Sunday, May 19, 2024

Are you taking too many pills?

Americans take a lot of pills! About 20% of adults between 49 and 75 are taking 5 or more prescription medications daily. This gets commoner as we get older. Surveys found that 13% of young adults (30-49) take 4 or more prescription drugs daily, while 54% of those over 65 do so.

While many of these medications are beneficial or even life-saving, there is a lot that can go wrong. Many medications interact with each other in harmful ways. Many more are of only minimal benefit while carrying serious side effects.

The problems with over-medication are much worse in older adults. As we age, we accumulate more chronic illnesses, and these often lead to more drugs prescribed. With age, the kidneys and liver are less able to eliminate drugs and levels may pile up to dangerous levels. Older adults are more susceptible to many drug side-effects, including confusion and excessively low blood pressure.

Another potential issue is that as medicine has become overly specialty-oriented, multiple doctors may be prescribing medications that seem fine from their perspective without realizing that other doctors are prescribing medications that may be conflicting with the new one.

How can you protect yourself?

First, be sure your primary care doctor knows what you are taking. I would have my patients make a yearly “brown bag visit,” bringing in ALL of the medications they were taking, including over-the-counter pills. A common finding was that people were taking the same medication twice – one bottle had the brand name and the other the generic, and the pills looked nothing alike – so they were unaware of this double dosing. We also often found medications that I was sure they had stopped but which their pharmacy “auto-refilled” and they kept taking.

Whenever your doctor suggests a new pill, always ask if there are life-style changes you could try instead. It may be that you need the medicine now, but could come off it in the future if you do make those changes.

Ask if the symptom being treated (ankle swelling, dry mouth, high blood pressure, etc.) could be a side-effect of a medicine you are currently taking. Perhaps that symptom would be better treated by changing the culprit pill rather than adding a new one.

Be particularly cautious when adding a drug on the Beers list, a list of drugs felt by the American Geriatrics Society to have a poor benefit to harm ratio. It is easily found on-line. You may still benefit from the medication, but have a frank conversation with your doctor.

Almost any time a new medication is added, a good rule is “start low and go slow.” Begin with a low dose and raise the dose only after giving the initial dose a trial.

Modern medications can be life- and health-saving, but they can harm. Caution and common sense should prevail.

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