Aspirin is often blamed for causing accidents. However, according to emergency physician Dr Gérald Kierzek, this is far from being the main cause of trips to the emergency room linked to medication. So, which medications should you take with the most caution?
Everyday treatments
The reality is more complex, more silent: these are very common treatments, prescribed every day, which are most often the cause of serious adverse drug reactions (ADRs), especially in the elderly and people taking multiple medications.
“Drug iatrogenics is a major public health problem, but it remains largely underestimated”recalls Dr. Gérald Kierzek. And for good reason: the more medication a patient takes, the more the risk explodes.
Among those over 65 taking at least five medications, the danger becomes particularly high. After ten treatments, nearly 35.6% of adverse drug reactions occur. A real therapeutic time bomb.
Psychotropic drugs, the main silent culprits
Contrary to popular belief, it is not painkillers that dominate the ranking, but psychotropic drugs: anxiolytics, hypnotics, antidepressants and neuroleptics. They represent approximately 20.5% of serious adverse effects.
“These drugs act on the brain, therefore on alertness, balance and heart rate”explains Dr. Kierzek. Result: falls, rhythm disturbances, overdoses, even coma. Among the elderly, they are involved in 5.2% of hospitalizations for falls.
The problem worsens when these treatments are combined with others, notably diuretics or antihypertensives, multiplying interactions and side effects.
Anticoagulants, a major bleeding risk
Just behind come anticoagulants, whether VKAs (like warfarin) or DOACs (like rivaroxaban). They are responsible for approximately 8.8% of serious adverse drug reactions.
“The main danger is digestive or cerebral hemorrhages”underlines the emergency doctor.
These complications are often linked to an overdose, a drug interaction (particularly with NSAIDs or aspirin) or insufficient monitoring of the INR for VKAs.
Cardiovascular drugs: an underestimated risk
Cardiovascular treatments, excluding anticoagulants, represent between 15.4% and 21% of ADRs.
Among them:
- Antihypertensives, which can cause hypotension and falls;
- Beta blockers, responsible for bradycardia;
- Diuretics (11.7%), associated with hydro-electrolyte disorders and acute renal failure (6%).
“In an elderly patient, simple drug-induced hypotension may be enough to cause a fall and hospitalization”warns Dr. Kierzek.
Analgesics and NSAIDs: a very real danger (but not number one)
Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) represent approximately 13.9% of serious adverse reactions.
They can cause:
- Digestive bleeding (aspirin, ibuprofen);
- Renal failure;
- Respiratory complications and opioid addictions.
“Self-medication with NSAIDs is particularly problematic, because it is often added to treatments already in progress,” insists the emergency doctor.
Antidiabetics, antibiotics and heavy treatments: specific risks
Oral antidiabetics, such as metformin or sulfonamides, are a common cause of severe hypoglycemia, sometimes leading to coma, particularly among seniors.
Antibiotics can cause severe allergic reactions (anaphylaxis) or serious diarrhea, particularly linked to Clostridioides difficile.
As for antineoplastics and immunomodulators (16.8%), they expose one to sometimes severe toxicities, just like certain new targeted therapies or incretin mimetics, the use of which is expanding.
The real aggravating factor: polypharmacy
The common denominator remains polypharmacy.
“Beyond four medications, the risk of adverse effects increases three to four times. recalls Dr. Kierzek.
In patients over 65, the situation is even more pronounced: 90% of patients with a serious adverse effect are on polymedication, compared to 75% in those without complications.
Drug interactions, for example psychotropic drugs combined with diuretics, play a key role in these avoidable hospitalizations.
Preventing rather than suffering is possible
Good news: a large part of these trips to the emergency room could be avoided. Dr Kierzek emphasizes several essential levers:
- The shared medication use report (BUM);
- Therapeutic education of the patient;
- Remote monitoring (in particular of INR for anticoagulants);
- Avoidance of self-medication;
- Reporting of adverse effects to pharmacovigilance.
“Each medication is useful, but none is harmless. The danger is not necessarily in a single treatment, but in their accumulation and their interactions” he concludes.
In short, the main drug risk today is not an isolated tablet like aspirin, but the combination of common treatments, especially among the elderly. A daily clinical reality in the emergency room, which recalls a simple rule: the more complex the prescription, the higher the vigilance must be.