Common medications may increase heat wave risk

Yves gentlemen. We deviate (only slightly) from our usual programming in order to bring you this public announcement. I may have missed it, but I don’t recall seeing anything in the mainstream media about possible bad interactions between high ambient temperatures and widely used drugs.

Neha Pathak, MD, FACP, DipABLMs, dual certification in Internal Medicine and Lifestyle Medicine, who works on the medical team responsible for ensuring the accuracy of health information in WebMD and reports on topics related to lifestyle, environment, and change climate. health impact. Pathak is a co-founder of Georgia Clinicians for Climate Action and co-chair of the American College of Lifestyle Medicine’s Global Sustainability Committee. She is Public Voices’ Op-Ed Climate Crisis Fellow and the Yale Program on Climate Change Communication. Originally posted on Yale climate connections

Heat waves can be deadly. And experts fear that certain drugs could make the danger even worse.

Tens of millions or Americans take one or more medications. And many common prescription and over-the-counter medications, such as some antidepressants, antipsychotics, antihistamines, and drugs used to treat diabetes and high blood pressure, can reduce the body’s ability to maintain a safe temperature.

Medications can upset the body’s internal thermostat or impair sweating. review 2021 in The Lancet, a peer-reviewed medical journal.

Kenneth Mueller, a pharmacist and clinical instructor at the Emory School of Nursing, says certain medications can affect a person’s perception of heat and internal thermostat. And they can change the body’s ability to redirect blood flow to the skin, a key way to keep it cool.

In hot weather, these side effects can increase the chance of life-threatening consequences such as severe dehydration or heat stroke.

“Physicians and pharmacists should warn patients of the potential dangers [these] medication during extreme heat,” CDC spokesman Bert Kelly wrote in an email.

What medications can make a fever more dangerous?

Antidepressants are selective serotonin reuptake inhibitors or SSRIsmay increase sweating, increasing the risk of dehydration.

Others like tricyclic antidepressants or TCAsmay reduce sweating by making it difficult to cool down.

Antipsychotics can interfere with sweating and alter the body’s internal thermostat.

Anticholinergic drugs, a large category of drugs commonly used to treat a variety of conditions such as urinary incontinence, overactive bladder, allergies, and Parkinson’s disease, can affect sweating and the body’s internal thermostat. They can also reduce blood flow to the skin.

Patients with heart disease may be prescribed several medications, including diuretics and ACE inhibitors. These drugs can cause dehydration, affect kidney function, and limit the body’s ability to redirect blood flow.

Pharmacist Müller adds that dehydration can also be dangerous.

Dehydration can increase blood levels of certain medications. Even small increases can lead to toxic effects for some drugs such as lithium. These effects can range from tremor and weakness to agitation, confusion, and even death.

And some diabetes medications, including insulin, can lose their effectiveness in hot weather.

Who is most at risk for drug-heat interactions?

Anyone can experience heat-related illness.

But adults aged 65 and over and people with chronic illnesses are among the most vulnerable to extreme heat.

The study a 2003 heat wave study in France found a 40% increase in excess mortality among people over 65 and a 70% increase in excess death among people over 85 during the event. Other found a higher risk emergency hospitalizations among the elderly during a heat wave in California in 2006.

Older people may be more sensitive to heat because as they age, their sense of thirst may decrease, as well as their ability to sweat.

People with chronic conditions such as heart disease and diabetes are also more sensitive to heat. Heart disease can make it difficult for blood to flow to the skin. Diabetes can reduce blood flow to the skin and reduce sweat production. Both processes are necessary to cool the body when the temperature rises.

In addition, older people and people with chronic diseases are more likely to take medications that cause more frequent urination and changes in sweating patterns.

Many people over 65 take more than five drugs. Some have drug lists in double digits.

Sixty percent of Americans have at least one chronic disease, and 40 percent have two or more.

In a world of climate spikes and longer summers, the combination of age, chronic illness and medication can make people vulnerable.

How to protect yourself in hot weather

If you’re at increased risk for heat stroke, especially if you’re older and on chronic medication, watch yourself for the first signs of heat stress: dizziness, fatigue, or thirst.

Make sure you have access to a cool place to rest. Drink non-alcoholic fluids regularly, though follow your doctor’s advice – drinking large amounts of plain water in a short amount of time can be dangerous due to the risk of electrolyte imbalance in some people.

Frequent contact with family or other caregivers can also save a life.

But the experts interviewed for this article could not offer advice other than knowing the potential risks of drugs and thermal interactions.

“People take medicine because they need it. But what do you do when it gets hot? Is it just to stay inside and stay air conditioned? Does it reduce the dose by 10%?” asks pediatrician Aaron Bernstein, director of the Center for Climate and Global Environment Health at the Harvard Harvard School of Public Health. T. H. Chana. “We do not know”.

More research is needed to understand the features

Ollie Jay, director of the University of Sydney’s Heat and Health Research Incubator, warns that researchers have not completed systematic studies that show the exact link between medications and heat risk.

Although various studies show that people taking certain classes of medications are more likely to need emergency care and that there is an association between certain medications and a higher chance of dying during heat extremes, researchers have yet to conduct “gold standard” experiments. to demonstrate the exact effect of drugs on the body’s ability to respond to heat.

Jay is working on research that tracks how anticholinergic drugs can affect how people regulate their body temperature through sweating and changes in blood flow to the skin.

He adds that there is strong evidence that cocaine affects sweating and skin blood flow, and reduces the sensation of heat.

“So in terms of evidence for this type of drug, it’s clear, but there aren’t that many prescription drugs,” he says.

Bernstein, a pediatrician, agrees that more research is needed to establish a direct link between specific prescription drugs and the exact contribution to heat illness, and to understand whether the risks are higher for people taking multiple medications.

“But we absolutely see that people on these drugs are showing up in hospitals in greater numbers because the drugs are affecting them,” he says.

Health professionals have a lot to learn

Another problem: Many healthcare professionals are unaware of the risks of heat-drug interactions. Most of them do not usually advise their patients on how to stay safe.

Cheryl Holder, a primary care physician in Miami, Florida, has been named Co-Chair of nascent Miami-Dade County in 2021. Task Force on Climate and Heat for Health. Holder now wants the task force to work on developing a local heat action plan that educates the public and healthcare professionals about the health risks of heat, including medication.

“Many doctors here have made some general changes where most doctors don’t prescribe diuretics for patients who have to work outdoors,” she says. Since diuretics, commonly known as diuretic pills, can lead to dehydration, their use is especially important during times of extreme heat.

“But in terms of full awareness of excess mortality and better preparation, we are just getting started,” she says.

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