The law of unintended consequences can lead to devastating outcomes. During the 1950s thalidomide was developed and prescribed in Europe to help pregnant women cope with morning sickness and insomnia. Tragically, the drug led to an epidemic of birth defects.

No one intended for babies to be born with deformed limbs. It was an unexpected side effect of the drug that was not immediately recognized.

Unintended consequences are not always so dramatic, but they may go equally unrecognized. They may be especially common when it comes to older patients taking multiple medicines.

One example is Bob, an 82-year-old reader who shares the following story of woe and intrigue: “I take 14 medications plus supplements. My nine doctors (four of whom are specialists) often disagree about what is best for me. My diabetes doctor says that the hydrochlorothiazide (HCTZ) diuretic for my blood pressure could make blood sugar rise, but my cardiologist disagrees.

“I was given 14 different blood pressure medications at different times. They included amlodipine, Benicar, clonidine, diltiazem, felodipine, methyldopa, Toprol XL and Ziac. Most knocked me out and made me feel dizzy and dazed. I rarely got a decent night’s sleep. Some of these drugs made it hard for me to urinate.
“I have tried many drugs to control my cholesterol, including statins, Zetia and Tricor. They all gave me severe explosive diarrhea.

“Several doctors prescribed Indocin to treat arthritis. All together, I took it for 28 years, until three years ago when they recognized that it was killing my kidneys. I now take Tylenol for pain relief, but I worry that 1500 mg daily will affect my liver.

“Doctors prescribed a dozen different medicines for depression, including citalopram, mirtazapine, trazodone, alprazolam, clonazepam and temazepam. None of them really helped, and the side effects were severe. I don’t take anything for depression now.

“I think I am taking too many medicines that may conflict with each other or aggravate my conditions.”

Bob’s situation may seem extreme, but it is not truly unusual. Older people frequently take handfuls of pills to treat a variety of conditions. Sometimes drugs are prescribed to counteract side effects from other medications.

When doctors disagree, as they have in Bob’s case, it puts the patient in a difficult position. As people age, their bodies change. Bob may have done fairly well with Indocin (indomethacin) for his arthritis pain when he was in his 50s. But as he neared his 80s, his kidneys were less capable of withstanding the assault.

Older people need all the help they can get to navigate the pitfalls of the medical system. It can be extremely confusing, so family members and physician allies are crucial.

To help people ask the right questions, we offer our Guide to Drugs and Older People with a Drug Safety Questionnaire for doctors to fill out.

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  1. R.G.
    Reply

    I was given Trazodone HCL 50MG to help with my sleep. (TEVA pharmaceutical). I took just half a pill at night, per the directions on the bottle. I only took it three nights. All three nights I slept, but the mornings were the worrisome part. The first morning I woke up I noticed a slight lower back pain (kidney area). The second morning, more intense pain, and the third morning, my right kidney area hurt so bad, I considered going into the doctors office. I stopped the trazodone immediately.
    Along with the pain I experienced swelling to my hands and feet, and face. Since discontinuing, the pain has gone away as well as the swelling. I have since set up an appt. to have a complete physical just to be on the safe side. Just wanted to share the experience.

  2. Reyo M.
    Reply

    I have been taking Simvistatin (Zocar) for many years and read in one of your columns that a possible side effect of long term use in Lou Gerhigs disease. Should I stop taking the medicine? By the way, I am 78 yrs, old and am a cardiac survivor.
    PEOPLE’S PHARMACY RESPONSE:
    As a heart attack survivor you definitely need to keep taking your medicine. Lou Gehrig’s disease is extremely rare and not something you should be worrying about. On the other hand, if you develop muscle pain and weakness, please let your doctor know promptly.

  3. Marie
    Reply

    I totally agree with the previous writer – “..We have a vicious cycle going..”
    Yesterday I went to listen to different lectures on training for middle aged and older people.
    They also talked about ruptured tendons and tendonitis.
    The speakers didn´t say a word about that you can actually get these problems from certain medications – for instance statins and quinolones (Cipro, Levaquin etc).
    There is also an interesting book “Bitter Pills” by Stephen Fried.
    Returning to statins……..
    They neither said a word about the fact that statins can make it impossible to do any training, at all!
    Before the lectures I talked to an old couple. He had experienced a terrible cramp in his calf during the nigth and was going to ask the scientists from Umeå University what to do. (He didn´t).
    He was taking a statin.
    I didn´t ask which.
    But before I told him about different side effects, books, webb-sites etc, I asked him if he had any symptoms that he had wondered about.
    His answer was yes.
    He thought that it had affected his memory!
    He would forget things and had a heard time to find words sometimes.
    I wonder how many people are on statins and don´t want to talk about the problems because they are afraid that it might be the beginning of Alzheimers or something?
    I am also pretty sure that many doctors, whether in the US or here, would just dismiss the problem and say that it was part of “natural aging”.

  4. AA
    Reply

    Several years ago, my BP averaged 210/190 WHILE I was on 5 BP meds a day, prescribed by a well-credentialed nephrologist.One was Toprol XL, which I complained left me SOB and so fatiqued I felt like life wasn’t worth living.
    In addition, a couple of these were listed as contraindicated if you have Lupus or asthma, both of which I do. I was told I needed to take them anyway.
    I heard about a hypertension grant that a hospital had and made an appt. there. They took me off the Toprol XL, switched me from 5 to 3 meds a day. Within ONE WEEK, after years of being out of control, my BP was within normal limits.
    It has been approx. 5 yrs. now, and I have had no trouble with my BP since. My advice is to see if there is such a grant near your readers and get a second opinion. And you could not pay me to ever take Toprol XL again!

  5. sh
    Reply

    We have a vicious cycle going. Doctors no longer practice their art. They go by guidelines (if your cholesterol is 201, you get a statin). In fairness to them, patients are demanding of walking away with a medicine rather than old fashioned advice.
    “Preventive” healthcare too often results in multiple drugs prescriptions.
    I have made my decision (and am at peace with it). That is I visit a doctor when I have something really wrong (like a skin cancer that needs removed). I am fortunate that is very rare. Otherwise I stay away. I tried the other way, and suddenly found myself on 3 medicines (and feeling rotten from side effx). If I die a couple of years earlier, so be it.

  6. CSM
    Reply

    The drug companies have paid for studies that say their products improve certain common conditions. AND if the practitioner does NOT order these drugs the practitioner is NEGLIGENT–and is held accountable.
    There are checklists that must be filled out before hospital discharge to ensure that these drugs have been started–and if not–WHY NOT. Example: an ace-inhibitor, beta-blocker, diuretics for heart failure. Blame the drug companies for this issue.

  7. hl
    Reply

    I was on a anti depressent that did not help. when I quit it I asked the doctor for suggestions. He told me my TSH was always borderline low, [4.5; 1-5 is considered ‘normal’] which oftens gives depression, He recommended thyroid suppliments and told me that the ‘best’ TSH level for mood was between 1 and 2.0.
    And i have been on synthroid generic for 5 years and am feeling much better.

  8. Marie
    Reply

    This story is not unusual.
    I live in Sweden and the situation is exactly the same although we don´t have the amount of advertising that you have.
    My father, who died in 2003, had around 12-14 different medications.
    Then he visited a nursing home, only for one week, and came home with another two medications.
    He was in a terrible state and I knew, immediately, that my father was drugged.
    That started my “journey” to find out more about his medications.
    It was not so hard because I had just got Internet. What a blessing!
    I found out that the neuroleptic – Melleril (Mallorol in Sweden) – that they had added, was no longer prescribed in England because it could cause heart artyhmias/sudden death among other things.
    Here, in Sweden, it could be prescribed for another year.
    That`s how it is.
    Okay in one country – forbidden in another!
    Naturally, I protested.
    Wrote 3 letters to the prescribing doctor and also asked for a total revision of my father´s medications.
    No revision was made and my father passed away a few months later.
    Thinking back I am sure my father´s constant head aches, for instance, was a result of his statin medication (Simvastatin).
    I would not be surprised if his need to take sleeping pills also had to to with the same medication.
    He had a lot of other health issues as well, and – not once, during the years, did any medical staff think in terms of side effects/interactions etc.
    Most of the books that I have read about medications come from USA.
    Of course, medications, are needed – now and then – but not in the way it`s today.
    The best thing you can do for yourself – and others around you – is to “educate” yourself on these issues and dare to have an opinion of your own.
    It`s your body and you know best how you feel!

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