Doctors warn of dangerous drug mixes

Lack of knowledge about what patients are taking raises risks of prescribing drugs that could form part of a lethal cocktail.

DUBAI // Doctors are struggling to keep up with what medication their patients are taking, leading to a risk of prescribing drugs that could form part of a lethal cocktail.

Over-prescription and patients’ silence over medication – even those sold over the counter and herbal remedies – is making it more difficult for doctors to ensure they do not cause more health problems.

The national health insurer, Daman, said 700 prescriptions were rejected in the first three months of this year because of risks in mixing them with medication patients were taking.

But this figure is only the tip of the iceberg as Daman has no records of drugs sold over the counter, herbal remedies or supplements.

And the rise of “polypharmacy”, where patients are prescribed at least four drugs to treat chronic conditions, has added to problems in avoiding bad combinations.

“It is the doctor’s duty to select the right medication when it comes to chronic illnesses,” said Dr Ahmed Saleh, consultant internal medicine at Medeor 24x7 in Dubai. “But patients do not always disclose other health supplements they are taking as they are not viewed as medicine by some, so it can be risky.”

Everyday drugs such as paracetamol and aspirin are often taken to treat similar ailments but can react differently to prescription medicines.

Other over-the-counter drugs that can be dangerous include anti-inflammatories, Voltaren and ibuprofen, which can lead to kidney problems, ulcers and internal bleeding.

Herbal remedies, vitamins, garlic and omega-3 fish oil also come with a risk of adverse side effects if taken alsongside certain prescription medications.

“Trust between doctor and patient is very important,” said Dr Saleh. “Doctors should know which drugs reduce the efficacy of other medication. They are like cooks dealing with a recipe.

“It is a challenge, especially with so many new drugs on the market. Awareness from doctors is very important but patients should take a list of drugs they are on to a clinic or hospital when they need treatment.”

Those with illnesses such as diabetes, hypertension or ischaemic heart disease – all of which are common in the UAE – can end up taking a dangerous mix if their doctors do not know what they are using.

Medbase Oy in Finland is providing research to the UAE to help identify dangerous drug combinations.

“When a pharmacy is the only gatekeeper to certain drugs and supplements, a doctor may not always be aware of what a patient is taking,” said Dr Kari Laine, its chief executive.

“There are about 1,600 drugs in our database. I would say less than 10 do not cause drug interactions. Most of them can cause problems when combined with other unsuitable drugs.

“By using electronic health records we can give automatic warnings if a doctor is prescribing something that does not go with other medication a patient may already be taking.”

Dr Jad Aoun, chief medical officer at Daman, said the Pharmacy Benefit Management system, introduced in 2012, is being updated to help identify bad drug combinations.

“The system is implemented across pharmacies for Abu Dhabi Basic plan members and is being trialled at select pharmacies for members of other plans,” Dr Aoun said.

Online support tools are being developed to reduce patient risk by improving the information available to them.

These include portals to share patient information between doctors, hospitals and insurers, and integration with electronic health records to trigger automatic warnings.

“When doctors are prescribing, or pharmacies are dispensing medication, problems can occur,” said Roman Konovalov of Greenrain Healthcare Intelligence in Dubai.

“If it has already arrived as a claim for reimbursement from insurers, it is too late.”

A US national survey of people aged between 62 and 85 revealed that a third of respondents were taking at least five prescription medications, while two thirds were also using dietary supplements and 40 per cent took over-the-counter medication.

The survey was published in April this year in the American Medical Association’s journal of internal medicine.