Know the risks: understanding possible drug interactions

This article was written for our sponsor, Cape Fear Valley Health.

Drug interactions can have long-term effects, but what can we do to prevent them?

There are hundreds of thousands of medications out there – both prescription and over-the-counter, not to mention the wide variety of dietary and herbal supplements available. Add to that the fact that some interactions are actually caused by food or drink, and it can feel nearly impossible to feel safe when taking multiple pills or medications per day.

Cape Fear Valley Health System pharmacist Autumn Mittleider explained the basics of drug interactions.

"A drug interaction is an adverse reaction that occurs when a medication interacts with either another medication, food, drink or herbal supplement," she said. "Some are more serious than others, so it's important to be aware of any potential interactions before they occur."

Types of Drug Interactions

There are three primary types of interactions, all of which can be serious.

• Drug+Drug Interaction – These occur when two or more medications or supplements react with one another.
• Drug+Food/Drink Interaction – These result when a drug reacts with a certain food or beverage. Most of us know that alcohol can react with many drugs, but did you know interactions can also occur with everyday grocery items such as milk, grapefruit juice, bananas and even leafy vegetables?
• Drug+Health Condition Interactions – When a medication interacts with an existing medical condition, unwanted side effects may occur that can range from inconvenient to downright dangerous.

Effects of Drug Interactions

Some interactions are certainly more serious than others, but there are also differing effects that occur when drug interactions happen.

• Interaction can cause the drug to become less effective. A common example of this is the interaction that occurs when you combine certain antibiotics and birth control, which can cause the contraception to lose its efficacy.
• Interaction can cause the drug to become over-effective or toxic. When two substances combine and there is an increase in one drug's effect, serious interactions can occur. For example, when you combine a statin medication with grapefruit, the statin level is increased, which can lead to severe muscle pain and liver problems.
• Interaction can cause unwanted side effects. Many medications used to treat blood pressure (including ACE inhibitors and potassium-sparing diuretics) can interact with foods that are high in potassium, such as bananas. The unwanted side effects that occur in this instance are severe muscle weakness, slowed heart rate or heart palpitations/irregular heartbeat if the potassium level gets too high.
• Interaction can have an additive effect. This is when two medications have similar side effects or affect similar parts of the body, resulting in additive effects. For example, taking an opioid medication with Bendadryl can result in significantly increased drowsiness.

The Keys to Preventing Interactions

"Limiting your risk and avoiding drug interactions isn't always easy," Mittleider said. "However, there are several key things I encourage my patients to do to limit their risk."

Keep an updated medication list. Your physicians play an integral role in helping you avoid drug interactions, but they can only do this if they know everything you are taking.

"I tell my patients to bring an updated medication list to every doctor's appointment and every visit to the pharmacy," Mittleider said. "Keep it as detailed as possible to include the medication, dose and what it's used for. Also, don't forget to include supplements, vitamins and herbals in your list, especially those you take regularly."

Get all medications from one pharmacy. "This is by far the most important thing you can do to reduce your risk of experiencing a drug interaction," Mittleider urged. "You may have multiple physicians and health conditions, so you can't always rely on your primary care provider to catch potential interactions. Getting every medication you take from the same place is a critical safeguard, as pharmacies have sophisticated software that can flag potential problems before they occur."

Educate yourself. "While it can feel overwhelming, some of the responsibility also falls on you as the patient," Mittleider explained. "Read your patient leaflets that come with your prescriptions, maintain an active and accurate medication list, ask questions of your doctors and pharmacist and when in doubt, you can use an online drug interaction checker such as Epocrates or MedScape to identify potential issues that you can discuss with your healthcare team. With that said, never stop taking a medication without first talking to your physician."

Preventing drug interactions is an important step to maintaining your health and well-being.

Mittleider concluded with this advice, "Build a relationship with your pharmacist – one where you feel comfortable asking questions and confident that they are working to keep you safe from interactions."

This article was written for our sponsor, Cape Fear Valley Health.