important OTC drugs, continued to page 4