Monday, January 19, 2009

Polypharmacy II


A new study has come out from the United States. I am going to try get my hands on it. The American health care system is different than ours, with more options and opportunities to access health care, but there are lessons from this study on polypharmacy.

They looked at the drugs people of various ages were taking. They found a huge number were taking more than 3 drugs (polypharmacy) but many were taking over-the-counter drugs that were contraindicated by the prescription drugs.

The Ontario Government recommends that seniors be monitored carefully to determine if polypharmacy is an issue causing more harm than good. Dr. Holly M. Holmes (Holmes, et al., 2006 and 2008) have done much research in this area. There are questions we must ask regarding polypharmacy. Many studies exist, but many more exclude seniors in their study population. This includes self-medications, prescriptions, as well as chemotherapy treatments and radiation.

www.heartandstroke.ca
The Heart & Stroke Foundation recently released a warning and estimates that 175,000 Canadians are taking a combination of blood-pressure drugs (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers - ACE & ARB) that can trigger severe heart and kidney problems. If this is the case for you, you should go directly to your doctor.

The Ontario government has a program whereby they pay for pharmacists to sit down with patients and talk about their prescribed drugs. This is the time that many can determine contraindications and the impact of polypharmacy. It is meant to help those who are not taking their drugs properly or are mixing drugs from various medical practitioners , i.e., clinics, emergency room, family physician.

Many seniors are vulnerable for this. It is important that older seniors be counselled, since many mistake or misunderstand what they have been told by pharmacists or family physicians. I know I have to write down information from the doctor quite carefully.

What I heard about, in a CBC interview (with Dr. Peter Lin), was that there are contraindications that are missed when people take blood thinners, or combine prescriptions with herbal or folk remedies. There are many risks to this practice. Consumers must be careful.

One big concern is when you take anti-inflammatories and combine this with aspirin. Another example: if you take antidepressants they can have strong interactions with St. John's Wort.

It behooves the patient, and their families, to take the print out from their pharmacy, and write down all of their other supplements: whether they be vitamins, or minerals, as well as the other chemicals they take, and speak to both their physician and their pharmacist.

While advanced age is not a contraindication to chemotherapies and other treatments, we must be vigilant in determining the risk versus reward of treatment, based on studies that tend not to include older patients. The toxicity of chemotherapy presents great risks for those already frail and dosages must be carefully prescribed.

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