Four Drugs Responsible for the Most Hospitalizations

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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What are the most dangerous medications? Results from a recent study highlight four drugs that are responsible for a shocking number of negative effects. Data from 2007 – 2009 shows that these four drugs were involved in more than two-thirds of the hospitalizations of older patients for harmful drug reactions and incidents.

Researchers looked at emergency hospitalizations of adults aged 65 years and older that were attributed to the use of a drug, or a drug-specific adverse effect. This included vaccines, dietary supplements, and prescription and over-the-counter medications.

First, why should we care? In this two-year period almost 100,000 patients older than 65 had emergency hospitalizations for dangerous drug reactions or incorrect dosages. Four medications taken alone or in combination were linked to 67% of the cases!

1) Warfarin (Coumadin) = 33.3% of the hospitalizations

– Almost all of these hospitalizations involved unintentional overdoses. In the case of warfarin, a blood thinner, an overdose means the blood is too thin (usually referred to as an INR or International Normalized Ratio that is too high).

– In those patients who were hospitalized, 13% were also taking an antiplatelet medication to prevent blood clotting (such as aspirin or Plavix).

2) Insulin = 13.9% of hospitalizations

– Most patients were hospitalized because of low blood sugar (hypoglycemia) from taking too much insulin.

3) Oral antiplatelet medications = 13.3% of hospitalizations

– Examples of these medications intended to prevent harmful blood clots include Plavix and ticlopidine.

4) Oral diabetes medications = 10.7% of hospitalizations

– Examples of these medications include Glucotrol (glipizide) and glyburide.

– Most hospitalizations in these cases were due to low blood sugar from an overdose of these diabetes medications.

What should we learn from this? These four drugs are excellent, important medications that need close attention and monitoring. Clearly the management of blood thinners and diabetes drugs is not ideal, and that is our fault as physicians. Newer diabetes medications exist which do not result in low blood sugar (hypoglycemia): metformin, Januvia and Actos. Newer long-acting insulin options also exist, like Lantus and Levemir, which carry much less risk of hypoglycemia—though they are expensive. Are they worth it to avoid low blood sugar episodes? I think so, but talk to your doctor about your options.

Dr O.

Generics warfarin, ticlopidine, glipizide, glyburide, and metformin are all typically covered by insurance as Tier 1 medications, meaning you’ll pay your minimum copay. Some may also be available for as little as $4 for a 30-day supply. Because warfarin is an approved generic for Coumadin, if it Coumadin covered by insurance, it will likely be a Tier 3 drug requiring the highest copay. Januvia, Actos, Glucotrol, Lantus, and Levemir are all typically covered as Tier 2 drugs, meaning you will pay a moderate copay. Cash prices for the brand name medications vary greatly, from around $80 for a 30-day supply for Glucotrol to around $220 – $250 per month for the rest.

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