RX ROULETTE; SOME DRUG COMBINATIONS HAZARDOUS TO YOUR HEALTH.

Byline: Carol Bidwell Daily News Staff Writer

Her late husband, Harry, had been battling bone cancer for three years, so Ruby Pickett wasn't surprised when his doctor prescribed still another medication for him to take.

They made the all-too-familiar trek to the pharmacy.

But she remembers vividly the warning flashing on the pharmacy computer screen when the pharmacist typed in the name of the new drug. It cautioned that taking it, along with drugs her husband had already been prescribed, could cause a dangerous reaction.

``The pharmacist called the doctor to tell him you couldn't take those drugs together,'' said Pickett, 77, of Canoga Park. ``You'd think the doctor would know that. It worried me a lot.''

The Picketts' experience is not an uncommon one, according to the National Center for Health Statistics. It estimates that more than 9 million adverse drug reactions occur annually among older Americans, whose aging bodies often don't process medicines as efficiently as when they were younger.

Seniors are at greatest risk for drug interactions because, while people 65 and over account for only 11 percent of the population, they consume 25 percent of prescription and nonprescription drugs, with each senior taking an average of 10 to 20 prescriptions and over-the-counter medications, said the NCHS.

The result of a drug interaction can range from drowsiness - a common problem - to more serious health problems. Rarely, death can even occur from drugs that don't mix safely; the National Center for Health Statistics said that about 150 Americans died in 1995 from drug interactions.

But drug interactions can cause other damage. Some 32,000 elderly people who suffer hip fractures in falls each year and 16,000 more who are hurt in auto accidents have had these incidents traced to an adverse drug reaction, according to the NCHS. The agency estimates that medication problems cause as many as 17 percent of hospitalizations among seniors, resulting in medical costs the U.S. Food and Drug Administration says top $20 billion annually.

The problem of drug interactions is especially acute when cold and flu sufferers run the risk of mixing over-the-counter drugs that either shouldn't be used together or with prescribed drugs, said William I. Bergman, president of the New York City-based Council on Family Health, a nonprofit educational group funded by the drug industry.

The best advice: Read the label and use common sense. The label on a bottle of cough syrup, for example, will tell you whether there are other medications it might interact with, Bergman said. And common sense should tell you if you're taking an all-in-one medication that relieves congestion, soothes coughs and eases muscle aches, you shouldn't also take cough syrup, decongestants or aspirin, he said.

Let the doctor know

Patients who don't tell their doctors all the medications they're taking risk serious interactions, said Dr. Spasoje Neskovic, chief of family practice at Glendale Memorial Hospital.

He estimated that the older patients he sees take an average of four to six prescription drugs - most for high blood pressure, heart disease, chronic lung disease, diabetes, anemia or to ease the symptoms of menopause - and three or four over-the-counter drugs.

``They don't tell us a lot of what they buy at the drugstore,'' he said. ``Some of them can get so ill from taking over-the-counter medicines, they end up in the hospital.''

Most reactions to mixing medicines aren't that dramatic or dangerous, but combining the wrong drugs can cause acute allergic reactions such as itching, hives, rashes and - in a few cases - breathing problems.

``Medicine causes many more problems than people think,'' Nescovic said. ``We need to weigh the side effects against the beneficial effects.''

Even if doctors are careful about what they prescribe, patients can cause problems when they don't follow instructions.

``Humans just don't follow directions,'' Neskovic said. ``If you order medications four times a day, more than half don't take it correctly - 70 (percent) to 80 percent of patients will take that medication once a day. Thirty percent will never get the prescription filled.''

Pacific Care/Secure Horizons says up to half of the nearly 2 billion prescription medications taken in the United States annually are used improperly.

It's often difficult for a doctor to determine how well a patient has complied with directions because many people are embarrassed to admit that they haven't been following orders.

``It should be teamwork between the patient and the doctor,'' Neskovic said. ``After all, we see a patient for only a few minutes, but a patient lives with himself 24 hours. So 80 percent of the treatment is up to the patient.''

One of the problems with drug side effects or interactions is that new medicines are being developed and approved for use by the FDA faster than most doctors can keep up with them, Neskovic said.

That's where the pharmacist comes in.

Red flag goes up

Most pharmacies - even small neighborhood drug stores - have computer software that will send up a red flag when a drug interaction is detected, said Barry Keane, pharmacist at Northridge Pharmacy.

``But the key thing is that a patient has to get all their prescriptions at one pharmacy. If not, an interaction can be missed.''

An interaction is even more likely if a patient has more than one doctor prescribing medication.

Keane said his pharmacy's computer picks up potentially harmful interactions in approximately 5 percent to 10 percent of prescriptions filled, triggering a phone call to the doctor, who usually modifies a dosage or orders a different medication.

Pharmacist Mark Shinmoto, who discusses potential drug interactions with seniors as part of the Pacific Care/Secure Horizons health program, said he understands why patients are often confused about medications, and pharmacists try to offer information doctors don't or can't provide.

``I think part of the problem is that physicians don't have the time to spend to talk to their patients about their medications,'' he said. ``And people aren't prepared when they go to the doctor. One woman told me when she sees her doctor, she forgets all the questions she wanted to ask him.''

That's why patients should write down their questions and concerns before visiting their doctor and, during the visit, make notes on the doctor's diagnosis, the medications he prescribes and other directions.

``If you don't know what you're taking these medications for,'' Shinmoto said, ``how can you be compliant?''

Avoid problems with your pills

Here are some tips from doctors and pharmacists that will help avoid drug interactions:

When your doctor prescribes a drug, ask him what it will do for you; how, when and how long to take it; and whether there are any side effects.

Write down all the medications you take, including over-the-counter medicines, and take the list with you when you go to the doctor. Ask your doctor before trying herbal remedies.

Get all your medications from the same pharmacy so the pharmacist can tell if a prescribed drug may cause an interaction with another medication you're already taking. Make sure your pharmacy has a built-in warning system on its computer to flag drug interactions.

Carefully read the labels on over-the-counter drugs and the package inserts in prescription medications for drug-interaction warnings and dosage information. If the print is too small, use a magnifying glass, or ask someone to read it to you.

Buy an inexpensive pill container with separate compartments for days of the week and/or times of day, and portion out your medications.

Take medicine with a full glass of water, unless otherwise directed by your doctor or pharmacist. Don't take medicines with a hot drink because the heat may alter the effects of the drug. Never wash down medicine with alcohol.

Don't stir medicine into food or take apart capsules without a doctor's approval, because it may change the way the medicine works.

Ask your doctor or pharmacist whether your medicine requires special handling or storage.

Source: American Academy of Family Physicians 

Common drug interactions

Here are some of the most common drug interactions to watch out for, according to health experts:

Patients taking Coumadin, a blood thinner often prescribed for heart patients, shouldn't take aspirin, also a blood thinner, for a headache because the combination could cause internal bleeding.

A woman taking birth control pills could find herself pregnant if she takes an antibiotic, which lessens the effects of the contraceptive. A backup method of birth control is recommended while the antibiotic is being taken.

Taking calcium along with an antibiotic blocks the effects of the antibiotic.

Taking protease inhibitors for AIDS with antifungal medications could lessen the effects of the protease inhibitors.

Taking an acid-blocker with a blood thinner can increase the effect of the blood thinner.

Antacids and laxatives could reduce absorption of other medications.

Alcohol can dangerously intensify the effects of sleeping pills and seizure medications.

Drinking grapefruit juice could prove deadly for patients who take blood pressure or cholesterol-lowering medications, blood thinners, anti-rejection transplant drugs or some anti-depressants because the juice greatly magnifies the effects of those drugs.

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Find out how to avoid dangerous drug interactions

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