Millions of patients may be unknowingly exposed to lethal complications, including organ damage, due to common drug combinations, according to a new study by Canadian researchers. The findings, published in the British Medical Journal, identify 24 frequently prescribed drug cocktails that could lead to avoidable side effects and serious health issues.
One particularly concerning combination involves statins, commonly prescribed for heart health, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, often used to manage side effects like muscle aches associated with statins. Over time, this regimen can significantly increase the risk of severe stomach bleeds and kidney damage. Pharmacists warn that this cycle can also mask the underlying cause of symptoms, as medications are taken to combat the side effects of other treatments.
Dr. Paula Rochon, a geriatrician at the University of Toronto and the study's lead author, emphasized the importance of patients understanding their medications. "Knowing what medications you are taking, when they were started and what for is important in order to identify possible prescribing cascades that may be problematic," she stated. The study suggests that older women are disproportionately affected by these potentially harmful prescribing patterns.
Another common and risky combination identified is the use of iron supplements, known to cause constipation, followed by prescriptions for laxatives. While intended to alleviate discomfort, laxatives can lead to diarrhea and dangerous chemical imbalances. Similarly, cholinesterase inhibitors used for dementia symptoms combined with sleeping pills have been linked to an increased risk of falls and hospital admissions, especially among the elderly.
Researchers analyzed prescription records from Ontario, Canada, examining 65 drug patterns initially believed to pose risks. They identified 24 common and potentially harmful prescribing patterns in real-world usage. For instance, nearly one in ten patients experiencing constipation from iron supplements were prescribed a laxative instead of a review of the original iron treatment.
Ian Budd, Lead Prescribing Pharmacist at Chemist4U, noted that statin-associated myalgia, or muscle aches, is a recognized side effect of statins that can lead to the prescription of NSAIDs. He cautioned that long-term NSAID use carries risks of gastrointestinal bleeding, kidney injury, and cardiovascular complications.
These findings emerge as healthcare systems worldwide, including the NHS, are increasingly focusing on tackling polypharmacy—the simultaneous use of multiple medications. A 2021 government-led review found that one-tenth of prescriptions issued by general practitioners were unnecessary. Furthermore, adverse drug effects contribute to approximately one in five hospital admissions among individuals over 65.
Clinicians cited a lack of time to fully investigate new symptoms and long waiting lists for alternative treatments as primary drivers for prescribing cascades. The researchers hope that automated clinical decision support systems and increased pharmacist involvement could help identify and prevent these potentially harmful prescribing patterns in real-time. Patients are strongly advised not to stop any prescribed medications without consulting a healthcare professional.
