Just as society wizened to the tinctures of snake oil in centuries past, modern day pharmaceuticals are receiving a good dose of scrutiny - often with similar concern.
Open nearly any newspaper or magazine and there are stories that speak of drug disasters. One story relates how the wrong medicine was given because a hurried doctor's handwriting was mistakenly interpreted as an order for a different drug. Another story talks about dosage errors; adult doses given for children or pediatric doses prescribed for an adult. Add to these stories the interaction of drugs that may be harmless alone, but in deadly in combination, and a clearer picture comes into view. A vision that gives credence to the words of Moliere written almost 4 centuries ago: "Nearly all men die from their medicine, not of their diseases."
Physicians in England chose to evaluate lung cancer patients being treated with the targeted therapy Tarceva (erlotinib) to determine if any of these people were being treated with inappropriate medications. Though it was a small study, the results were heavy.
Among the patients evaluated, 95% were taking medications that were considered inappropriate. Inappropriate meaning, at best, unnecessary.
Over half of the participants -- 55% -- were taking medications known to interact with Tarceva by inhibiting absorption. These medications (proton pump inhibitors such as Prilosec (omeprazole) and Prevacid (lansoprazole) among others) reduce the amount of Tarceva that is absorbed, and hence, able to perform it's function - reducing the risk of lung cancer returning or progressing.
I remember rounding with a geriatric specialist back in residency, a man who seemed to outshine the rest when it came to taking a deliberate, thoughtful approach to his patients. Hoping to glean as much as I could from this physician, I asked him what he thought was the most important thing we could do for patients. His answer was something I watched him do every day. "Review the list of medications a patient is taking, and see what you can eliminate." It sounds like this practice might not be a bad idea for lung cancer patients as well.
When it comes to inappropriate medications, those with lung cancer aren't alone. Here is an article that gives you an opportunity to check out the Beers List -- a list of drugs that may be inappropriate for elderly people (and young people as well.):
And check out these articles for ideas on lowering your risk of experiencing drug interactions. Keep in mind that over-the-counter drugs, herbal preparations, and even foods may interact with some medications. The second article provides sites that allow you to plug in the exact medications you are taking.
Photo: flickr.com, user e-MagineArt.com
Todd, A. et al. Patients with advanced lung cancer: is there scope to discontinue inappropriate medication>. International Journal of Clinical Pharmacy. 2012 Dec 11. (Epub ahead of print)