One in every five older Americans takes medications that work against each other. That is the conclusion of researchers from Oregon and Connecticut who published their results in the February issue of PLOS One. This "therapeutic competition" – when treatment for one condition may adversely affect a coexisting condition – often results when doctors treat patients' illnesses in isolation. Unfortunately, said David Lee, an assistant professor in the Oregon State University/Oregon Health and Science University College of Pharmacy, even though most physicians are aware of the problem, "there isn't much information available on what to do about it." Should the more serious illness take priority? Can doctors find a way to treat them both? The situation quickly becomes tricky for both doctors and patients.
The situation is just as troubling with mixing over-the-counter vitamins, minerals and supplements and prescription drugs. A study published in the Journal of the Academy of Nutrition and Dietetics found that while there are some well-known bad interactions between prescription drugs and supplements – such as warfarin/Coumadin and vitamin K – others are not so well-known and can pose equally dangerous health risks. "Patients, especially those taking medications or given new prescriptions, should always inform their doctors about what dietary supplements they are taking, and doctors can help patients by asking about their supplements," said Harris Lieberman, the study's senior author and researcher with the Military Nutrition Division of the U.S. Army Research Institute of Environmental Medicine.
"What must we do to make sure that we derive the optimal benefit from the drugs we purchase and consume?" asks Jessie Gruman. She believes the answer has four parts:
- Be far more active in talking with our clinicians about the drugs they prescribe.
- Find an accurate source of information to research every new drug or supplement we take, whether it's prescribed or over-the-counter.
- Take the drugs as directed and talk with our clinicians about the effects.
- Diligently keep track of all the drugs and supplements we use.
"We – patients and families – have the most to gain and the most to lose here," Jessie writes. "Specific attitudes, practices, norms, expectations and training must change – not only ours but those of every other stakeholder whose interests touch drug development and use. Accurate information must be easily findable and usable. And we will need the encouragement and guidance of our clinicians, pharmacists, health plans, the news media and regulators to ensure that we are able to act on our own behalf to sort through the maze of drugs that might help us realize the benefits they promise. This is going to take a long-term commitment by all of us."