What medicines shouldn't be taken together? Pharmacist warns

A team of experts have urged Brits who take multiple medications to check whether they are suitable to be used together. 

The warning comes after new research from Taking Care revealed that half of Brits are unaware of the potentially harmful side effects. 

The data reported that 50% of people do not know about the side effects of the medicine combinations they take including common medications for high blood pressure, heart problems and blood sugar control conditions.

Additionally, the average 70-year-old in the UK takes around eight medications a day, according to TakingCare.

This puts elderly people at increased risk of facing severe side effects.

In light of the findings, Lauren Frake, Elderly Care Expert at TakingCare has teamed up with Peter Thnoia, Prescribing Pharmacist and the Chief Product and Innovation Officer at PillTime.

The experts have issued guidance on the common medicine combinations that could have deadly side effects for the elderly population.

Furosemide/indapamide and metformin - severe dehydration & low blood pressure

The Pharmacist has shared that medicines which are used for heart conditions such as heart failure or high blood pressure, for example furosemide or indapamide, can cause rapid drops in blood pressure and require the patient to maintain a steady water intake.

Peter shared an example if an elderly person taking one of these medications finds themselves sweating more than normal, they may quickly reach a state where their blood pressure is very low and which will drastically increase their chance of a fall.

He added that these types of tablets are taken by around 30% of patients at PillTime.

Commenting on the key considerations associated with increased fall risk among the elderly, Lauren added: “More than 40% of elderly falls recorded by TakingCare are from people who take medication for a heart condition, likely linked to the potential side effects of some of their medication, which can involve an increased risk of falling.

“This, combined with the fact that a person’s risk of having a fall drastically increases once they enter the 70+ age bracket, creates the perfect storm for older people who take multiple heart condition medications, as they are more likely to get dehydrated, dizzy and consequently have an accident.

"Our research shows that a person’s health can severely deteriorate after they’ve had a fall, so accident prevention is key here.”

Peter continued: “Type 2 Diabetes medication metformin can also cause a condition called Lactic acidosis in cases where a patient becomes dehydrated. This can lead to them feeling exhausted, and weak, experiencing a burning feeling in their muscles, as well as nausea, and cramps.

“It would be safe to say that an elderly person taking both metformin and furosemide are at increased risk if they become dehydrated, placing them more at risk of a fall.”

Antihistamines (Hay fever medication) and sedatives or benzodiazepines
- dangerous drowsiness

Peter has issued a warning to hay fever sufferers that they need to exercise caution when taking multiple other medications.

“Lots of the active ingredients of hay fever medication belong to a group of medicines called antihistamines,” Peter explained.

He added: “These are very effective in reducing symptoms of hay fever, however, they are known to cause drowsiness - some more than others.

“If someone is maybe not as steady on their feet and also taking another medication which has a sedative effect, alongside hay fever medication, they could quickly become at risk of a fall.  

“Benzodiazepines such as temazepam, loprazolam, lormetazepam, diazepam and nitrazepam, which are typically prescribed to reduce anxiety and promote calmness, relaxation and sleep all include drowsiness and confusion as one of their potential side effects, so taking antihistamines in conjunction with these medications should also be handled carefully.

Lauren added: “Hay fever medication is an easy go-to to help relieve symptoms during the summer months. However, the increased risk of drowsiness, combined with other medications that have a similar effect isn’t to be underestimated.

“Patients should also be careful driving whilst taking multiple medications with a sedative effect, as the effect could be very dangerous.”

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Oral decongestants (pseudoephedrine) and antidepressants 
- irritability, delayed reactions & confusion

Peter also highlighted that antidepressants can also interact with common over-the-counter medicines.

The expert explained that selective serotonin reuptake inhibitors (SSRIs), which are used to treat depression and anxiety, can also cause drowsiness, confusion and slowing of reactions.

He continued: "Fluoxetine is a very well-known SSRI. Other SSRIs include citalopram (Cipramil), escitalopram (Cipralex), paroxetine (Seroxat) and sertraline (Lustral). 

“Another medication found in cold and flu products will interact with some antidepressants. For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure".

Peter warned that if someone is unaware to look out for these they can display very odd behaviour which can be alarming for the individual and those around them.

Lauren added: “Our experience with elderly people shows that people who experience confusion and delayed reactions are at a higher risk to themselves.

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"This can mean they will put themselves in unnecessary risk because they haven’t understood their surroundings, or in more severe cases, they may neglect an injury or wound, which can lead to dangerous consequences. This could be even riskier for those with Dementia or Alzheimer’s.

Lauren pointed out that emergency alarm services can help monitor patients who take multiple medications, and response teams will be on the lookout for common side effects.

She added: "It’s important that family members are also aware of potential side effects and the signs to look out for.

“For example, patients who are suffering from sudden confusion as a result of their medication may be unnaturally irritable and perhaps even aggressive.

"They will likely have changes in their personality, may have rambled speech and seem easily distracted from conversation".

Lauren explained that special care should be taken around people who are expressing these symptoms, as they may be at risk of an accident, so ensure the home space has been checked for any trip hazards or poor lighting in stairwells.

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She went on to say: "It may sound simple, but a quick check to make sure corners of rugs are taped down and that there are non-slip mats in the bathroom areas and kitchens can make all the difference for preventing accidents at home.

“Whilst an increased risk of falling may be alarming to the families of patients who are unaware of this information, the key takeaway is that there are simple preventative measures that can be put in place to reduce the risk of patients having a fall.

"By taking simple preventative steps early on, both patients and their families and ensure that elderly people can live independently and safely at home for longer.”