There’s an unfamiliar door up ahead. It’s dark and in disrepair. Intriguing. You have heard that cures for many ailments may be found on the other side. Tempting. Well then… turn that knob! But wait! A distant voice warns that for every 6 people who open that door, one person does not walk back out unscathed. Unpredictable sickness befalls them. Sometimes they recover; sometimes they are never the same; sometimes they die.

Will you still turn that doorknob?

Aaah! What a relief! That pain pill got you some reprieve from a throbbing toothache. An antibiotic allowed you to function with a nasty sinus infection. Medications are great when they work and are sometimes necessary. But has a drug ever tied knots in your stomach? Have you ever been rushed to a hospital after a pill caused a severe allergic reaction or fainting?

Medications can be lifesaving; medications can be life-sapping. People must choose them carefully and wisely. A recent report  released by the Agency for Healthcare Quality Reporting (AHRQ) found that medication-related bad reactions caused nearly 2 million hospitalizations in 2008, up 50% from 2004 numbers. These reactions tend to be more serious in the elderly.

There are four general medication no-no’s to be alert to:

The Wrong Medication

There are a number of medications that are best avoided in older adults. Research has shown these drugs often cause side effects that overshadow small benefits. Examples include old antidepressants such as amitriptyline, muscle relaxants like flexeril, older sleeping aids like Valium, and over the counter antihistamines such as Benadryl (diphenhydramine).

Some of the more serious bad reactions: Confusion, dizziness, and falls leading to hip fracture. Hip fractures are a major cause of disability and death in older adults.

Medication Side Effect Mistaken for New Disease

A patient complained to her doctor of weakness and general fatigue. The doctor prescribed vitamin B12 injections rather than stopping the cholesterol medication (statin) that actually caused that problem. A depressed patient was treated with antidepressants; but the doctor should have stopped the beta blocker heart medicine instead because it was the actual culprit. Medications should always be considered the bad guys, particularly if started recently, when someone develops new problems.

Drugs Can Worsen an Existing Medical Condition

Even if you take low-risk and appropriate medications, these drugs can aggravate an existing medical problem. For instance, aspirin-like drugs can worsen heart failure, high blood pressure or bleeding tendencies. Antihistamines like Benadryl can flare up prostate, memory or eye problems. (See “Beware Anticholinergic Drugs”)

Aging: Squeaky Kidney, Lazy Liver, and Missing Muscles

With each passing decade after age forty we lose about 10% of our kidney function. No surprise there. As we age, the back aches a bit more, the knees buckle more quickly, reading becomes more of a challenge. Simply put: our parts wear out. Similarly, the liver gets lazy and is not quite as lubed and primed. More importantly, we lose muscle mass as we age so smaller doses of medications can jolt older folks. Doctors sometimes give the elderly equal doses of medication as the young weight lifter who just left the office. Another common doctor oversight: neglecting to reduce medication dosages as people lose weight and become more frail.

Must-do Medication Tips

• More = Not Merrier. Studies have clearly shown that the more medications and pills you take the greater chance for adverse reactions. What do taking medications and golf have in common? Always aim for the lowest number.
• Use the balance scale: Do benefits of taking the drug far outweigh possible risks? For instance, a mild cough can best be nursed with tea and cough drops. Turn down the potent antibiotics unless you have high fever, breathing trouble or lung disease or other serious ailments. Coumadin, Insulin and digoxin have been found to cause a large proportion of adverse drug reactions. However, an irregular heart rhythm that poses a high stroke risk may warrant use of Coumadin. Out-of-control diabetes may make insulin necessary for adequate sugar control. Only a patient and doctor can come to that decision after careful thought and discussion.
• Always try non-drug treatments first. Insomnia: warm bath, soothing music, daytime exercise and avoid caffeine. Back or neck pain: hot tub or warm bath, stretching and non-impact exercise, massage.
• Ask your doctor if that medication poses a high risk for dizziness or drowsiness. Unless there are compelling reasons to take it, avoid it. Some common but unexpected culprits that may increase fatigue and fall risk include Benadryl and other antihistamines; DM or dextromethorphan in off-the-shelf cough suppressants; and stomach settling pills such as Donnatal, Bentyl, Levsin or dicyclomine.
• Ask your doctor for your “Estimated GFR” value. That is a more accurate calculation of your kidney function. A simple blood test can show a falsely normal level in the elderly. Those who do have “squeaky kidneys” will need to avoid some medications and use lower doses of others.
• As a general rule, avoid drugs that are “hot off the presses.” Newfangled drugs may be all the rage – but you will be the guinea pig on which that new medication will be tested. It is not unusual for a serious side effect of a drug to be discovered only after it was approved for use. Case in point: Vioxx, a pain medicine later found to increase heart attack risk. Vioxx is now off the market.
• Med Reviews: Be sure your doctor periodically reevaluates all medications you take for possible dosage adjustments, drug-drug reactions, drug-disease side effects, and if a drug can be safely discontinued.
• Tell your doctor about any over-the-counter pills you take such as vitamins, herbals and cold and pain remedies. Do not forget about the skin creams, eye drops and injection drugs. These may interact with other prescription medications or have side-effects.
• Patient Right of Refusal: A patient has the right to turn down a medication prescribed by a doctor. Some doctor’s may get offended, but medication decisions are ultimately up to the person who must take them (or a close relative).

Financial incentives for corporations and political motivations surely can affect decisions of an oversight agency like FDA to approve a drug. Doctor prescribing behavior may be swayed by drug company marketing. But you are the ultimate authority for what drugs you allow into your own body! Choose them wisely.

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Sidebar: Beware Anticholinergic DrugsBeware these medications that may increase confusion, aggravate glaucoma, cause difficulty urinating, constipation, dry mouth, blurred vision and fatigue. The Elderly are especially sensitive to these drugs:Antihistamines: Benadryl and similar Nausea: Compazine Motion sickness: Meclizine, Dramamine Antispasmodics: oxybutynin, dicyclomine Muscle relaxants: Flexeril Parkinson’s: Benztropine Herbals: Deadly Nightshade Antidiarrheals: Lomotil

Sources

Adverse Drug Events in Ambulatory care. New England Journal of Medicine. April 17, 2003, Number 16. Volume 348:1556-1564.

Beck, John C. Geriatric Review Syllabus: Normal Aging Changes in Renal Function. Chapter 54.

Budnitz, DS et al. National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events. JAMA. 2006; 296:1858-1866.

Budnitz, DS et al. Is It Safe to Conclude that Beers Criteria Medications Led to Few Adverse Events? Annals Int Med. April 15, 2008. Volume 148, Issue 8. Page 629.

Medication Side Effects, Injuries, Up Dramatically. AHRQ News and Numbers, April 13, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn041311.htm