<p>It now appears that Heath Ledger died from taking an unwise combination of prescription drugs – including drugs prescribed by his U.S. doctor along with drugs for similar purposes prescribed by doctors in Europe where he filmed his last movie.</p>
<p>Chances are, the doctors in one country didn’t know what the doctors in the other country had prescribed. I think this is especially likely to have happened if Mr. Ledger had stopped taking the medications prescribed by one doctor before he went to see another. He might not have thought to mention the old medicines to the new doctor if he wasn’t taking them anymore, and therefore he was not cautioned about the dangers of mixing them. But that doesn’t mean that he didn’t still have leftover pills lying around the house.</p>
<p>The parallels to the situation of our college kids are obvious. Like Mr. Ledger, they often have two sets of doctors in two places – their college communities and their home towns. And unless they make a specific effort to tell each doctor what the doctors in the other place have prescribed, the doctors may not find out. Pharmacists may not catch dangerous combinations either because our kids also deal with two different pharmacies, one in each place.</p>
<p>Our kids may also have leftover drugs from previous medical problems lying around, and they might consider taking them again if the problem recurs – even if they are also taking other medicines at the same time for the same or other problems. </p>
<p>Before they go to college, many young people are very unsophisticated about medicines. They often rely on parents to make all the decisions in this area. But when they get to college, suddenly they’re on their own, and there’s a potential for dangerous mistakes. I think we should all be making sure that our kids learn something from Heath Ledger’s tragedy.</p>
<p>I guess that has never been my experience. Every visit with every doctor, dentist, specialist, no matter how many times I’ve seen them, or how recently I’ve seen them, asks me for any current prescriptions and over-the-counter meds I’m taking, either on a regular basis or PRN. I’ve never had to be the one to bring it up.</p>
<p>Also, any doctors my kids have been with have done the same.</p>
<p>Good post, Marian. Another issue is that frequently student health clinics are staffed by stressed-out, impersonal, overworked, or even inexperienced doctors and nurses; this contrasts sharply with the friendly pediatrician in a family practice that the student likely saw previously.</p>
<p>Just a couple of weeks ago I was at my school’s health center. Overall I received very good treatment, including blood work, scheduled follow-ups, a phone call after some test results came back abnormal, etc. The nurse wanted to prescribe me a medication, though, and it was only by chance that I discovered the medication contains a drug that I had a severely bad reaction to in the past. The two drugs aren’t prescribed for the same thing; they are in different forms; they work on a different part of the body. I’m sure that I wrote on my original health form that I couldn’t take this drug, but she just never looked. </p>
<p>Students assume that doctors and medical professionals are looking at all of the information and considering everything, and frequently they are, but it’s always important to go that extra step and ensure that everything is being considered. If I had taken that drug even once, I would likely have suffered the effects (which are extraordinarily rare) for years, possibly forever. Luckily, perhaps, I have a chronic condition and a somewhat interesting medical history, so there are things that I look out for on my own. Students who have always had relatively clean bills of health, though, can very easily be caught off guard and be given medications that interact or that they shouldn’t take.</p>
<p>I’m glad you have had such good experiences, teriwtt.</p>
<p>But still, let’s say that you sprained your ankle badly three months ago and were given some pain medicine – which you only took for two days even though the doctor gave you a week’s worth. Now let’s say that you injure your wrist today, and a different doctor gives you some prescriptions. The doctor isn’t likely to ask about what you might have taken for a short period three months ago, and you’re not likely to volunteer the information because it’s ancient history.</p>
<p>Now let’s say that later tonight your wrist starts to hurt something awful. Wouldn’t you be tempted to take some of your leftover pain medicine from the previous injury? Well, maybe you wouldn’t be, but if it was your kid in the same situation, wouldn’t the temptation be there? Yet those leftover pain pills might be incompatible with the drugs that were prescribed today.</p>
<p>I can’t help but think that the same sort of thing might have happened to Heath Ledger. Perhaps he had a problem while in New York, where he lived, and received some prescriptions. Then he went to Europe to film a movie. Maybe he forgot to bring his pills or maybe he left them home deliberately because the problem had cleared up. The problem recurred. He saw a European doctor. He didn’t mention the old medicines because he wasn’t taking them anymore. Then he got home, and he had two sets of medicines lying around. And he made a terrible mistake.</p>
<p>Even if my take on what happened to Mr. Ledger is wrong, I wouldn’t put too much trust in health professionals. Last year, I broke my leg very badly and spent two days in a hospital followed by five more in a rehab facility. While in the rehab facility, I was taking a prescription pain medicine that consisted of a narcotic plus acetaminophen (the active ingredient in Tylenol). One night, I ran a temperature (for reasons that were never figured out). The nurse on duty offered me some Tylenol for the fever. This was inappropriate and dangerous. It is not safe to take Tylenol on top of a combination drug that contains the same ingredient. You can destroy your liver by doing that. I knew that. The nurse didn’t.</p>
<p>For example, it seems that he was taking the normal therapeutic dosage of two different tranquilizers. Taking either one in those amounts would have been OK. Taking both was not. Apparently, he also did the same thing with two different pain medicines.</p>
<p>You can get in trouble taking normal therapeutic dosages of two different medicines of the same kind. You can also get in trouble taking normal therapeutic dosages of two different medicines that interact adversely with one another or that contain overlapping ingredients. You can also get in trouble taking the same drug for two purposes.</p>
<p>Look back at my last post. I was taking a normal therapeutic dosage of a prescription pain medicine (Percocet, if you must know). I was offered a normal therapeutic dosage of Tylenol. Either one alone is OK. The combination is not.</p>
<p>Or consider this other example: My daughter, like lots of other young women, sometimes takes an ordinary nonprescription dose of ibuprofen (Motrin or Advil) for menstrual cramps. She also gets migraines on rare occasions. Her neurologist has told her to take a much larger, prescription-only dose of ibuprofen if she gets a migraine. He never warned her not to take the full dose if she had already taken ibuprofen that day for another purpose. Yet realistically speaking, that could happen. She could easily get a migraine on a day when she has already taken ibuprofen for cramps. She knows how to handle that situation, but I suspect there are many people who would not.</p>
<p>I agree with cbreeze. I think our kids would know the effects of the kind of drugs Mr. Ledger was taking and avoid this situation. It’s wise to caution them, of course, but I think this was a symptom of depression, not carelessness or ignorance.</p>
<p>DS takes ADD medication and has since fifth grade. I think he is very savvy about this and wouldn’t mix things.</p>
<p>It may be that depression just makes us less careful with ourselves. But I’m sure most people know the effects of a tranquilizer and that taking two different ones would be the same thing as doubling up on one, and they would avoid this.</p>
<p>I’m hoping my kids would have this good sense.</p>
<p>But I am really saddened by Heath Ledger’s passing. I know he will be missed, and my S will feel particularly sad when the new Batman movie, The Dark Knight, comes out. Ledger plays The Joker, which is my S’s role in the little movies he and his friends make.</p>
<p>We ran into the possible dangers of prescription medicine a few years ago. My then 15 year old daughter started feeling ill at school - her heart would start racing so fast it would make her start throwing up. Then she’d be ok then it would happen again. My husband took her to the family doctor and while she was examining her her heart started really racing - can’t remember the number of beats per minute but it was a dangerous level. Turned out a medicine prescribed by the family Doc and one prescribed by her ear nose and throat specialist - neither at all dangerous on their own - both caused an elevated heart rate and in combination caused a dangerous situation where she could have had a heart attack. Scary. We are very careful now about making sure we communicate all medicines to all doctors. And she learned that prescription medicines can be very dangerous.</p>
<p>That’s because Percocet already contains Tylenol. If you had taken both, you may have a temporary elevation of your LFT (Liver Function Test) but it’s not going to hurt you much. Indeed , it is unlikely to kill you. And again, we are talking about normal therapeutic dosages.</p>
<p>My kids have had it beaten into their skulls for years that you do not take ANY drug on top of ANY other drug without clearing it with a doctor or pharmacist. </p>
<p>They make pests of themselves by doing this. I don’t care. It’s the only way to be safe, in my opinion.</p>
<p>And of course, kids with special issues related to medicines, like corranged, have to bring up that issue every time they see a health professional.</p>
<p>One more anecdote before I get off my soapbox (and yes, I admit that I’ve been up there): More than 20 years ago, I took a benzodiazepine tranquilizer for 6 years. I never exceeded the recommended dose. Never. No doctor ever warned me about the dangers of discontinuing the drug abruptly. So one time I did just that (I didn’t want to build up a tolerance to the drug). After having taken the drug almost daily for six years, I didn’t take any for four days. I had a grand mal seizure – a known withdrawal reaction to that particular drug, which I had never been told about. Fortunately, this happened while I was in a shopping mall. If it had happened fifteen minutes earlier, when I was driving to the mall, I could have killed myself and other people. And remember, this was a drug where I had never exceeded the therapeutic dosage.</p>
<p>I’m just saying that when it comes to medicines, be careful and be informed. Even if you only take the therapeutic dosage.</p>
<p>Being in pharmaceutical industry (sort of, if one includes biotech), I have read too many papers describing various drug interactions. Even though I always use one pharmacy for my family’s prescriptions (they should have the list of all our prescriptions and see any upcoming danger, right? - wrong!), I always talk to the pharmacist whenever something new is prescribed to me or someone else in my family and question them about potential drug interactions with our current medicines and any OTC and HERBAL SUPPLEMENTS we are currently taking.</p>
<p>Kids should also learn that alcohol can play a huge role in how their bodies will process a drug. Something as “innocent” as an OTC NSAID painkiller can become very dangerous when mixed with alcohol.</p>
<p>Today my pharmacist insisted on a counseling session for an old med re-prescribed, with the blessing of two dr.'s offices by phone consultation following my dr’s visit to one of the offices.</p>
<p>SHE (the pharmacist) caught a rare interaction possibility and told me to stop taking one of these as long as I took the other two.</p>
<p>So you know I will be talking with my Dr. next visit about that. Thanks to a pharmacist at a chain store! </p>
<p>Since my Dad died from an autoimmune response to a new cardiac drug, and the flu-symptoms that should have flagged it were dismissed as “just flu” instead of allergic reaction to a new drug, both the medical practitioner and cardiologist pointed fingers at each other. So this is my least favorite topic in the world, prescription drugs getting by you and causing harm.</p>
<p>And my Dad’s and my stories concern two sets of two experienced doctors, living in the same town. All the more challenging: Heath Ledger’s situation is from prescriptions from across two continents.</p>
<p>Of course each person MUST be very vigilant, and there is a system at place (at the pharmacy) to catch potentially harmful drug interactions, Thinking on it now, the one that she warned me to stop is one I’m prescribed and allowed, but set aside on an as-needed basis (the one that could have interacted with the brand new one). </p>
<p>Here’s the question asked at the dr’s office of me: “What meds are you taking?” I thought of what I was currently TAKING rather than all that have been prescribed and available to me on an “as-needed” basis. Surely I could have taken it sometime in the coming month, “as needed” and with powerfully bad interactions possible (seizures).</p>
<p>C’mon. This is really scary. I don’t judge anyone who has a pill mixup. Please be very careful yourselves, AND teach your kids about this.</p>
<p>Good point bunsenburner. The trouble with our insurance driven world is we have to get out prescriptions from 2 different sources. Anything ongoing for more than one month we have to get it by mail order. Anything one off we can get from the local pharmacy. We do talk to the local pharmacist - not possible with the mail order.</p>
<p>I always remember an experience when my son was a toddler. He was prescribed something by a doctor when we were living in Egypt. The pharmacist looked at the prescription and, seeing my son, asked if it was for him. Turned out the antibiotic could have caused loss of hearing.</p>
<p>Interesting post. Someone who works for me dislocated a shoulder badly while skiing. They refused to give him ANY medications at the hospital near the mountain because they said they didn’t know what medications he might be taking or have prescriptions for at home.<br>
At the time I couldn’t believe they would let him go without meds…thinking about it later, especially with a twenty something guy, they probably were smart to use caution and tell him to see his doctor at home.</p>
<p>cbreeze,
I can’t take Tylenol <em>at all</em> due to the daily oral chemo I’m on for my leukemia. People have died from liver failure due to the combo. It means I have to watch out for all the other drugs out there that contain acetominophen as an ingredient, too. (This is most annoying when I have a cold, like I do now. Sniff. Cough. Hack.)</p>
<p>Nevertheless, even though I fully disclose my meds to the docs (and note my allergy to codeine), I had surgery three times this fall – and <em>EVERY TIME</em> I was offered a Tylenol + codeine product for post-op pain. I have coached my DH about this in case I am ever in a situation where I can’t speak for myself.</p>
<p>None of my regular docs are familiar with my leukie drug – and none have ever bothered to check the PDR in my presence when prescribing me something when I’m in the office. On the other hand, my kids’ pediatrician did and told me “You know you shouldn’t take…”</p>
<p>I’ve also talked to my kids about the medications they take and what precautions need to be in place, as well as how drugs/alcohol can exaggerate the effects of normal, safe doses of OTC or prescription meds.</p>
<p>Well, I don’t think it’s on the parent to teach their kid about taking medicines. I would hope that at 17-18, a student would know that if you take too many pills, you might overdose.</p>
<p>CountingDown: That is really scary. I face a similar situation. It seems that asthmatics with other conditions present are known to need to avoid aspirin and ibuprofen. No one knows this, and I have been offered both on numerous occasions. The results can be fatal.</p>