A Dangerous Mix

By January W. Payne
Washington Post Staff Writer
Tuesday, February 27, 2007

You're taking a couple of prescription medications and you develop a cold -- so you head to the nearest pharmacy to get something for your headache, cough and stuffy nose.

Not so fast, experts advise. Mixing medications can be dangerous-- even deadly, a fact highlighted by the death in November of popular R&B singer Gerald Levert. An autopsy determined that Levert, 40 -- who reportedly had been suffering from a shoulder problem, pneumonia and the effects of surgery in 2005 to repair a severed Achilles tendon -- died of accidental acute intoxication caused by a mixture of the pain medications Darvocet, Percocet and Vicodin, the anxiety medicine Xanax and two over-the-counter antihistamines.

A report this month by the Centers for Disease Control and Prevention found that deaths from accidental drug interactions rose 68 percent between 1999 and 2004, continuing a steady climb since the early 1990s. Unintentional drug poisonings accounted for nearly 20,000 deaths in 2004, said the CDC, making the problem now the second-leading cause of accidental death in the United States, after automobile accidents. "Prescription drugs, especially prescription painkillers, are driving the prolonged increase," the report stated.

Experts advise patients to consult their doctors and pharmacists before adding new medications -- prescription or over-the-counter -- or herbal remedies to their regimens. "Many of the products you can buy OTC today were still prescription [medications] just a few years ago," so don't underestimate their strength, said Catherine M. Polley, senior vice president and chief policy officer at the American Pharmacists Association.

The Internet provides a growing repository of information about drug interactions. But the depth and quality of such information vary greatly by site.

Online "drug interaction checkers" -- available on the Web sites of such major medical centers, retailers and pharmacies as Caremark, the University of Maryland Medical Center, Drugs.com, Eckerd, Discovery Health, Drugstore.com and Express Scripts -- allow patients to plug in the names of their medications and produce a report that typically lists their possible interactions with certain foods, alcohol and other drugs. (See sidebar for addresses of drug interaction checkers and other online resources.)

But the absence of a Web warning doesn't mean a drug combination is generally safe -- or, more important, safe for you, say Polley and others. Many factors, including a patient's health and medical history, can affect safety, and the Web sites warn patients to consult their doctors for specific advice about their medications.

Even when online reports warn of the potential for harmful interactions, it's possible that the medications may still be combined -- under a doctor's eye. Cancer patients, for example, and those with severe injuries may require more than one strong painkiller, said Kathy Vieson, an oncology pharmacist and vice president of clinical pharmacology at Gold Standard Inc., which develops online drug interaction tools.

"This is where clinical judgment" comes into play, Vieson said. Don't panic about a Web alert about your medications, she advised. "This is where you really need to take the cautionary statement but then go talk to your health-care provider."

Further reason for caution: Web sites that offer warnings about drug interactions are not regulated and draw their information from a variety of sources, some more detailed than others. As might be expected, their results differ.

On Drugstore.com, for example, a drug interaction search on Percocet, Vicodin, Darvocet A500 and Xanax -- a variation of the mix that Levert reportedly took -- produced alerts of 22 interactions, some considered "major" risks. Most alerts warned that "using two types of opioid analgesics together is usually not recommended, but may be required in some cases" and that doing so "may cause problems with your breathing."

But on Drugdigest.org, Express Scripts' site, a search for the same medications triggered alerts for only three interactions, mostly warning patients not to mix the medications with alcohol because it could interact with the acetaminophen in the painkillers, causing liver damage.

A search on Eckerd's Web site came out somewhere in the middle, showing 18 or more potentially harmful interactions -- ranging in severity from high to low -- between either the drugs themselves or the drugs together with alcohol and certain foods.

The reason that some potential interactions may not show up on some online reports is that "it's very hard to know, especially when you don't know why someone is taking something," Vieson said. "Almost nothing is totally black and white. There's always that gray area."

Pharmacies typically use databases that flag potential drug interactions -- but using them properly requires patients to disclose all the medications they're taking and any drug allergies they have.

"It is very important for patients to use the same pharmacy and make sure that they share all of their prescription drugs and their OTC drugs with their pharmacies," said Jody Cook, a spokeswoman for Rite Aid.

"Nothing replaces a conversation" with your doctor or pharmacist with your list of medications in hand, said Kasey Thompson, director of patient safety at the American Society of Health-System Pharmacists. "It's a real concern. Drugs are treated like commodities in society, and the reality is they all have a risk." ยท

Wire services contributed to this report. Join January W. Payne today at 2 p.m. athttp://www.washingtonpost.comto discuss this article. Comments:paynej@washpost.com.

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