At 58 years of age, tech industry veteran Tiberius Pereira was diagnosed with an ongoing renal disorder and subsequently started a medication regime to manage his condition. However, not long after embarking on the treatment, an extensive body rash became a cause of concern. The nephrology specialist in charge of Pereira’s care showed deep worry over this development and quickly had him admitted into the intensive care unit at Beaumont Hospital for close monitoring.
In an attempt to identify the substance causing the rash, the decision was made to halt all his current medications and reintroduce each one subsequently to monitor the reaction. Upon reintroduction of a drug called Plaquenil [hydroxychloroquine], used in the treatment of lupus symptoms, the rash re-emerged. Consequently, it was determined that Pereira was suffering from drug hypersensitivity syndrome. This is a severe, sudden reaction to medication that can impact various organ systems concurrently. This necessitated the need for a kidney transplant, which occurred within a year of Pereira’s initial symptoms, using a kidney donated by his sister.
After the transplant surgery and subsequent period of recovery, Pereira regained his strength and resumed his active lifestyle. Reflecting on his ordeal, he noted that there are inherent risks in healthcare and that despite doctors’ best efforts, adverse events can still occur. He continued to express his gratitude for his doctor’s transparency about the situation and the high-quality care he received.
Incidents of medication harm, also known as adverse drug reactions (ADRs), are more prevalent than initially thought. An investigation conducted by researchers at the Royal College of Surgeons of Ireland (RCSI) discovered that ADRs were the main cause behind hospitalisation in one out of ten older patients. Moreover, over 40 per cent of such patients were hospitalised due in part to an ADR.
In the study conducted by RCSI, it was found that a third of hospital entries due to adverse drug reactions (ADR) were linked to the use of blood-thinners such as warfarin and aspirin. Additionally, another third was associated with various heart medications. The startling revelation of the study, which will be discussed at a forthcoming RCSI seminar titled Medication Without Harm, is that almost 70% of these ADR-driven hospital admissions could have potentially been avoided.
Professor David Williams, a stroke medicine specialist at RCSI and Beaumont Hospital, and one of the researchers involved in the study, highlighted the complications arising from treating an ageing population with multiple health conditions. He mentioned the unpredictability of adverse drug reactions in older patients taking several medications. Doctors must assess each patient individually, balancing the potential benefits and risks of prescribed medications.
Instances where short-term drugs (for example, certain antibiotics) used for curing infections block the absorption of other long-term medications used for chronic diseases, can lead to toxic reactions. The confusion over the medication patients are taking further complicates the matter of detecting whether a patient has had an adverse drug reaction. Prof. Williams added that patients often consume medications without their doctors’ knowledge, which complicates matters further. This includes consuming medications prescribed to someone else. Moreover, certain individuals might also forget their medication intake.
Another separate study carried out on older patients from 15 Irish GP practices highlighted that within a span of six years, a quarter of older individuals had experienced at least one ADR. According to Professor Emma Wallace, a General Practice professor at University College Cork (UCC) and one of the researchers on this study, whilst nine out of ten ADRs were minor (like nausea), patients prescribed more than 10 medications were over three times more likely to experience an ADR.
The study further revealed that drugs for cardiovascular issues, nervous system disorders, and antibiotics were found to be linked most frequently to ADRs. It also emerged that a third of those who experienced a moderate adverse drug reaction (which accounts for 10% of all ADR patients) ended up needing immediate hospitalisation.
Polypharmacy, the practice of taking more than five prescribed medications regularly, is most prevalent in the elderly and primarily increases the risk of adverse drug reactions (ADRs). It’s challenging to discern adverse drug reactions in older adults with multiple ailments, as the signs may vary and include nonspecific symptoms such as drowsiness, delirium, constipation, feeling fatigued, and experiencing falls.
These adverse drug reactions can often be misinterpreted as a new health issue rather than a result of specific medication, which may lead to further medication being prescribed, known as the prescribing cascade. This can put the patient’s health at additional risk.
Patients who consume multiple or high-risk drugs or those in transition into or out of hospitals are the most susceptible to ADRs. A study involving elderly patients carried out by GPs in Ireland suggests structured medication reviews at general practices to address the supposed 10 per cent over-prescription of drugs in primary care.
The researchers observed that dealing with polypharmacy is pivotal in reducing medication burdens and decreasing the probability of ADRs in vulnerable patients. Professor Wallace recommends regular medication reviews for seniors taking ten or more long-term drugs.
Ciara Kirke, the pharmacist and Health Service Executive’s (HSE) clinical lead for the National Medication Safety Programme, stated that employing pharmacists for comprehensive medicine reviews is too expensive, despite many GPs advocating for the approach for patients with complicated medicinal needs. A recent project involving GPs from Scotland and Northern Ireland found comprehensive medicine reviews by pharmacists in GP practices resulted in fewer side effects for 63% of patients. Sometimes the number of medications patients were taking was significantly scaled down.
Kirke asserted that nearly half of ADRs could be prevented if pharmacists conducted these reviews in GP practices. The HSE is now exploring how to fund such a service.
In Ireland, a handful of GP surgeries hire a part-time pharmacist to conduct medication assessments. Health Information and Quality Authority guidelines mandate quarterly drug evaluations for nursing home residents. Both patient support groups and medical experts strongly advise individuals to be well acquainted with their medications and maintain a current record of their drugs at all times.