Thursday, March 7, 2019

Do I really need all these pills?

A prior post discussed the importance of taking medication as prescribed, focusing on medications that were intended to prevent things like strokes, heart attacks and fractured hips. There is another side to the coin.

Doctors are increasingly aware of the problem of “polypharmacy:” taking a lot of pills. Almost 60% of all Americans take at least one prescription medicine and a third of Americans over 65 take five or more medications daily. Add to these various supplements and over-the-counter (OTC) pills and that can add up to quite a handful. At times this may be appropriate and beneficial. If you have diabetes, hypertension and congestive heart failure, most of your pills may be needed. However, in many cases pills have been added by one doctor unaware of what another doctor prescribed.

Your primary care doctor (if you are fortunate enough to have one) may not even be aware of everything you are taking. Many medications interact in ways that may be harmful. Some may have been intended only for short-term use but were never stopped. Some may have been appropriate when you were younger but have more side effects as you age.

Some specifics: many drugs to treat bladder problems cause dry mouth in everyone but also constipation, confusion and falls in the elderly. Young patients with diabetes with good home support benefit from having their blood sugar tightly controlled; it prevents later eye, kidney and vascular problems. Older patients benefit less and are much more at risk of low blood sugar (hypoglycemia) which can be a serious threat, even fatal, if they are over-medicated.

Some patients whose blood pressure has been well-controlled can lower or stop their medications and maintain good pressure for extended periods or indefinitely.

Anti-anxiety medications and many sleeping pills have been repeatedly linked to falls in older patients who take them. Digoxin has been used for a century to treat heart failure but more recently has been found to increase death rates in people who take just a bit too much.
What can you do? First, be sure to carry with you a list of every pill you are taking. This may be life-saving should you end up in an emergency department, but it should also be shown to any doctor you see. Periodically it is useful to ask your primary care doctor to review what each of the pills is for, and to ask whether there are any that might be safely stopped.

I would always ask my patients once a year to make a “brown bag visit,” bringing in every pill they had at home and we would often be able to cull many that were duplicating each other. It was amazing to find that people were often taking the same medication twice, because the pills in the different bottles looked different because of different manufacturers and may have even had different names – one branded, one generic. It may be appropriate to ask if lifestyle changes could take the place of some of your pills. If you are willing to put in the effort, this is often possible.

The same review may be able to identify expensive pills that have an equally good and cheaper alternative.

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