A small study suggests that older psychiatric inpatients may be a “vulnerable 
target” for polypharmacy and are, in fact, frequently discharged with multiple 
medications that have potentially hazardous interactions, according to data 
reported at the European Psychiatric Association 18th European Congress of 
Psychiatry.

Researchers presented the results of a study that assessed the extent of 
polypharmacy and potential drug interactions in 25 elderly psychiatric inpatients 
at the time they were discharged from the hospital to their home, a nursing home, 
or residential care. Eighty percent of individuals over age 75 years take at least 1 
prescription medication, with 36% taking 4 or 5 medications," according to the 
study director. .

Multiple Medications at Discharge

For this study, the researchers identified potential interactions by entering 
information on the patient’s medication prescriptions as documented in their 
medical records on a UK Website known as www.BNF.org. The organization aims to provide UK health 
professionals with authoritative and practical information on the selection and 
clinical use of medicines in a clear, concise, and accessible manner.  Overall, 8 
patients (32%) had prescriptions for 4 or fewer medications at discharge, 10 
(40%) had 5 to 8 prescriptions, and 7 (28%) had 9 or more prescriptions at 
discharge. The median number of prescriptions at discharge was 6.5.The median 
number of hazardous interactions was 3.1.  A prescription for 6 or more 
medications was more likely to cause drug-drug interactions and hazardous drug-
drug interactions. 

Preventing Polypharmacy 

To improve patient outcomes, Dr. Kumar the study author echoed prior published 
recommendations: including:  

             
Know your patient well before starting treatment;
 

             
Order a treatment package, not just a prescription;

             
Educate the patient;
 

             
Choose the right medicine;
 

             
Ensure that the patient takes the medication;
 

             
Use as few drugs as possible;
 

             
Tailor the treatment to the patient’s needs;
 

             
Familiarize yourself with the drug;
 

             
Have a high index of suspicion; and
  

             
Consider the patient’s viewpoint.
 

 

The psychiatrist may need to work with nurses and social workers to ensure that 
these recommendations are implemented given that older patients may have 
difficulty in communicating. H e also said that a dedicated in-house pharmacist 
may be pivotal in reducing the risk of polypharmacy in elderly psychiatric 
inpatients.

In her latest column, Carolyn M. Clancy, M.D., Director of the Agency for 
Healthcare Research and Quality (AHRQ), highlights for consumers information on 
two common medicines used to treat high blood pressure, and explains the steps 
individuals can take to find the medicine that works best for them.

The U.S. Food and Drug Administration (FDA) has received five reports of serious 
medication errors involving consumers who used Maalox Total Relief, the upset 
stomach reliever and anti-diarrheal medication, by mistake, when they had 
intended to use one of the traditional Maalox liquid antacid products.

Due to the potential for serious adverse events from product confusion, the maker 
of Maalox brand products has agreed to:

Change the name of Maalox Total Relief to one that will not include the 
name "Maalox" and revise the graphics and information displayed on the front of 
the product container to help distinguish the active ingredients and uses of this 
product from the traditional Maalox antacids. 
An educational program that includes outreach to healthcare professionals and 
consumers to inform them about the different products sold under the Maalox 
brand, including how to select the appropriate Maalox brand product.
 
Active safety monitoring and reporting of adverse events associated with the 
use of Maalox brand products.
 

Advice for Consumers

To help avoid potentially serious health risks associated with Maalox product mix-
ups, the FDA recommends that consumers:

Check with a healthcare professional or pharmacist if they are not sure what 
Maalox product is right for them.
 
Carefully look at the labels of all Maalox products to make sure the right 
product is being purchased for the right condition.
 
Read the active ingredients, uses and warnings in the "Drug Facts" box prior to 
purchasing any Maalox product.
 
Report any side effects from the use of Maalox products to the FDA 
MedWatch program, using the information at the bottom of this page.

The company expects to begin selling the renamed product in September 2010. 
Until that time, healthcare professionals and consumers should be aware of the 
following:

Maalox Total Relief and the traditional Maalox products are both liquid 
medications available without a prescription (OTC), but are NOT interchangeable. 
These products are intended to treat different medical conditions.
 
Maalox Total Relief is not appropriate for individuals who want to use an 
antacid, especially if they have a history of gastrointestinal ulcer disease or a 
bleeding disorder.
 
 
The traditional Maalox liquid products including Maalox Advanced Regular 
Strength and Maalox Advanced Maximum Strength are well-recognized antacid 
drug products that contain aluminum hydroxide, magnesium hydroxide, and 
simethicone. Both are OTC products and are used for the relief of acid indigestion, 
heartburn, sour stomach, upset stomach, and pressure and bloating commonly 
referred to as gas.
 
Maalox Total Relief should not be confused with traditional Maalox liquid 
antacid products.
 

Additional Information for Healthcare Professionals

When recommending an OTC product such as Maalox, refer to the product by 
its full product name (for example, Maalox Total Relief, Maalox Advanced Regular 
Strength, or Maalox Advanced Maximum Strength) or use the active ingredient 
name.
 
Ensure that patients know the product name and understand the uses of the 
product prior to purchase.
Report adverse events or medication errors involving Maalox products, such as 
using the wrong product because of confusing names, to the FDA MedWatch 
program.  BY PHONE @ 1-800-332-1088; BY FAX @ 1-800-FDA-0178; BY 
COMPUTER @  medWatch Online 

Medicines are safe and effective only if used as directed, said Margaret Harris, 
Ph.D., assistant professor-health for the University of Arkansas Division of 
Agriculture.  "There are more than 100,000 drug products on the market," she 
said. Each has at least one active ingredient that works with your body to relieve 
symptoms. "With more than 1,000 active ingredients on the market, overdosing, 
drug interactions and drug abuse of both prescription and over-the-counter drugs 
are growing increasingly common."

With the number of over-the-counter and prescribed medicines that might be in a 
family's medicine cabinet, Harris offers tips on using medicines wisely. The tips are 
part of the Be Medwise Arkansas program, a health literacy initiative that pairs 
the University of Arkansas Division of Agriculture with the UAMS College of 
Pharmacy and the National Council on Patient Information and Education (NCPIE).

Always start by reading the entire drug facts label before using a medication. 
Reading the label will help you decide if you have selected the right product for 
you.
  
Look for an over-the-counter medicine that will treat only the problems you 
have.
 
  
Know what to avoid while taking an over-the-counter medicine to prevent a 
bad side effect.
  
Take the medicine exactly as stated on the label.
 

"When it comes to medicines, more is not better," Harris said. "Taking too much of 
a medicine can be harmful.

"Take only the amount recommended on the label and at the exact intervals 
stated on the label," she said. 

Amounts are especially important when giving medicines to infants and children. 

"Unless labeled otherwise, adult-strength products should not be given to 
children," Harris said. "Doing so could result in accidental overdosing. 

"To be safe, don't cut adult tablets in half or estimate a child's dose of an adult-
strength liquid product," she said. 

Medicine directions can be confusing as well as too small to read. Be sure to ask a 
pharmacist or your doctor to explain if the directions aren't clear, Harris said.

"Your health is too important to play guessing games," she said. 

For more information about how to Be MedWise, contact your local county 
Extension agent or visit www.uaex.edu. 

The National Foundation for Celiac Awareness (NFCA), a recent new member of 
the National Council on Patient Information and Education (NCPIE), is actively 
seeking resource support to develop a Continuing Medical Education (CME) 
program for pharmacists and pharmacist technicians that will educate about celiac 
disease and the identification of gluten in medication. NFCA current educational 
programming, the Gluten-free Resource Education and Awareness Training 
(GREAT) programs, provides comprehensive information for food service and 
healthcare professionals, including nurse practitioners, physician assistants, 
nursing professionals, dietitians, and mental health professionals. 

 NFCA is a national 501(c)(3) not-for-profit organization whose mission is to raise 
awareness of celiac disease among the general public and the healthcare 
community, and to facilitate research to better understand the causes, 
mechanisms, and treatment of celiac disease. Awareness brings treatment that, in 
turn, brings improvement of the quality of life for those with celiac disease and 
gluten intolerance. NFCA is affiliated with the leading researchers internationally 
and supports collaboration and partnership among scientists and institutions to 
optimize research potential with the goal of improving the quality of life for those 
who have celiac disease.