How Safe Is Your Medicine Regimen?
If you fill multiple prescriptions each month, welcome to the club. More than one-third of people between ages 62 and 85 take at least five prescription drugs.
But as people age, many drugs are harder on the body. “Older people may be more sensitive to medications than younger ones,” says Ronan Factora, M.D., a geriatrician at the Cleveland Clinic.
Body fat increases while water levels drop. That means drugs can become more concentrated and may also stay in your body longer (so you may feel the effects at lower doses, and they may last longer).
Declining liver and kidney function can exacerbate such issues. “That’s why a drug you had no problem taking in your 40s can suddenly start causing side effects in your 60s,” Factora says.
Even the most innocuous-seeming drug, such as aspirin, can have negative consequences. For years, doctors recommended an aspirin a day for healthy older adults to help prevent heart attacks.
Then a study of more than 19,000 healthy people older than 70, published in 2018 in the New England Journal of Medicine, found that daily aspirin didn’t reduce cardiovascular disease risks but did hike rates of gastrointestinal bleeding by 38 percent.
The American College of Cardiology and the American Heart Association now advise against routine aspirin use in adults over 70 without heart disease. And in a recent update of its Beers Criteria—a list of meds that may be inappropriate for seniors—the American Geriatrics Society urged caution toward using aspirin as a heart-disease preventive in people older than 70 with no history of heart disease.
But when used properly, many medications are life-enhancing or lifesaving. Here’s how to make sure you’re getting the benefits with as few risks as possible.
Know Which Drugs to Avoid
For older adults, certain meds may be best left on the shelf, notably benzodiazepines, such as the anti-anxiety drugs diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan), and sleeping pills like zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta).
“All increase your risk of falls and cause confusion,” says Judith Beizer, Pharm.D., a clinical professor at St. John’s University College of Pharmacy and Health Sciences in Queens, N.Y., who worked on the new Beers guidelines. Their effects can last into the next day, causing a hungover feeling.
Certain over-the-counter products are also considered risky for seniors, specifically the antihistamines diphenhydramine (Benadryl) and chlorpheniramine (Aller-Chlor, Chlor-Trimeton)—also found in some nighttime cold medicines.
These drugs (called anticholinergics) have been linked to dry mouth, blurry vision, constipation, dizziness, trouble urinating, and confusion and dementia in older adults, Beizer says.
A 2018 analysis that included more than 300,000 people, published in The BMJ, found that anticholinergics are associated with a higher dementia risk even 20 years after use.
Use Some Meds With Caution
If you’ve had a heart attack or stroke, a daily aspirin can help prevent a second one, Factora says. But if you’re older than 70 and don’t have heart disease, gastrointestinal bleeding risks outweigh the benefits of daily aspirin.
For those prescribed an opioid for a few days after surgery, the Beers guidelines note that mixing it with benzodiazepines can cause oversedation, and nerve-pain meds, such as gabapentin, can hike the risk of respiratory depression and death.
Antidepressants, meanwhile, can make patients more susceptible to drowsiness and dizziness, says Mary Tinetti, M.D., a geriatrician at the Yale University School of Medicine in New Haven, Conn. Consider talk therapy. And if you take an antidepressant, start with the lowest dosage and have your doctor monitor you closely for adverse effects, she says.
OTC pain relievers such as ibuprofen (Advil and others) and naproxen (Aleve and others), may be problematic if used on a regular basis, says Michael Hochman, M.D., M.P.H., an associate professor of clinical medicine at the Keck School of Medicine of USC in Los Angeles.
These can increase gastrointestinal bleeding risks, raise blood pressure, and harm your kidneys. If you have ongoing discomfort, consider using OTC topical patches that contain ingredients such as methyl salicylate and menthol.
Talk to the Doc About Dosages
Sometimes the problem isn’t the drug but the amount being taken—especially with a chronic condition such as heart disease or type 2 diabetes.
Doctors may be trying to get your blood pressure or blood glucose lower than necessary for your age, which can raise the risk of side effects significantly, Factora says.
Annually, meet with your primary care provider or pharmacist and go through all the meds and supplements you use to ensure that you’re getting the right medications at the right dosages.
Watch for Side Effects
About one-third of older adults have a drug-related side effect each year, with nearly 30 percent of them requiring a doctor’s appointment or hospitalization. “Sometimes this can cause a prescribing cascade—the doctor mistakes the drug reaction for a new disease and prescribes an additional medication, which can make the problem worse,” Beizer says.
When you get a new drug or a dosage change, go over possible side effects with your doctor or pharmacist (see below). If you notice anything amiss, don’t stop the drug but let your doctor know right away. Switching to another dosage or medicine may help.
Keep Your Info Up to Date
One key step in ensuring that you’re taking your meds safely: Carry an up-to-date medication list with you, even if your doctors have the info in your electronic medical record and you always use the same pharmacy or chain to fill prescriptions. This practice is especially important if you’re traveling and might not have easy access to records.
In your list, include all your regular OTC and prescription drugs, as well as any vitamins or other dietary supplements you take.
Make sure that your primary care doctor and pharmacist have the list and that any updates are entered into your electronic medical record. It’s also a good idea to give the list to a close friend or family member who may make medical decisions for you in case of an emergency.
For each medication or supplement, list its name, what it’s used for, the dosage, any special instructions, and the name and contact info for the prescribing doctor. If there are any side effects to be aware of, or foods or drugs to avoid, note those as well.
You can make your list on paper or digitally, or create a “pill card” at the Agency for Healthcare Research and Quality website.
Ask Questions About Any New Rx
When you get a new drug, you want to be clear on its name, purpose, risks, benefits, dosage, and how long you’re likely to be taking it. Also ask:
1. How do I take this drug? Ask when and how often to take it and whether to do so with food or drink, or which foods, drinks, or activities to avoid.
2. What side effects could this medication have? Ask about any possible negative effects of the drug, how long they may last, and what to do if you experience one.
3. Can it interact with other drugs or supplements I use? “The more drugs you take, the greater the chance that it will interact with something else you’re on,” Factora says.
4. How will I know if the med is working? Your doctor can explain to you what to look for and how long it may take to see the medication’s desired effect.
5. What follow-up tests or monitoring will I need with this drug? With certain meds, you may need to be checked from time to time. For instance, blood thinners and diuretics can affect kidney function, so you’ll have periodic blood tests if you use these.
Editor’s Note: This article also appeared in the November 2019 issue of Consumer Reports On Health.
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