Most common drugs tied to ER visits by Jenifer Goodwin, HealthDay on
Nov. 25, 2011, under USA Today News

An estimated 100,000 older Americans are hospitalized for adverse drug
reactions yearly, and most of those emergencies stem from four common
medications, a new study finds.

The four types of medication — two for diabetes and two blood-thinning
agents — account for two-thirds of those drug-related emergency
hospitalizations.

“Of the thousands of medications available to older patients, a
small group of blood thinners and diabetes medications caused a high
proportion of emergency hospitalizations for adverse drug events among
elderly Americans,” said lead study author Dr. Daniel Budnitz, director
of the U.S. Centers for Disease Control and Prevention’s medication
safety program.

Medications previously designated “high-risk” were implicated in
only 1.2 percent of hospitalizations, the study found.

Working with a nationally representative database, CDC researchers
identified more than 5,000 cases of drug-related adverse events that
occurred among people aged 65 and older from 2007 to 2009 and used that
to make their estimates for the whole population.

Nearly half (48 percent) of the hospitalizations occurred among adults
80 and up, according to the study, published in the Nov. 24 issue of
the New England Journal of Medicine. Nearly two-thirds (66 percent)
were the result of unintentional overdoses.

The four medications, used alone or together, most often cited:

The blood thinning medication warfarin (Coumadin, Jantoven), which
is used to treat blood clots, was involved in 33 percent of emergency
hospitalizations.

Insulin, used to control blood sugar in diabetes patients, was involved
in 14 percent of cases.

Antiplatelet drugs such as aspirin and clopidogrel (Plavix), which are
used to prevent blood clots, were involved in 13 percent of cases.

Oral hypoglycemic agents — diabetes medications taken by mouth —
were involved in 11 percent of cases.

With antiplatelet or blood thinning drugs, bleeding was the main
problem. For insulin and other diabetes medications, about two-thirds
of cases involved changes in mental status such as confusion, loss of
consciousness or seizures.

“These are important findings,” said Dr. Michael Steinman,
an associate professor of medicine in the division of geriatrics at
the University of California, San Francisco, who is familiar with the
research. “This study highlights a few key issues that are important for
doctors and patients to be aware of. The first is that serious adverse
reactions to drugs are common among older people, particularly among
people over 80. But even those 65 and older are at substantial risk of
having an adverse effect from their drugs.”

One challenge for doctors and patients is that the medications may be
necessary, Budnitz said.

“These are often critical medicines for patients’ health,” he
said. “Patients who are on these medicines should tell all their
doctors what they are taking and work together with their doctors and
pharmacist to make sure that they are taking these medicines correctly.”

Among U.S. adults aged 65 and up, 40 percent take five to nine medications
and 18 percent take 10 or more, according to the study authors. Prior
research has also found that older adults are nearly seven times more
likely than younger people to have an adverse drug event that requires
hospitalization. “As most people age, there often are changes in how
their kidneys, liver, heart, and other organs work that can make them
more susceptible to adverse drug events,” Budnitz said.

And though taking lots of pills raises safety issues, in 82 percent of
cases the treating physician attributed the overdose to a single drug,
Budnitz added.

To reduce risks, Steinman said doctors and patients need to discuss
whether the drug is truly necessary. For people with very high blood
pressure or blood sugar, “the answer is almost always ‘yes,’
you should treat it,” Steinman said. “But if you have only mildly
elevated blood pressure or blood sugar, the benefits of treating it
versus the harms start to shift. Do these drugs really provide enough
benefit that it’s worth taking them?”

Physicians and patients need to consider a person’s age, overall health,
other medications they take (keep a list including dosages) and patient
preference, such as how easy they find it to keep track of blood sugar
and dosages, he said.

With anticlotting or blood-thinning agents, stopping them is probably
not an option, Steinman said. So patients need to be attuned to any side
effects they experience, even if they seem minor. Catching side effects
early can prevent more serious problems later on, and doctors may be
able to change the medication or lower the dosage, he said.

—-

Copyright 2011 HealthDay. All Rights Reserved.

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