In 1999, an 83-year-old Maryland woman wound up in the hospital after a particularly bad asthma attack. She'd quit using her inhaler, since it made her nauseated. While in the hospital she was given powerful steroids to treat her asthma. These raised her blood pressure. So she was given an antihypertensive drug. It made her dizzy.

When her ankles swelled, she was prescribed a diuretic to reduce water retention. But that dropped her potassium level. Naturally, potassium supplements were added. She was also given an osteoporosis drug. This made her stomach bleed.

"I came out sicker than I went in," says the grandmother, who was willing to tell her story but asked her name not be published.

She was so sick, in fact, that she couldn't care for herself after getting out of the hospital and had to stay with her daughter. When she became depressed, an antidepressant was added to her regimen. Then came another drug for stomach acid.

Medicines save lives, but few are completely free of risks or side effects.

The more drugs that are taken together, the greater the risk for side effects and interactions.

The Maryland grandmother's troubled relationship with her medications is far from unique. In fact, it's common enough that experts have even given the phenomenon the requisite Latinate label that confers official status in the medical world: polypharmacy.

The term describes cases in which patients are prescribed many different medications, often by different doctors, for a succession of conditions or for side effects created by other medications. Polypharmacy has been committed when the conditions can be effectively treated with fewer medications.

Seniors and the Chronically Ill

Polypharmacy is more commonly seen in older people, who tend to have more chronic conditions that call for drug treatment. At the same time, aging changes the body's ability to tolerate and process medications: Muscle tissue and fluid levels decrease, fat tissue increases, liver mass diminishes and kidney function declines.

Persons aged 65 and older constitute approximately 13 percent of the U.S. population, but they take about one-third of all prescribed drugs.

The typical senior citizen regularly takes four to six prescription drugs, plus a couple of over-the-counter preparations. Nursing home residents typically take more.

"Statistically, if you take six different drugs, you have an 80 percent chance of at least one drug-drug interaction.

With eight drugs, the chance is 100 percent," according to Wayne K. Anderson, dean of the School of Pharmacy and Pharmaceutical Sciences at the State University of New York at Buffalo.

No advocates of reducing medications suggest that people just stop taking their prescribed medications or attempt to adjust their regimens themselves. Proper adjustments require the efforts of a physician and pharmacist working together.

Polypharmacy often happens when a patient sees more than one physician, each of whom prescribes medications that interact or overlap with those another physician has prescribed. Often there's no one person charged with the responsibility of overseeing the patient's total drug therapy regimen.

People often assume that over-the-counter drugs are safe.

Some of the most dangerous drug-drug interactions occur when patients take over-the-counter medicines along with their prescription drugs. For instance, nonsteroidal anti-inflammatory agents like ibuprofen can cause bleeding ulcers when taken with more powerful prescription painkillers.

Combining ginkgo biloba, an herbal product promoted to improve memory, with blood-thinning drugs like aspirin or warfarin also can lead to severe bleeding.

Of course, prescription drugs also interact with each other. The antibiotic erythromycin, for example, can lead to a toxic reaction when combined with certain cholesterol-lowering drugs, potentially leading to kidney failure.

Pharmacy computers will flag many potential prescription drug interactions, but not if the patient fills prescriptions at different drugstores or has an unusual reaction. Moreover, computers can't address the complexity of interactions among six or eight different drugs.

And older people may not complain, assuming that feeling bad is an inevitable part of aging, or a symptom of the condition for which they are being medicated. The Maryland grandmother didn't mention her medication concerns to her physician because "I didn't want to noodge him."

The Role of the Pharmacist

According to some estimates, as many as one-fourth of all nursing home admissions and an even higher percentage of hospitalizations among the elderly may be due to "preventable drug therapy failures," resulting from adverse reactions or interactions, noncompliance or use of medications inappropriate to the patient's condition.

Pharmacists will not tell patients to stop taking their medicine. But they can alert the physician about potential problems and make recommendations. Think of your pharmacist as your drug advocate.

The problem is, with a few exceptions, pharmacists don't get paid anything extra for such services. Insurance companies typically reimburse pharmacies for dispensing, but not for clinical or administrative services.

Although pharmacists routinely answer customers' questions about medications as part of their jobs, in-depth consultations may be difficult to schedule in busy drugstores where the dispensing volume is high. It's best to call ahead for an appointment.

The Washington Post February 6, 2001; Page HE09