In a study conducted by Rutgers University 38% of patients
discharged from the emergency department had at least one drug interaction
resulting from a newly prescribed medicine.
The study published in the American
Journal of Emergency Medicine, identified the most common prescription drug
combinations that may result in a negative interaction.
Pain medications (oxycodone/acetaminophen)
were most commonly found to cause an interaction followed by ibuprofen,
antibiotics and steroids.
Examples of these interactions included:
- Oxycodone/acetaminophen and has been associated with
neurologic disorders such as seizures, delusions, and hallucinations.
- Oxycodone/acetaminophen and the diuretic, hydrochlorothiazide
may decrease the effectiveness of the diuretic and cause significant drops in
blood pressure or sodium levels, which could lead to an increased risk of
- The blood pressure medication lisinopril and ibuprofen can
cause increased rates of kidney damage.
“Most times, negative interactions can be avoided with
thorough monitoring and a complete change in therapy is not needed. However,
patients often may not know what medications they are taking at home, and
emergency departments do not have standard procedures to identify medication
interactions,” said co-lead author Patrick Bridgeman, a clinical assistant
professor of pharmacy practice and administration at Rutgers Ernesto Mario
School of Pharmacy.
He suggests physicians weigh the benefits and risks of all
medications before prescribing a new one, as well as monitor therapy after the
patient leaves the hospital. If patients have a complex medication list, the
physician may wish to consult an emergency department pharmacist to verify if
there is a major interaction with any of the patients’ home medications.
Further, emergency providers may communicate with the patients’ primary care
physician, and patients should be educated about interactions so they can ask
their primary care doctor if they have any questions.
“By educating physicians, we can promote selecting the
best medication with the most benefit and least risk,” Bridgeman said.
“We can also help to ensure providers are monitoring patients after they
return home. Patients can help to be aware of potential interactions by keeping
and bringing updated medication lists whenever they see a doctor, especially
one that is not their primary provider, and by making and keeping follow-up
appointments after they are discharged.”
Reference: Jawaro T, et al. Descriptive study of drug-drug
interactions attributed to prescriptions written upon discharge from the
emergency department. American Journal of Emergency Medicine. Published 26