The dangers of mixing medicines

CHOICE investigates adverse events associated with medication and what can be done to prevent them.
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01.In brief

Mixing pills
  • Many elderly people are at risk of adverse events from medicines, many of which result in hospital admissions.
  • There are several steps you, your doctor and pharmacist can take to manage your medication regimes.
  • CHOICE is calling for systemic changes to reduce the incidence of medication-related problems.

Research shows many elderly people are taking medicines that are unnecessary or possibly even harmful individually or in combination with other medicines. Conversely, some people are suffering the effects of under-dosing because they can’t afford medicines they’ve been prescribed.

CHOICE investigates adverse events associated with medication, explaining who’s at risk, the sorts of problems and issues that arise, and what can be done to prevent them.

Please note: this information was current as of September 2009 but is still a useful guide today.

How big is the problem?

Adverse drug events account for more than 400,000 GP visits and 140,000 hospital admissions annually. These figures are conservative and don’t necessarily include hospitalisations for injuries such as car accidents or falls that may have been a result of medication issues.

The most commonly implicated drugs are cardiovascular medicines, anticoagulants, anti-inflammatories and chemotherapy medicines, and while it’s hard to put a total dollar cost to the health system of medication-related problems, hospital admissions alone have been estimated at $380 million. Yet it’s estimated about half of these hospitalisations are avoidable.

People most likely to be affected are those who:

  • take five or more medicines
  • use 12 or more doses per day
  • have had significant recent changes to their treatment regimen
  • require ongoing monitoring of medication effects
  • have language difficulties, problems with dexterity, poor eyesight or dementia
  • attend several different doctors

Many older people fit one or more of these criteria. Not only are they more likely to suffer adverse drug events, but their recovery is likely to be poorer. The imperative, therefore, is to get medication regimens right.

What CHOICE wants

  • Greater recognition of and adherence to Beers Criteria medicines when prescribing for the elderly.
  • Greater consideration of non-pharmacological therapies in conjunction with or instead of drugs.
  • Improved prescribing and dispensing software. A test conducted by the NPS of commonly used prescribing software found many of them didn’t pick up key drug interactions, or else had so many false alarms they could lead to health professionals ignoring all alarms.
  • A reduction in the role of pharmaceutical marketing to doctors and in hospitals, and also reduced role of drug companies in creating treatment guidelines. The problems of bias and influence arising from drug information provided by pharmaceutical companies were examined in Prescription Overdose.
  • A review of the role of pharmacists in primary care. As more health professionals acquire prescribing rights, pharmacists will increasingly become gatekeepers for individuals’ medication regimes. Research has shown closer collaboration between GPs and pharmacists, and improved medication review by pharmacists, can help identify and resolve medication-related problems.


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