There’s Peril in Mixing Prescriptions : Medicine: Doctors say some ‘illnesses’ in older Americans can be traced to what’s in the bathroom cabinet: too many prescribed drugs.

Older Americans fill more than 650 million prescriptions a year. That’s a lot of drugs. And, according to a new consumer health guide, that’s a lot of risk.

Although adults 60 and older make up just one-sixth of the population, they use almost 40% of the nation’s prescribed drugs--and too many of them are misprescribed or misused, say the editors of “Worst Pills, Best Pills II: The Older Adult’s Guide to Avoiding Drug-Induced Death or Illness.”

According to Dr. Sidney Wolfe and his researchers, the average older patient fills about 15 new prescriptions per year, or three times the number filled by younger patients. While age brings more chronic medical problems, Wolfe’s group insists that many “illnesses” in older people are in fact adverse drug reactions to medications already being used.

The risk to older patients is sometimes compounded by physicians’ unfamiliarity with their special needs and vulnerability to drugs, Wolfe says. He cites a recent study of older patients who left the hospital with three or more prescriptions. The survey found that 88% took home prescriptions with problems, and 22% had prescription errors that were potentially life-threatening.

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While the controversy over drug-induced illness is not new, “Worst Pills, Best Pills II”--an updated version of the 1988 bestseller published by Public Citizen Health Research Group, an advocacy group founded by Ralph Nader and Wolfe--fuels the fire by adding more brand names to the list of drugs Wolfe’s group believes older patients should avoid.

Among them, such widely prescribed painkillers and arthritis drugs as Valium, Halcion, Xanax, Darvon and Indocin, as well as the popular gastrointestinal medications Lomotil and Tigan. Taken together, the 119 medications on the guide’s “Do Not Use” list account for about one of every four prescriptions filled by older adults.

Physicians and pharmacists are quick to point out that not every older adult has the same reaction to the same medications and warn patients never to stop or alter any drug regimen before consulting their doctors.

Drug manufacturers have long insisted that when pills are not safe for all ages, consumers, pharmacists and physicians are duly warned. But Wolfe says the popularity of pills on the forbidden list proves the system cannot always be trusted. He notes that more than half of the Food and Drug Administration’s adverse reaction reports of deaths and more than a third of hospitalizations involve older adults.

The FDA, which oversees testing of drugs for marketing as well as their labeling, has grown increasingly aggressive in its efforts to protect older consumers. Not only does the agency require older patients to be involved in trials of all new drugs, but drug makers must include labeling for doctors that explains how the drugs may affect men versus women, and elderly versus younger patients.

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By about age 30, the liver’s ability to metabolize, or break down, drugs and the kidneys’ ability to flush drugs out of the body begins to diminish. As a result, older patients may have a lower tolerance for certain drugs.

Dr. Paul Stolley, chairman of the University of Maryland’s preventive medicine department, says older people are “extraordinarily sensitive to adverse effects of medicine” and may suffer such serious drug reactions as Parkinsonism (tremors), confusion, loss of coordination and mental deterioration.

For the American Pharmaceutical Assn., the largest professional organization for pharmacists, the problem of overprescribed and misprescribed drugs has been a focus of vigorous lobbying on Capitol Hill.

“We are trying to educate the public about the potential for problems with medications for the elderly,” says spokeswoman Melanie Privette. “But we also are working very hard to help patients see their pharmacist as the person with the expertise, the gatekeeper who should know everything they’re taking and sound the alarm when there is a problem.”

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At Michael’s Pharmacy in Pasadena, Michael Zaifert is fighting an uphill battle to keep track of all the drugs his customers take. At least half of the patients he sees are over 60 and most of them have multiple prescriptions.

A sophisticated computer system, which nightly updates information on new drugs and their effects, has armed Zaifert with the technology to spot potentially dangerous interactions or dosages. Still, he needs more information--information only patients can provide.

“I’ve been a pharmacist since 1963 and the problem I see more and more is that patients, especially those on fixed incomes, are looking for the best price. That means they may go pharmacy to pharmacy, filling one here, one there,” Zaifert says.

“What if the patient gets his prescription filled by a mail order plan? They sacrifice not only the personal relationship with a primary pharmacist but rob me of my gatekeeper role. Pharmacists who don’t know everything patients are taking cannot fully protect them from adverse reactions,” he says.

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Advocate Wolfe cites recent studies that suggest the whole “older drug abuse epidemic” may have its roots in unhealthy doctor-patient relationships. One study found that doctors overprescribed 40-50% of the medications they ordered for outpatients. These included mind-altering drugs such as tranquilizers, as well as gastrointestinal drugs and antibiotics.

“Although it is easy to blame older patients (for wanting) to take more drugs,” says Wolfe, “the overwhelming share of blame must be placed on the drug industry for inadequate testing and heavy marketing, and on physicians for their appalling lack of information about how drugs work in older patients.”

But drug makers say the industry has always sponsored on-going campaigns for educating physicians and patients about using medicines as directed. “We are as concerned as anyone that the medications we make are safe to take and taken safely,” said an industry spokeswoman.

The National Council on Patient Education and Information, a group supported by the pharmaceutical industry, has designated the month of October as a time for older patients to bring all their prescriptions into their pharmacists or physicians for a full counting and evaluation.

“Worst Pills, Best Pills II” suggests a similar exercise and provides readers with a tear-out work sheet for listing all prescription and over-the-counter drugs being used. The list would then be shared with family, pharmacists and physicians.

“Too few patients feel they have the knowledge or right to question the medications prescribed by a doctor,” Wolfe says. “We hope (to) change that. Lives depend on it.”