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Adverse Drug Reactions (ADR) is an adverse reaction that occurs and is directly attributable to the drug itself. These include drug interactions, accidental overdose, adverse effect and allergic reaction among other things. ADRs are a considerable health and safety issue, one of the leading causes of morbidity and mortality in health care and constitute a large burden on the health care system.
ADRs become increasingly more important in the elderly as the population over 65 increases, can be harmful, and are potentially life-threatening. The elderly are more susceptible due to multiple medications at once, age-related physiologic changes, and more disease associated with age.
Nursing homes and similar long-term care facilities comprise a large number of elderly patients. In a past survey, there were more than 1.5 million Americans receiving care in nursing homes. Residents on average were using 6 medications, and some were using 10 or more. This study had estimated that roughly 350,000 ADRs were occurring each year in nursing homes and over half of these ADRs were due to unintentional overdose. 1
More recently, a study published in the New England Journal of Medicine (2011) had estimated that almost 100,000 emergency hospitalizations occur each year in U.S. adults 65 years of age or older and half of these hospitalizations were among adults 80 or older with the greater portion of these preventable. 2
Most Common Drugs Causing Adverse Reactions 3
Both studies paid specific attention to older Americans, however they differ in findings due to the setting in which the studies took place. Both agree that the anticoagulant warfarin ranked highest among these patients as the most frequent and preventable most likely due to the difficulty in managing the use of the drugs.
In addition to warfarin other anticoagulants that can have a similar adverse effect if not taken properly like Pradaxa (dabigatran) and Lovenox (enoxaparin) were not available at the time of this study and should be taken into consideration. Still other drugs have been identified as problematic. In nursing homes, psychoactive drugs (such as antipsychotics, antidepressants, and sedatives/hypnotics) were also a common cause of adverse reactions, many of which were preventable. The study indicates a growing issue of concern with suboptimal prescribing in nursing homes. Still other commonly used medications outside the nursing home setting have also been identified as the source of common preventable adverse reactions. Included along with warfarin were insulin, oral antiplatelet drugs (such as aspirin, prasugrel, and dipyridamole), and oral hypoglycemic agents (such as sulfonylureas, metformin, and pioglitazone). Difficulty in management and lack of understanding of optimal use of the drugs were the common theme.
Tips to Avoid Problems
One way to prevent ADRs is by understanding drug safety. Drug interactions play an important role in preventable ADRs. Drug interactions can mean Drug-Drug, Drug-Food, and Drug-Dietary Supplement. Talk with your prescribing doctor about the medicines you are taking and be wary of certain foods and beverages like alcohol and grapefruit juice, Dietary supplements like St. John’s Wort and Vitamin E and a host of drugs like Cordarone (amiodarone), antihistamines, and Lanoxin (digoxin) that may interact with the medicine you are prescribed.
A list of tips to avoid problems
Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M, Benser M, Edmondson AC, Bates DW. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000 Aug 1;109(2):87-94 ↩
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011 Nov 24;365(21):2002-12 ↩
Both of these studies included over-the-counter medications. ↩