Common scenario: You swallow the two pills your doctor has told you to take daily. One is supposed to help, say, your heart, and the other addresses a problem with your lungs…and each drug does do what it’s supposed to do. So what’s the problem? That heart pill could be worsening your lung condition—and that lung pill could be harming your heart!
Sadly, this situation is all too common, and it’s not limited just to patients with heart and lung ailments. Three-quarters of older Americans have more than one chronic medical problem (for instance, diabetes and osteoporosis…or arthritis and atrial fibrillation). When researchers looked at the 14 most common chronic conditions, they discovered that more than half of the drugs used to treat one chronic condition could adversely affect another chronic condition.
Here’s what you need to know about how your medications might be working against each other—and against you…
Therapeutic competition is the term doctors use to describe the situation when a drug helps one medical condition while worsening another. To find out how significant this problem is, researchers evaluated two years’ worth of data on 5,815 Medicare recipients age 65 or older. The researchers determined the most common chronic conditions for which at least one oral or inhaled prescription medication is recommended according to standard professional guidelines…and then they interviewed the participants to identify which medications were being used. (Only prescription medications that were recommended by professional guidelines were considered for this analysis.)
The 14 most common nonmalignant chronic conditions included atrial fibrillation…benign prostatic hypertrophy (enlarged prostate)…chronic obstructive pulmonary disease (COPD)…coronary artery disease…dementia…depression…gastrointestinal esophageal reflux disease/peptic ulcer disease (GERD/PUD)…heart failure…hyperlipidemia (high cholesterol)…hypertension (high blood pressure)…hypothyroidism (low thyroid)…osteoarthritis…osteoporosis…and type 2 diabetes. These 14 chronic conditions can form 91 possible pairs of coexisting conditions. Of course, some people have more than two such conditions, but for the sake of this study, the researchers focused on pairs of conditions.
Scary statistics: The researchers discovered that…
• Of the 27 classes of medication considered in this study, 56% of those recommended for one of the chronic conditions listed above could adversely affect another chronic condition.
• Of the 91 possible pairs of chronic conditions studied, 28% had at least one potential therapeutic competition.
• 78% of study participants had at least one pair of coexisting chronic conditions…31% had at least 10 possible pairs of conditions.
• Among the participants, 23% received at least one medication that could worsen a coexisting condition…and 8% were taking medications for three or more pairs of competing conditions.
Example #1: More than 3.5 million older Americans have both hypertension and COPD. In this study, among participants with that pair of conditions, 40% used a COPD medication that could worsen their blood pressure…and 16% used a blood pressure medication that could worsen their COPD.
Example #2: Another competing pair of conditions, coronary artery disease plus GERD/PUD, affects about 1.9 million American adults. Among participants in this study who had both these conditions, 27% were taking the anticlotting drug clopidogrel (Plavix) to reduce the risk for heart attack or stroke—but this same drug can increase the risk of bleeding from an ulcer.
BALANCING RISKS AND BENEFITS
Don’t doctors take the risk of therapeutic competition into consideration when prescribing drugs? Not often enough, it appears. If they did, you would expect to see potentially harmful medications used less often among patients with competing conditions than among patients without those competing conditions—but the researchers found that this occurred in only 16% of cases. And, shockingly, in 14% of cases, the opposite occurred—participants who had a competing condition were more likely to receive the potentially harmful medication than participants without the competing condition!
Bottom line: When considering whether to use a given medication, doctors and patients need to consider the drug’s effects as a whole, not just its effects on the condition it is meant to treat. Electronic medical records software helps point out drug interactions (when two drugs adversely affect each other) but does not alert doctors to the problem of therapeutic competition. This is an enormous issue that needs to be fixed as soon possible. For now, we are dependent upon real live people to spot these potentially dangerous competitions.
Self-defense: You probably see various specialists for your various conditions, but you still need a general doctor, such as an internist or geriatrician, to be the “manager” who oversees all of your care and takes primary responsibility for spotting instances of therapeutic competition. And you must talk to this doctor about any new prescription you are offered. It’s also vital to tell all of your doctors about all of the conditions you have and all of the medications you use. Whenever a drug is prescribed, ask whether there is a drug-free treatment or alternative medication that would be safer and wouldn’t interact with any of your other medications or worsen any coexisting condition. It also may be helpful to have all of your prescriptions filled at the same pharmacy, preferably a local one where the pharmacist knows you—so you can ask him/her to keep an eye out for any instances of therapeutic competition.