Weekly challenge: 5 steps to lower your risk of dangerous drug side effects

By Deborah Kotz, Globe Staff

Just four categories medications are responsible for two-thirds of emergency room visits in those over 65: the blood thinner warfarin and oral anti-platelet drugs like Plavix -- which are both taken for heart disease -- and insulin and blood-sugar lowering medications like metformin, Actos, and Avandia, which are used to treat diabetes. That’s according to a new study published in the New England Journal of Medicine, which counted nearly 100,000 emergency hospitalizations for adverse drug reactions, many of which could have been prevented.

The key, say the researchers from the Centers for Disease Control and Prevention, is for seniors and their doctors to continually monitor chronic medications to ensure that they’re working as well as they should. Warfarin often requires daily or weekly adjustments to dosing, so patients don’t get an overdose which can lead to brain and gastrointestinal hemorrhages. (For this reason, many heart disease patients only take it for a short period of time.) Insulin and other blood-sugar lowering drugs can cause hypoglycemia if blood sugar levels dip too low.

Of course, less commonly prescribed drugs can also send patients rushing to the emergency room with adverse reactions, so it’s important to be proactive whether you’re taking a new medication or have been on one for years. Some smart rules of thumb suggested by the American Association of Family Practitioners:

1. Make sure you have oral and written instructions from your doctor on the name, dosage and use of the medications. Ask your doctor to repeat them if you don’t understand them on first explanation.

2. Check the label of the drug once it’s prescribed to make sure the medication and dosage matches what the doctor prescribed.

3. Make sure you understand possible side effects that can occur with the medication. Instead of automatically signing the box that you don’t wish to speak to the pharmacist when you pick up your prescription, take a few minutes to ask the pharmacist for details on side effects.

4. Report back to your doctor for blood tests when told to do so. This may be necessary to adjust the dose of your medication to ensure you’re getting the optimal amount.

5. Don’t take any medications without discussing them with your doctor -- especially if you’re already on other prescriptions. This includes over-the-counter pain relievers, vitamin supplements, and herbal remedies, many of which can have dangerous drug interactions.