The death of actor Heath Ledger from an interaction of prescription medications is an important reminder that mixing medications improperly can be harmful—or even fatal. Tests showed that Ledger died from "acute intoxication by the combined effects" of the pain medications oxycodone and hydrocodone, the antihistamine doxylamine (also used for insomnia), the sleeping medication temazepam, and the anti-anxiety drugs diazepam and alprazolam. The office of the chief medical examiner for New York City, where Ledger died in January, concluded that the death was an accident, "resulting from the abuse of prescription medications," according to a February 6 statement.
It's a mistake that all too many people make. According to a 2007 report by the Centers for Disease Control and Prevention, at least 20,000 unintentional drug poisoning deaths were occurring annually by 2004. The portion involving prescription opioid analgesics—including such drugs as oxycodone, hydrocodone, and methadone—had risen from about 2,900 in 1999 to 7,500. "For the first time, it became apparent that prescribed controlled substances were driving the upward trend in drug poisoning mortality," according to a transcript of congressional testimony delivered in October 2007 by Leonard J. Paulozzi, a CDC medical epidemiologist. Rates of drug poisoning were twice as high for men as for women in 2004. Middle-aged men were most at risk, and whites died at higher rates than African-Americans.
"It really is a cautionary tale that medications that are intended to help can cause great harm when used inappropriately like this," says Kasey Thompson, director of patient safety at the American Society of Health-System Pharmacists. "Accidents like this are entirely preventable."
How? For starters, it's a good idea for anyone who needs several medications to have a primary-care physician who can keep track of all of your care, experts say. (It's not unusual for people to get prescriptions from different doctors and fail to share a list of all of the drugs they're taking—prescription and OTC—with each.) That person can be on guard against the danger of cumulative effects, says Edward Langston, chair of the board of trustees for the American Medical Association. It can be dangerous to combine sleeping medications, antihistamines, and other medications that slow breathing or have an effect on the central nervous system, for example, Langston says. "You may want to talk to your physician and say, 'Do I need to decrease some other medication I'm taking?' "
U.S. News asked Langston and Thompson for other tips on taking medications safely. Here's their advice:
• Remember that doctors, hospitals, and pharmacies generally don't share information. So you can't assume that your cardiologist knows that you're already taking anti-anxiety medication prescribed by your psychiatrist and an inhaler prescribed by your allergist, for example. "Consumers need to be vigilant about sharing information" with their doctors and pharmacies themselves, Thompson says.
• Stick with the same pharmacy. Most pharmacies have computer systems that automatically flag potential interactions between medications. But you lose this alert system if you fill your prescriptions at different pharmacies.
• Maintain a list of your current prescription and OTC medications. Bring it with you to every medical appointment—and when visiting a new pharmacy.
• Don't check the box. When picking up a new prescription, don't sign off on skipping a consultation with the pharmacist, Thompson suggests. "It's one thing when you're getting a refill, but anytime you get a new medication and you're concerned that there might be an interaction, ask to speak to that pharmacist and don't sign your rights to counseling away."
• Be careful with alcohol. Ask your doctor or pharmacist if it's safe to drink alcohol while taking your medication. Alcohol can make you sleepy, lightheaded, or drowsy, and combining it with some medications may intensify these effects. And medicines themselves may contain alcohol or other ingredients that could react to alcohol. Women and older people face greater risk, according to the National Institute on Alcohol Abuse and Alcoholism.
• Do your homework. Some websites allow consumers to check for potentially harmful drug interactions online. "The more information that you as a patient have at hand, the better off you are," Langston says. "Perhaps it will give you a warning that, 'I need to alter my behavior until the sun is up and I can talk to my pharmacist or physician.' " Among the online resources: CVS Caremark, Drugstore.com, and Medscape.
Ledger is the latest in a string of celebrities who have died after mixing prescription medications. R&B singer Gerald Levert, 40, died in November 2006 after taking pain medications, antihistamines, and anti-anxiety medicine. Anna Nicole Smith, 39, died in February 2007 from a combination of a sedative and several other medications found in her system. And in December, popular southern rap artist Chad Butler, 33, also known by the stage name Pimp C, died as a result of sleep apnea and the effects of two prescription medications.