Health experts have issued a warning to Britons taking multiple medications after a survey found one in two people were unaware of the potentially harmful side effects.
New Data Take care Half of Britons are unaware of the side effects of the combinations of medication they take, with drugs to treat common ailments such as high blood pressure, heart disease and blood sugar control all known to have potentially life-threatening side effects.
In light of this research, GB News asked Carolina Goncalves, head of drug management at Pharmaca, to list the most “dangerous” combinations.
According to pharmacists, “some dangerous combinations can affect the majority of people,” she told GB News.
The worst culprits are:
Anticoagulants and NSAIDs
As the name suggests, blood clotting inhibitors reduce blood viscosity and stop it from clotting, preventing blood clots and treating conditions such as thrombosis (blood clots).
“There is a risk in combining non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen with blood thinners because NSAIDs affect platelets,” Gonsalves told GB News.
According to the pharmacist, because platelets are crucial in forming blood clots, combining anticoagulants with NSAIDs can significantly increase the risk of gastrointestinal bleeding.
Research uncovers some scary stories. A meta-analysis published in the journal Thrombosis and Hemostasis They concluded that patients taking NSAIDs in combination with warfarin, a commonly prescribed blood thinner, were at “substantially increased” risk of bleeding compared with patients taking warfarin alone.
“It is important to caution patients about the combined use of these medications,” the researchers wrote.
Anticoagulants and antibiotics
Antibiotics work by killing bacteria or inhibiting their growth.
According to the online pharmacist, taking antibiotics in combination with blood thinners such as warfarin can “alter the metabolism of the blood thinner, increasing its efficacy and making you more susceptible to excessive bleeding.”
In one study, American Journal of MedicineStudies have shown that patients on warfarin therapy who were exposed to high-risk antibiotics were 50% more likely to experience serious bleeding events compared with patients taking low-risk antibiotics.
Azithromycin, an antibiotic used specifically to treat lung and chest infections, was associated with a nearly doubled risk of serious bleeding events, while trimethoprim-sulfamethoxazole (TMP-SMX), used primarily to treat bladder infections, was associated with a more than doubled risk of bleeding, the researchers said.
Although many patients think that the drug interaction is only caused by the pill, topical antibiotics can also be absorbed into the bloodstream and interfere with warfarin. This includes ointments, creams, and suppositories.
“A common cause of elevated INR is antifungal creams prescribed for women with vaginal candidiasis,” explained Lynn Ortel, MD, of Massachusetts General Hospital.
Doubling down on opioids
Opioid drugs such as diazepam are prescribed to reduce the perception of pain, and because they often produce a feeling of euphoria or pleasure, they are highly addictive.
Taking two or more opioids together can have “deadly effects because each opioid compound potentiates the effects of the others, leading to excessive depression of the central nervous system,” Gonsalves said.
She told GB News: “This can cause breathing rate to drop significantly to dangerous levels and can lead to respiratory arrest.”
Combining opioids with benzodiazepines, a type of sedative used to treat anxiety and insomnia, can be particularly dangerous.
U.S. Food and Drug Administration (FDA) review It found that the increased use of opioids in combination with benzodiazepines or other drugs that depress the central nervous system (CNS) was causing serious side effects, including difficulty breathing, difficulty breathing, and death.
Similarly, the UK’s medicines regulator, the Medicines and Healthcare products Regulatory Agency, has warned that combining benzodiazepines with opioids can cause “respiratory depression” that can be fatal if not recognised in time.
Respiratory depression (hypoventilation) means breathing is too slow or shallow, leading to a buildup of carbon dioxide in the blood (hypercapnia).
Calcium channel blockers and beta-blockers
Calcium channel blockers are prescribed to slow the heart rate and dilate the arteries, lowering blood pressure.
Gonsalves warned that these effects could be “exacerbated” when calcium channel blockers are combined with beta-blockers, which are also designed to slow heart rate and blood pressure by blocking the action of the hormone epinephrine (adrenaline).
“This can cause your heart rate and blood pressure to drop too much,” she told GB News.
According to the National Institute for Health and Care Excellence (NICE), verapamil, a commonly prescribed calcium channel blocker, should not be prescribed alongside beta blockers because it can cause an abnormally slow heart rate, cardiac arrest (where the heart stops beating), severe hypotension (abnormally low blood pressure) and heart failure.
What else should you avoid?
Furosemide/Indapamide
Taking indapamide in combination with furosemide, a drug used to treat heart conditions such as heart failure and high blood pressure, can cause a sudden drop in blood pressure, and patients should maintain constant fluid intake, said Peter Tonoia, a prescribing pharmacist and chief product and innovation officer at Pill Time.
“For example, if an older adult taking one of these drugs sweats more than usual, they could quickly develop a condition in which their blood pressure becomes very low, dramatically increasing the likelihood of them falling,” he warned.
Metformin and Furosemide
Tonoai explained, “The type 2 diabetes drug metformin can also cause a condition called lactic acidosis if a patient becomes dehydrated. This can make patients feel tired, weak, have burning muscles, nausea and cramps. It is fair to say that older adults taking both metformin and furosemide are at increased risk if they become dehydrated, increasing their risk of falls.”
Antihistamines (for hay fever) and sedatives or benzodiazepines
Hay fever sufferers are suffering from numerous “pollen bombs” this summer, and Peter warns that those who are also taking several other medications need to be careful with their hay fever medication.
“Many of the active ingredients in hay fever medications belong to a group of drugs called antihistamines,” Peter said, adding: “These are very effective at reducing hay fever symptoms but are known to cause drowsiness, some more than others.”
“If you’re unsteady on your feet and are taking other sedating medications alongside your hay fever medication, you could be at immediate risk of falling.
“Benzodiazepines, such as temazepam, loprazolam, lormetazepam, diazepam and nitrazepam, which are often prescribed to reduce anxiety and promote calm, relaxation and sleep, can have side effects such as drowsiness and confusion, so these medications should also be used with caution when combined with antihistamines.”
Oral decongestants (pseudoephedrine) and antidepressants
Peter highlighted that antidepressants, which the NHS says are taken by 8.6 million people in the UK, can interact with common over-the-counter medicines, with potentially dangerous consequences.
“Selective serotonin reuptake inhibitors (SSRIs), which are used to treat depression and anxiety, can also cause drowsiness, confusion, and slowed reaction times. Fluoxetine is a very well-known SSRI. Other SSRIs include citalopram (Cipramil), escitalopram (Cipralex), paroxetine (Seroxat), and sertraline (Lustral),” he explained.
Pharmacists say that other drugs found in cold and flu medicines can interact with some antidepressants. For example, taking a selective SSRI antidepressant with an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia, and affect blood pressure. People who are unaware of this can exhibit very strange behavior that can be disturbing to them and those around them.
Who is most at risk?
Data from TakingCare shows that the average 70-year-old in the UK takes around eight different medicines per day, with older people being particularly at risk of facing serious side effects.
Responding to the findings, Lauren Flake, aged care specialist at TakingCare, said: “Our experience with older people shows that those who experience confusion and delayed reactions are at higher risk to themselves – this means they may not understand their surroundings and put themselves at unnecessary risk, and in more severe cases, they may leave injuries or wounds unattended, with dangerous consequences. This can be even more dangerous for those with dementia or Alzheimer’s.”
“The emergency alert service helps monitor patients who are taking multiple medications and response teams will be on the lookout for common side effects. It’s also important that families are aware of potential side effects and signs to look out for.”
“For example, a patient who is suddenly confused by the medication may become unnaturally irritable or aggressive. Their personality may change, they may speak incoherently, or they may have trouble concentrating on conversations.
“Extra care should be taken around anyone showing these symptoms as there may be a risk of accidents, so check your home for tripping hazards and poorly lit stairs. It may sound simple, but simple things like making sure rugs have tape on the corners and that there are non-slip mats in the bathroom and kitchen can make a big difference to preventing accidents in the home.”
“While the increased risk of falls can be worrying for patients’ families who are unaware of this information, the important thing is that there are simple preventative measures that can be taken to reduce a patient’s risk of falling. By taking simple preventative measures early on, patients and their families can ensure that their seniors can live independently and safely at home for longer.”
