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Polypharmacy: The dangers of mixing too many -

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Dr Maryanne Demasi

Nowadays there's a pill for just about everything. And it seems the older you are, the more you
take. Up to 40 per cent of elderly people take five or more medications every day.

NARRATION

It's a phenomenon known as "polypharmacy", where patients are on five or more medications, some of
which are doing more harm than good.

Prof David Le Couteur

It's just that our psychology and our culture prefers to give medications rather than to withdraw
them.

NARRATION

Whether they are prescribed or complementary medicines Australians consume more than 40 million
pills each day.

Paul Sinclair

Patients may be accessing consultations from a number of different doctors and then seeking
medications from a number of different community pharmacies.

Assoc Prof Sarah Hilmer

There's no one person to overlook all of those drugs together and that's when people really run
into trouble.

NARRATION

In fact each year over 140,000 Australians are hospitalised because of problems with their
medicines.

Prof David Le Couteur

Adverse drug reactions are probably the fourth or fifth greatest killer after heart disease, cancer
and stroke.

NARRATION

And the bad news is that with our ageing population the problem is getting worse. The older you
are, the more health problems you have and the more specialists you see. Then you wind up on
multiple medications putting you at risk of dangerous drug interactions.

Prof David Le Couteur

Most commonly we see confusion and delirium, falls, and injury as a result of falls, and general
symptoms like weakness and nausea.

NARRATION

Jack McEnally was admitted to hospital after he fell and broke his hip.

Prof David Le Couteur

And how's your walking been going?

Jack McEnally

Ah, slowly.

NARRATION

His medical records show he is on 19 different medications.

Jack McEnally

I felt a headache coming across here and then I felt some nausea.

Prof David Le Couteur

Could I see you walk? Would you be able to take one or two steps for me do you think?

NARRATION

Professor Le Couteur is now trying to work out which of Jack's medications are causing him
problems.

Carmel McEnally

Some of his heart tablets were interfering with the diabetic tablets so they're trying a different
tablet and seeing if one doesn't interact with the other. They'll give us a list when we're ready
to leave hospital of what he will be taking once he goes home.

NARRATION

Across the ward, Mrs Meldrum has just been admitted. She's also on a cocktail of drugs.

Joan Meldrum

I don't know exactly but I would say around 25 to 30.

Dr Maryanne Demasi

Wow, that's almost a meal!

Joan Meldrum

I take arthro-aid for joints, a pill for heart and fluid... I have two that look at the reflux...
the chest pain, angina... one that looks after my bladder... and the mood swing I do need
because...

Dr Maryanne Demasi

And the list goes on.

Joan Meldrum

And the list goes on, yes. It goes on and on.

Prof David Le Couteur

Our typical patient is on between five or 10 medications and I would say without exception, there
are drug interactions in all of these patients. The common ones we would see would be interactions
between drugs that cause bleeding, so these are the various drugs that are used to treat heart
disease, and drugs that lower blood pressure, and drugs that act on the brain, so sedative drugs
and anticholinergic drugs.

NARRATION

Adding to the problem are complementary medicines.

Prof David Le Couteur

High doses of vitamin E are used to delay ageing but in fact increases bleeding so it can interact
with other drugs used to treat heart disease and increase mortality. Ginko biloba is used by some
people to try and help with their cognitive impairment and that also will interact with
anti-platelet drugs and anticoagulants. St John's Wort is typically taken by people who have
problems with depression and it will interact with the anti-depression, anti-depressive drugs that
people are taking.

Assoc Prof Sarah Hilmer

If you don't know someone is taking something you can't even begin to tell them that, hey, the
reason you've got that dizziness when you stand up is probably because you're taking that extra
medicine.

NARRATION

The problem is, clinical trials test the safety of individual drugs, but no-one is testing whether
multiple medications interact with each other.

Prof David Le Couteur

Clinical trials without exception exclude people on polypharmacy. So we just don't know whether
treating hypertension in someone who is already being treated with depression and osteoarthritis is
of benefit.

NARRATION

The other oversights in clinical trials are that drugs are always tested on young healthy
volunteers, and only for short periods of time.

Prof David Le Couteur

Clinical trials do not include much older people, so people in their 80s and beyond, and the long
term use of these medications is associated with adverse drug reactions that we just weren't aware
of when the drugs came on to the market.

NARRATION

Mrs Thorburn came to hospital a few days ago feeling unwell. She was on five medications.

Agnes Thorburn

I was vomiting and very, very sick and he seemed to think that it was the tablets.

NARRATION

Over the last week, her doctor has been slowly reducing her medications.

Dr Maryanne Demasi

How do you feel?

Agnes Thorburn

Well, I feel terrific...

NARRATION

Mrs Meldrum often asks her doctor to reduce her medications.

Joan Meldrum

One doctor told me that he would take as many as I liked as long as I took the blame if I dropped
dead, he said because who knows which ones are keeping you alive, and at 86 I don't want to drop
dead.

Prof David Le Couteur

There's a fear of litigation. So doctors are concerned that if they don't prescribe medications
they will be sued for inappropriate withholding of medications.

NARRATION

New research has developed a tool to help doctors work out which drugs are causing problems. It's
called the Drug Burden Index.

Assoc Prof Sarah Hilmer

It looks at a person's total exposure to high risk drugs in terms of how many of those high risk
drugs they're on and also what dose they're on. Here we've got an example of one patient. We note
down what medicines they're on, we look at the dose they're on and then we work out the drug burden
index.

Dr Maryanne Demasi

So what does a total of one mean?

Assoc Prof Sarah Hilmer

You could say that these two drugs that she's on are slowing her down as much as having depression,
plus heart disease, plus lung disease.

Dr Maryanne Demasi

So ideally you'd like to take the patient off these drugs?

Assoc Prof Sarah Hilmer

You would, yes you would aim to get this person's drug burden index down to zero.

NARRATION

But in many cases patients will have to stay on certain drugs, so substituting one for another will
help to at least reduce the patient's score. Another way to tackle the problem is to focus on
pharmacies, where the drugs are dispensed. One idea is to give pharmacists electronic access to a
patient's full drug history.

Paul Sinclair

Electronic health records will have a massive impact on polypharmacy by allowing both the doctor
who is prescribing the medication and the pharmacist who is dispensing it to view that patient's
entire health and prescription record if the patient elects that to be so.

NARRATION

In the meantime there's a government program available called the Home Medicines Review. This
enables you to have a pharmacist come to your home and conduct a comprehensive review of all your
medications.

Assoc Prof Sarah Hilmer

Anyone can access it, it's a Medicare-funded commonwealth program. If you talk to your GP about it
they can organise it, or often your GP will actually initiate organising it, and most community
pharmacies will have a pharmacist who is accredited to do home medicines reviews and will come out
and will do that for you.

Paul Sinclair

We'd certainly encourage customers or patients to establish a relationship with a community
pharmacy so that at any time when a medication is dispensed, it is dispensed with full knowledge
and availability of that person's medication history.

NARRATION

It's been two weeks and Jack McEnally has returned home with a new list of medications. He's not
taking less, but some of the tablets did change.

Jack McEnally

I feel pretty good now; I feel I'm getting better. Before, I could feel myself going backwards,
getting weaker every day.

Dr Maryanne Demasi

So just by changing the combination of drugs you felt better?

Jack McEnally

Oh yeah, by 100 per cent.

Prof David Le Couteur

One of the joys of geriatric medicine is stopping medications and seeing people get better. We have
phoenixes that rise from the ashes in geriatric medicine unlike any other specialty. People who
come in that are very unwell and by the simple intervention of stopping medications we see people
get better.

Agnes Thorburn

I'm going home tomorrow and I'm not having any medication.

Dr Maryanne Demasi

Are you pleased about that?

Agnes Thorburn

Of course I am, I'm as happy as can be, and I'll be in the garden as soon as I get home.

NARRATION

But before you go throwing away your pills, you should always consult your doctor.

Topics: Health

Reporter: Dr Maryanne Demasi

Producer: Paul Schneller

Researcher: Roslyn Lawrence, Matthew Levinson

Camera: Kevin May

Sound: Steve Ravich

Guenter Ericoli

Editor: Chris Spurr

Story Contacts

Prof David Le Couteur

Clinical Pharmacologist / Geriatrician

Centre for Education on Aging (CERA)

C22 - Concord Hospital

Concord NSW 2139

Assoc Prof Sarah Hilmer

Geriatrician / Clinical Pharmacologist

Department of Clinical Pharmacology

Royal North Shore Hospital

Reserve Road, St Leonards NSW 2065

Paul Sinclair

Pharmacist

Pharmacy Guild of Australia

Locked Bag 2112, St Leonards NSW 1590

Related Info

The Centre for Education and Research on Ageing (CERA)

Medicare Australia - Home Medicines Review

The Pharmacy Guild of Australia - Home Medicines Review