The word "overdose" implies that there is a safe dosage and therefore the term overdose is commonly only applied to drugs, not poisons.When a drug is ingested in quantities and/or concentrations large enough to overwhelm the homeostasis of a living organism, causing severe illness or death. It is a type of poisoning.
Symptoms of overdose occur in various forms:
Exaggerated form of normal action (sleepiness on antiepileptics, hypoglycemia on insulin)
Other effects due to chemical properties of the medication (metabolic acidosis in aspirin, liver failure due to paracetamol)
Non-specific symptoms due to central nervous system irritation (confusion, vertigo, nausea, vomiting)
This might happen also for underdose medication.
A new study shows,overall, 65 percent of the 196 study patients were on at least one drug that was unnecessary, a duplication of the effects of a drug they were already taking, or not recommended for older people, the researchers found.
"The steep rise in inappropriate medication use with increasing numbers of drugs provides a striking confirmation of the potential harms and need for extra vigilance" in patients prescribed multiple drugs, Dr. Michael Steinman of the San Francisco VA Medical Center and colleagues write.
Steinman and his team found that underprescribing was equally common; 64 percent of the patients were not prescribed a drug that they should have been taking.
Medication underuse and overuse were seen simultaneously in 42 percent of patients. Just 13 percent of the patients were not on an inappropriately prescribed medication or not on a drug that they should have been prescribed.
To better understand the relationship between "polypharmacy," or prescribing of multiple medications, and inappropriate prescribing, Steinman and his team evaluated VA Medical Center patients who were taking five or more drugs. All were outpatients, and their average age was about 75 years. The number of medications they took ranged from 5 to 17, with an average of about 8.
As mentioned, inappropriate drug use rose steadily with the number of different drugs a patient was prescribed. For example, those on five to six drugs averaged less than one inappropriate drug, while those taking seven to nine medications were on an average of one misprescribed drug. Patients taking 10 or more drugs averaged at least two inappropriate medications.
However, the researchers found, the frequency of underprescribing did not vary with the number of medications a patient was on. In addition, underuse was more common than overuse among patients taking fewer than eight drugs.
"Inappropriate medication use is most frequent in patients taking many medications, but underuse is also common and merits attention regardless of the total number of medications taken," the researchers conclude.
A special pharmacy care program encourages elderly patients to take all their medications, which can boost their long-term health, U.S. researchers report.
The study found that the program -- which includes education about medications, regular follow-up by pharmacists, and dispensing medications using time-specified blister packs -- increased medication adherence by more than 30 percent.
"We need to operationally figure out how to do this. There's so much effort going into figuring out which drugs are efficacious and so little in getting patients to take their pills," said researcher Dr. Allen Taylor, chief of cardiology at Walter Reed Army Medical Center in Washington, D.C.
"It's the delivery of clinical pharmacy care, which makes education, follow-up and custom medication available to patients. It's a model of pharmacy care that we don't think of," Taylor added at a news conference Monday at the American Heart Association's annual meeting in Chicago.
In their study, his team noted that, "barriers to medication adherence are numerous, but include the prescription of complex medication regimens, treatment of asymptomatic conditions and convenience factors. These factors are particularly prevalent among the elderly population, placing them at increased risk for medication nonadherence."
When patients fail to take their medications are required, the end result is often worsening illness and more, expensive hospital care.
The researchers studied 174 patients, average age 78, who took an average of nine different medications a day and were enrolled in a six-month pharmacy care intervention. When the six-month trial period ended, 159 of the patients were randomized to continue the pharmacy care program or return to their usual care for an additional six months.
At the beginning of the first phase, average medication adherence was 61.2 percent.
"After six months of intervention, medication adherence increased to 96.9 percent," the study authors noted.
"Six months after randomization, the persistence of medication adherence decreased to 69.1 percent among those patients assigned to usual care, whereas it was sustained at 95.5 percent in pharmacy care," they wrote.
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