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Multiple medications can add to health risks

Alex Lokeno studied the collection of blood pressure medicines, vitamins, dietary supplements, cholesterol-lowering drugs, sleep aids and pain killers arrayed on the table before him.

"How's your liver?" the Central Point pharmacist asked the man sitting on the other side of the table.

Lokeno was looking for medicines that might interact badly when taken together, or supplements that might compromise one of the man's medicines, or pain killers that might overload his liver. He'd come to the Southern Oregon Research and Extension Center to help people learn how to avoid hurting themselves with the medications and supplements that are supposed to make them feel better.

Managing medications becomes more challenging as people take more drugs, vitamins and supplements. The task can be more daunting as people age, because their ability to think clearly and follow directions diminishes even as the number of medicines they take increases.

These days the average person over age 65 takes somewhere between 16 and 19 medicines, when dietary supplements, medicinal herbs and over-the-counter remedies are counted along with prescription drugs, said Sharon Johnson, assistant professor in family and community development at Oregon State University Extension.

"The more you take, the more your risk of drug interaction increases," Johnson said during a presentation last week at the Extension Center.

Older adults' metabolism tends to be slower, which means drugs stay in the body longer. As a consequence, seniors often need less medicine than younger adults being treated for the same condition.

"The dosage for people over 65 might be one-third to one-half of what people take at 40," Johnson said.

Pharmacists and physicians can help people uncover potential problems with their medicines, but they need to know their patients' full list of medications and supplements as well as their habits, Johnson said. Drinking lots of coffee, for example, could cause problems because of the large amount of caffeine that it contains.

"Share your story," Johnson told an audience of mostly seniors. "Your pharmacist or your doctor is not going to know you drink 15 cups of coffee a day unless you tell them, or that you drink wine with dinner every night."

Johnson said several common problems have emerged from studies of how people use medicines. Perhaps the most surprising finding is that many people simply don't take the medicines their physicians prescribe.

"Seventy percent of the people with arthritis don't take their medications," Johnson said. "Fifty percent of the people with diabetes don't take their medications."

Others take more medicine than their physicians prescribe, on the theory that "if one works, then two will work better."

That could be a serious problem with over-the-counter pain medicines such as Tylenol.

"At some point (usually about 4 grams per day) it becomes toxic to your liver," Lokeno said.

Johnson said people react differently to drugs, and everyone needs to be aware of the potential for an adverse reaction. True drug allergies usually announce themselves with major symptoms such as a rash on the trunk, a swollen tongue or troubled breathing, and the drug should be stopped right away. Milder side effects, such as drowsiness, can often be worked around.

The chance of having an adverse reaction increases with the number of medicines in a person's daily pill box. Johnson said people who take as few as two medicines still have a 5.6 percent chance of having an adverse reaction of some kind, and 50 percent of those who take five medicines are likely to have some kind of reaction.

The odds increase to 100 percent when someone takes eight or more drugs, Johnson said.

Foods can interact with medicines, too. Johnson said researchers have found that eating grapefruit or drinking grapefruit juice alters body metabolism. Some drugs persist longer in the body, but others clear out faster. Ordinary milk can cause problems, too - the calcium compromises some antibiotics.

Johnson said people can protect themselves against "medication jeopardy" by consulting with their physicians and pharmacists and giving them all the information they need.

"If you understand the risk," she said, "you can reduce the risk."

What to ask your doctor

To stay informed about your medications, Sharon Johnson suggests asking your physician or pharmacist these questions whenever you start a new medicine.

- What is the name of this medication? Is this the drug company's brand name or the generic name?

- What is this medication for?

- How much of it and how many times per day will I be taking it?

- What foods, drinks, other products or activities should I avoid while taking this medicine?

- What side effects, if any, might I experience? What should I do if they occur?

- Are there any special instructions for storing this medicine?

- What should I do if I miss a dose?

- Is there any written information available for this medicine?

Reach reporter Bill Kettler at 776-4492, or e-mail bkettler@mailtribune.com.