A/Prof Sarah Hilmer: Problems with multiple medicines (II)
Listen to patients and health professionals speak about their experience with taking multiple medicines.
A/Prof Sarah Hilmer
Main occupation: Clinical pharmacologist
Years in clinical practice at interview: 16
Qualifications: BScMed (Hons), MBBS (Hons), FRACP, PhD
Associate Professor Sarah Hilmer, clinical pharmacologist and geriatrician, describes some of the problems with multiple medicines that can mean people have to go to hospital.
Associate Professor Hilmer:
When it comes to actual problems from having multiple medicines, the more medicines you have, the more likely you are to have an adverse drug reaction, the more likely you are to have a drug–drug interaction and also what we call a drug–disease interaction. So, you have a medicine prescribed for one of your diseases, but actually it affects another one of your diseases quite badly. The more medicines you are on, the more likely you are to have what we call ‘inappropriate prescribing’. So you’re more likely to be on a medicine that you don't need or is causing you more harm than good. And interestingly, the more medicines you are on, the more likely you are to not be on a medicine that is indicated. I think it's probably just because it's a marker of having a lot of problems. And the common things that we see as adverse reactions from multiple medicines are more … effects on someone's overall health. We see people who present with falls, with confusion and those are directly related to the multiple medicines … I think people are increasingly aware that medicines can cause problems and that multiple medicines in combination can be problematic. When you say, ‘Look, I think one of the precipitants to your mother falling over or being confused is her medicines', people usually, on balance, are relieved. At least it's something that you can do something about and to stop a drug that's causing a problem is relatively easy, compared with having to deal with another more complex cause of that syndrome …
Jacqueline:
Can you explain for me those terms you use ... ‘drug–drug interactions’, for example?
Associate Professor Hilmer:
Drug–drug interactions are when one drug interacts with another one. The drugs could either interact by affecting the concentration of the other drug, so one drug could, say, block the metabolism of another drug and result in a higher concentration of it, or could induce the metabolism of the other drug and result in a lower concentration of it. Drugs can also interact if they act on the same target, so they act in the same way. If you are on, say, two or three drugs that sedate you, you'll wind up very, very sleepy. That's what I meant by drug–drug interaction.
Jacqueline:
And ‘adverse events’?
Associate Professor Hilmer:
Adverse events are bad things that happen when you take a drug. They're a similar concept to side effects.
Jacqueline:
And there was ‘drug–disease interactions’… what's that?
Associate Professor Hilmer:
Drug–disease interactions are when a drug you're taking actually impacts negatively on another disease that you have. For example, if you're taking a beta blocker for your heart failure, but you also have asthma, then the beta blocker will make your asthma worse.
The Living with multiple medicines project was developed in
collaboration with Healthtalk Australia.