Millions of patients may be at risk of severe health complications, including organ damage, due to commonly prescribed drug combinations, according to new research. Experts have warned that the concurrent use of statins and non-steroidal anti-inflammatory drugs (NSAIDs), often prescribed to manage side effects, can significantly increase the likelihood of dangerous outcomes over time.
These combinations, alongside others like iron supplements with laxatives and dementia medications with sleeping pills, were identified in a study by Canadian researchers as potentially harmful "prescribing cascades." The study, published in the British Medical Journal, examined drug patterns in Ontario, Canada, and identified 24 common combinations that could lead to avoidable side effects and complications.
The research found that patients taking statins, which are cholesterol-lowering drugs, were frequently also prescribed NSAIDs such as ibuprofen. While NSAIDs can help alleviate muscle aches that may be a side effect of statins, their long-term use is associated with an increased risk of gastrointestinal bleeding, kidney injury, and cardiovascular issues. Pharmacists noted that this combination can trap patients in a cycle of prescriptions, where medications are used to counteract the side effects of other drugs, potentially masking underlying issues.
Another prevalent pattern identified involved iron supplements, commonly used to treat anemia, which can cause constipation. Instead of re-evaluating the initial treatment, many patients were prescribed laxatives to manage this side effect. However, laxatives can lead to diarrhea and dangerous chemical imbalances. Similarly, sleeping pills, sometimes prescribed alongside other medications, have been linked to an increased risk of falls and hospital admissions, particularly among older patients.
Researchers from the University of Toronto, led by geriatrician Dr. Paula Rochon, highlighted that these prescribing sequences are often overlooked in clinical practice. "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," Dr. Rochon stated. The study suggests that older women were more likely than other demographic groups to be prescribed these potentially hazardous drug cocktails.
In England, studies indicate that over one in seven people take five or more prescription medications daily, with the majority being elderly individuals managing multiple chronic conditions. The findings align with efforts within the UK's National Health Service (NHS) to address problematic polypharmacy, which involves the regular review of long-term medications to ensure they remain necessary and that their benefits outweigh their risks.
A 2021 government-led review in the UK found that approximately 10% of medications prescribed by general practitioners were unnecessary and called for more frequent patient medication reviews. Adverse effects from medications were also found to be a factor in about one in five hospital admissions for individuals over the age of 65.
Clinicians cited a lack of time to investigate new symptoms fully and long waiting lists for alternative treatments as contributing factors to prescribing cascades. The research team hopes that automated clinical decision support systems could help flag these cascades in real-time, preventing errors. Pharmacists are also seen as crucial in identifying potentially inappropriate prescribing patterns before they pose further risks to patients. Patients are strongly advised not to discontinue any prescribed medications without consulting a healthcare professional.