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What Doctors Don't Tell You © (Volume 10, Issue 6)

But as a recent UK National Health Service document admits, "drug interactions are not always easy to predict" (Medicines Resource Centre Bulletin, June 1999). And in any case, it would be impossible for drug companies to test every possible interaction. Ultimately, therefore, it is the patients who are the unknowing guinea pigs for both the drug companies and the regulatory authorities.

In Britain, GPs are meant to be on the look out for adverse drug reactions, including interactions, and report back to the Medicines Control Agency via the so called Yellow Card system. But with fewer than 10 per cent of GPs ever filling in a yellow card in the whole of their career, the system is obviously seriously flawed. In the US, there is no organised reporting system at all (Arch Dermatol, 1995; 131: 468-73).

Sometimes years can pass and many patients can suffer and even die before a drug interaction is recognised. For example, it took 60 years for doctors to recognise that the heart stimulant digoxin was seriously life threatening when given with another heart drug quinidine.

Similarly, by the time physicians realised that the powerful antidepressant drugs called monoamine oxidase inhibitors reacted with certain foods (see box, above), scores of people had experienced strokes and at least 15 people had died (A Gilman, et al, eds, The Pharmacological Basis of Therapeutics, Pergamon, 1990: 417).

Much the same story occurred in 1985, when the new antihistamine drug terfenadine (Seldane) was brought out. The manufacturers Merrell-Dow trumpeted it as "a major advance", claiming it had minimal side effects. Within five years, Seldane had become the world's best selling allergy medicine, with US physicians alone writing 16 million prescriptions a year. It was so popular, and apparently so safe, that Merrell-Dow lobbied for it to be available as a non prescription medicine, like aspirin. As a result, Seldane became an over the counter medicine (OTC) but only briefly.

Allergy patients soon began developing mysterious symptoms. One case concerned a 39 year old woman who developed "light headedness and fainting" after only 10 days on Seldane. Her heart was checked and the electrocardiogram (ECG) showed a dangerous irregularity called torsade de pointes (a twisting together of the ECG trace). Besides Seldane, she was also taking an antifungal drug, Nizoral, for a simple vaginal yeast infection.

More reports came in about Seldane some were of fatalities. One 29 year old woman had a cardiac arrest; she too had been on Seldane at the same time as ketoconazole, another antifungal drug. By the time the authorities had alerted doctors to its deadly interaction with other drugs, at least 25 people had been hospitalised and two had died (JAMA, 1993; 269: 1532-6). Seldane has now been withdrawn from the OTC market but is still available on prescription.

But in the Russian roulette of interactions, it is the elderly who most often have the gun put to their head.

Because the old tend to have multiple medical problems at the same time, the "pill for every ill" philosophy often dictates that separate drugs are prescribed for each condition.

Survey after survey reveals that modern medical treatment of the elderly has become polypharmacy on a grand scale. While the average elderly person used less than three drugs in 1978 (J Clin Epidemiol, 1991; 44: 1353-9), by the 1990s, that figure had risen dramatically, so that today people over 65 are taking up to nine medications at once (Drugs Aging, 1994; 4: 449-61).

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What Doctors Don't Tell You What Doctors Don’t Tell You is one of the few publications in the world that can justifiably claim to solve people's health problems - and even save lives. Our monthly newsletter gives you the facts you won't......more
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