Diabetes drugs and anticoagulants top the list of medications causing dangerous interactions or side effects

by Cheryl Platzman Weinstock, AARP, October 29, 2021

In a recent study of emergency room visits, diabetes medications and anticoagulants, which help prevent blood clots, were found to be the leading prescription medications sending older people to the emergency room with problems like adverse side effects or unintentional drug interactions.

“Certain medications may have been safer to use when you were younger, but now that you are older, these medications can be potentially more dangerous and cause side effects,” explains Ula Hwang, M.D., professor and vice chair for research in the department of emergency medicine at the Yale School of Medicine in New Haven, Connecticut.

That’s because older adults are typically on more medications than younger patients and because medications can interact in harmful ways. Older adults also metabolize medications more slowly and may be more sensitive to them than younger people, she says.

Hwang says the high number of emergency room visits indicates that doctors need to be more careful prescribing these drugs in the first place.

The high rate of older Americans visiting the emergency room for medication-related problems stood out when researchers compared it to ER visits by younger patients in the study, which was published in JAMA on Oct. 5.

The study looked at health record data from 60 emergency departments across the United States from Jan. 1, 2017, through Dec. 31, 2019. Researchers found that almost 96 percent of emergency room visits by patients ages 65 and older were for medication harm from drugs being used therapeutically (as opposed to, say, being intentionally misused for recreational purposes). 

The problems with anticoagulants

Anticoagulants are a game changer for people at risk of heart attack or stroke due to heart rhythm disorders, such as atrial fibrillation, or of a blood clot in a deep vein. Yet researchers found that anticoagulant use also caused about 20 percent of emergency room visits among adults ages 65 and older.

“All anticoagulants are risky in older patients,” says Hwang. “These drugs can interact with other medications, and for the older adult, who is at greatest risk of falls, being on a blood thinner increases their risk of bleeding with any trauma.” Anticoagulants can also cause gastrointestinal bleeding.

To reduce your risk of harm from anticoagulants, avoid activities that can cause bruising or bleeding. Also, limit certain foods, such as green leafy vegetables like kale, spinach and brussels sprouts. They can interfere with how your blood clots, says Seema Bonney, M.D., an emergency room physician at the Philadelphia VA Medical Center in Philadelphia.

Blood sugar spikes and drops from diabetes drugs

Diabetes drugs, commonly prescribed for the 1 in 4 older American adults with the disease, were the second most problematic medication, according to the JAMA study. They led to some 11 percent of emergency room visits related to medication harm in patients ages 45 and older.

Even though oral and injectable diabetes medications can provide long-lasting control of blood sugar levels, your blood sugar can spike or drop dangerously depending on your dose and what you eat during the day, Bonney says. To avoid these potentially dangerous peaks and valleys — which can cause everything from confusion to a coma — Bonney suggests patients take what she calls a safer approach: conferring with diabetes educators or nutritionists to learn how to control blood sugar levels by following a healthy diet whenever possible.

How antibiotics factor in

The study also found that emergency room visits for medication harm from therapeutic antibiotics were, overall, nearly as high as those for diabetes drugs.  

“Countless times, I hear people say things like, ‘I took antibiotics that were laying around,’ ” says Bonney. If you borrow some else’s antibiotics in the hope of avoiding a trip to the doctor, you run the risk of having an allergic reaction, she notes.​

And while it won’t land you in the ER, taking leftover unprescribed antibiotics can cause drug resistance and also affect gut health by unnecessarily wiping out good bacteria, she says.

Over-the-counter medications, such as nonsteroidal anti-inflammatory drugs, non-opioid analgesics, antihistamines, and cough and cold medications were responsible for about 10 percent of overall visits to the emergency department for all age groups, the study found.

Many of these medications can cause dizziness and delirium in older people and lead to falls, says Hwang. They can also raise blood pressure and cause headaches and chest pain, says Bonney.

Another major problem with these drugs involves so-called duplication errors. “If a patient is taking ibuprofen and then takes an anti-inflammatory medication which also has ibuprofen as an active ingredient, now you’re taking too much, which can have ramifications on your kidneys,” Bonney says. 

To curb prescription overload in older adults, experts at the American Geriatrics Society developed what’s known as the Beers Criteria, an inventory of medications that are not recommended for people ages 65 and older because they can cause confusion and other side effects.

Yet in a recent study, researchers found that 1 in 5 adults 65 and older were indeed being prescribed medications on the list. Many medication harms arise because “we’ve been so cavalier prescribing drugs,” Bonney says.

Guard Yourself From Medication Harm

“The more patients advocate for themselves and scrutinize what they are on, the safer they will be,” says Ula Hwang, M.D., professor and vice chair for research in the department of emergency medicine at the Yale School of Medicine in New Haven, Connecticut. Her tips: 

Question your prescriber when you begin a new medication. Ask about the drug’s risks and make sure the clinician is aware of all the other medications you take. Also ask about other medications the new one could potentially interact with, in case your drug regimen changes in the future. You can also ask your pharmacist about potential interactions.
 

At your appointment, ask your doctor if you need to be on so many medications and if you could potentially eliminate any.
 

Use pill boxes that clearly delineate when your medications should be taken.
 

Don’t use leftover medication or someone else’s medication. 
 

Use your medication at the recommended dosage. More is not better. 
 

Keep a list of the medications you take in your purse or wallet.

Cheryl Platzman Weinstock is a contributing writer who covers health and science research and its impact on society. Her work has appeared in The New York Times, NPR and Kaiser Health News.