ALARM BELL COMBINATIONS, THE ABC OF PHARMACOLOGY

We present a novel pharmacological concept, previously not described, the concept of the pharmacological alarm bell combination, a hypothesis different from the well-known problems associated with pharmacodynamics and pharmacokinetics. The prescription of drug A and the co-prescription of drug B, often by two physicians for the same patient may, as individual medications, be appropriately selected according to the patient’s pathophysiology, but when viewed together by a physician well versed in internal medicine, be illogical. Examples include the common co-prescription of frusemide and saline, or aspirin and iron.

The ageing Australian population includes increasing numbers of patients with multiple diseased systems, often under the care of multiple subspecialists, who are prescribed drug combinations that are often clinically inappropriate when the patient is reviewed carefully and holistically. We describe 202 consecutive admissions to general medical wards at two large suburban hospitals, evaluated for alarm bell combinations (ABCs). Approximately one patient in four was found to have drug combinations that were mutually illogical, clinically incompatible or inappropriate.