Did you know that hundreds of thousands of people are injured or killed every year as a result of the medications they are taking? These incidents are referred to as Adverse Drug Events. An Adverse Drug Event (ADE) is defined as any undesired, negative consequence of taking a medication. More than 700,000 people are injured or die every year as a result of the medication they are taking. This data was collected by a government-sponsored group who has been keeping track of why people visit the Emergency Room (ER). Of the more than 700,000 visits to the ER, about 3,500 people are admitted to the hospital.¹

There are several types of medications this group has identified as being most commonly associated with ADEs. These include insulin , opioid pain relievers, ‘blood thinners’ like warfarin (Coumadin®), amoxicillin, antihistamines and cold products.¹ This does not, however, mean that other medications can not cause an ADE. When taking any medication, you should work closely with your doctor and/or pharmacist to make sure you are using your medication in the safest, most effective manner.

Why Do ADEs Continue to Happen?

There are many reasons that need to be considered. Many times, patients are prescribed medications in the hospital and fail to follow up with their doctor after they are discharged to evaluate the medication. Other times, even though the patient follows up with their doctor, the doctor may not monitor the effects of the medication as closely as they should. Warfarin (Coumadin®) is a good example. Warfarin, a ‘blood thinner’, requires a test called an INR to be performed on a regular basis to make sure it is dosed appropriately for that patient.  Personally, I can’t tell you how many times I’ve seen a doctor in the hospital prescribe a patient ‘warfarin 5mg daily’ at discharge and instruct the patient to follow up with their Primary Care Doctor in 2 weeks. Warfarin is a medication that needs to be monitored closely and for some patients, two weeks is too long. Different people react to warfarin differently. One patient may need 5 or10mg daily. Others may only need 1mg daily. If a person that needs only 1mg daily receives 5mg daily, that person could experience excessive bruising, bleeding, or death.

Other people do not take their medications as they are told. They may decide to increase or decrease their dose on their own, stop taking their medication or take the medication when they didn’t need it. An example of this would be the patient who decides to take their morning dose of insulin , even though they skipped breakfast. This patient could experience a severe drop in blood sugar. This could result in loss of consciousness and/or death.

In other cases, the medication may have interacted with another medication the patient was taking. Most of the drugs mentioned above are subject to very serious drug interactions. For example, taking an antihistamine (like Benadryl®) or opioid product (like morphine) with alcohol can cause excessive sedation and depression of the central nervous system. This could result in a system shut down where the person stops breathing or goes into a coma. Likewise, taking warfarin with certain medications can cause the warfarin to thin the blood too much, causing excessive bleeding and/or death. 

Finally, many ADEs are caused by a reaction to the drug itself. For example, a person who is allergic to penicillin may have an allergic reaction if they take penicillin. Symptoms of an allergic reaction include any of the following: rash, hives, itching, redness, swelling, or problems breathing. Serious allergic reactions can cause death and require prompt medical intervention.

How Can I Avoid Being Another Statistic?

There are some events that can not be avoided. For example, it is hard to avoid an allergic reaction if you do not know you are allergic to the medication. You can avoid further complications from the allergic reaction by stopping the medication and consulting with a health care professional promptly. Also, make sure all of your health care providers, including your pharmacy, have your allergies on file.

To reduce problems with insulin, it is important to know your regimen well. Take the time to talk to your doctor and/or pharmacist and make sure you understand your insulin: how long they act, when you take them, what to do if you take to much or too little. If you find your insulin regimen too confusing or difficult to stick to, talk to your doctor about possibly simplifying it. It is also important to talk to your doctor about special situations where you would need to increase or decrease your insulin dose. Also, make sure you are able to draw up and administer your insulin correctly. There are many unique devices available these days such as pumps and pens to make dosing and administration easier. These principles should be followed for any diabetic mediation whether it be insulin or a pill you take by mouth. Following these suggestions will help ensure you get the most out of your medication while avoiding ADEs.

When taking pain relievers, especially opioid pain relievers like oxycodone , codeine , propoxyphene , or hydrocodone to name a few, one should ‘start low and go slow.’   Work with your doctor on finding the lowest possible dose that is still effective for your pain and remember that it is never a good idea to combine opioid pain relievers with alcohol. Always follow your doctor’s instructions. For over-the-counter pain relievers, or any other over-the-counter medication, never exceed the recommended dosage on the bottle unless instructed by a health care professional.

For other medications that have specific monitoring parameters like warfarin , digoxin , theophylline and phenytoin , make sure that your doctor is monitoring the effects of the medications frequently, at least in the beginning stages of therapy. These medications usually involve monitoring blood tests of some type. Many of these medications will require less testing as you find a dose that works best for you. Warfarin, for example, is an excellent example of a medication that requires extensive monitoring when starting therapy. Ideally, when first starting, your INR should be monitored daily. This part usually takes place in the hospital. After your INR is in the right range,  your INR should be monitored at least once a week until you are stabilized on a dose. Many doctor’s offices are not able to see patients this often. For this reason, many of them refer their warfarin patients to a clinic that does the monitoring for them. These clinics called ‘Coumadin Clinics’ or ‘Anticoagulation Clinics’ are usually run by pharmacists. Having worked at one of these clinics before, I can tell you that they are wonderful and may help decrease the number of ADEs from warfarin therapy. They help make sure the patient gets the monitoring they need. This helps to make sure the patient get the most out of their warfarin regimen while avoiding ADEs.

 For any medication, make sure you take it exactly as prescribed. Talk with your doctor if you want to increase or decrease the dose. Also consult with your doctor before you stop any prescribed medication. Many medications can cause problems if they are stopped abruptly.

Finally, to prevent drug interactions, make sure that each of your doctors and your pharmacist has a list of all of your current medications on file. This list should include any herbal or natural remedies that you take as these can interact with your medications as well. Before taking any over the counter medication or supplement, ask your doctor or pharmacist to review it to make sure it will not interact with any of the medications you are currently on.  

REFERENCES:

1. Budnitz, DS, Pollack DA, Weidenbach KN, et al. national surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006;296:1858-66.