Do you need all the drugs you’re taking?
The pills you’ve taken for years may not be the best ones to be taking today.
You probably go through your closet periodically, weeding out clothes that may no longer fit. But how often do you take stock of your medicine chest? If you can’t remember the last time you did an inventory of your pill bottles, you may want to add it to your to-do list. You could find that some of your medications are as inappropriate as your high school prom dress.
“It’s always a good idea to periodically question whether you need to be on a drug or on as high a dose of the drug,” says Sarah Berry, MD, MPH, a geriatrician and clinical researcher in the Division of Gerontology at Beth Israel Deaconess Medical Center and at Hebrew SeniorLife.
Why Our Drug Needs Change
Like some items in your wardrobe, the drugs that suited you at one point may not work as well as you go through life.
“Guidelines for drug therapy change and bodies change,” Dr. Berry says. “You may have needed multiple antihypertensive agents while you were still working, but you probably don’t need it later on.”
The physical changes that affect how you process drugs occur in your kidneys and liver, which are responsible for processing drugs. With normal aging, both organs clear drugs more slowly, so drugs stay active longer. As a result, a dose of a drug that was optimal 20 years ago may be too high today.
And, you may have developed some aches and pains and chronic conditions, so that you may be taking more prescription and over-the-counter medications than you did 20 years ago. Each of those drugs has the potential to suppress or enhance the effectiveness of other drugs you take.
The more medications you take, the greater the opportunity for adverse interactions. For example, you may have been taking warfarin (Coumadin) for atrial fibrillation to reduce your risk of stroke, but many over-the-counter supplements and prescription drugs metabolized by the liver will alter warfarin metabolism and the recommended therapeutic dosing of the drug.
Some Drugs to Approach with Caution
Because drugs stay in the body longer as we age, they can have exaggerated effects in people over 65. The following are especially likely to have troubling side effects.
This category of medications to treat anxiety or insomnia includes long-acting drugs like Valium (diazepam) and shorter-acting ones like Xanax (alprazolam) and Klonopin (clonazepam). They have been associated with increased risk of falls, confusion and memory loss. A recent observational study showed an association between long-term (more than three months) use of benzodiazepines and an increased risk of Alzheimer’s disease. They also tend to create dependence and you can have withdrawal effects if you stop taking them.
“These are drugs we should question,” Dr. Berry advises. “If you are taking one, it’s a good idea to ask your doctor if your dose can be lowered.”
An antihistamine developed in the 1940s, diphenhydramine was first used to reverse allergic reactions. It has been sold over-the-counter as Benadryl for allergy relief for decades. It also makes people drowsy, so it has been incorporated into sleeping aids like Zzzquil and Sominex. Because it constricts blood vessels, dephenhydramine raises blood pressure and increases the risk of heart attack and stroke.
“It’s the one drug I advise my older patients never to use,” Dr. Berry says.
Tricyclic antidepressants, including amitriptyline (Elavil), clomipramine (Anafranil), doxepin, and imipramine, can cause drowsiness and a sudden drop in blood pressure, increasing the risk of falls and accidents. Selective serotonin reuptake inhibitors, or SSRIs, like Prozac, were once thought to be safer, but recent research has indicated that they are also associated with an increased risk of falling.
The so-called “Z-drugs” zolpidem (Ambien), zapelon (Sonata), and zopiclone (Imovane) have many of the side effects of benzodiazepines, including next-day drowsiness.
“The increased risk of falls and fractures is elevated, especially when you first start,” Dr. Berry says.
In 2013, the FDA lowered the maximum recommended daily dose of Ambien for women from 10 mg to 7.55 mg because of concern of driving safety and cognitive performance with higher doses.
The “Brown Bag” Solution
Putting all of your prescriptions as well as all the over-the-counter drugs and supplements you take into a bag and bringing it to your next medical appointment is a great way to make sure you are taking only the drugs you need. Sometimes, what your provider thinks you are taking isn’t exactly the same as the drug you are taking. Bringing in everything is a good way for the doctor to see everything you take.
You should ask your doctor the same two questions of every drug in the bag, Dr. Berry says: “Do I need to be taking this?” and “Could I get by with a lower dose?”