Older man with pills, scary side effect, too many prescriptions

Next time you go to a pharmacy take a few minutes to do some secret research. Linger around the prescription counter and play detective by observing what happens.

If you watch people pick up their prescriptions at a busy pharmacy counter, you will discover that the majority grab and go. Only a few take time to talk with a pharmacist about drug side effects or interactions.

One reason people don’t bother to consult with the pharmacist is that drug side effects seem abstract to most patients. That is, they think bad things happen to other people, not to them.

A Close Call for Dad:

This kind of attitude can lead to disaster, as this reader points out:

“Last year we nearly lost our 85-year-old father to the interactions from the seven medications he was prescribed by three different doctors. None of his physicians was a real gatekeeper, monitoring all his medications.

“We discovered the problem after a friend of his called us with concerns. I went down and found him nearly a walking vegetable. I wrote down his meds, went home and started researching. He was taking aspirin, warfarin, digoxin, Sensipar, terazosin, metoprolol and Vytorin.

“As I looked at each drug’s side effects, it seemed that there was a tangled web of adverse reactions. Many of the ‘maladies’ he was experiencing could be side effects of other drugs he was taking for those very ailments.

“I found the Beers list and a drug interaction tool on the web site of his preferred hospital, plugged in his meds and got nine pages of potential interactions: eight with high potential for severe reactions and 16 with moderate potential for severe reactions. All but one of his prescriptions was filled at the same pharmacy, which never caught the potential problems.

“We have changed my father’s doctor to one who reevaluated his meds and made changes and is really overseeing his care. Happily, Dad is now back to his old self.

“The caution to others with elderly parents is to keep an eye on them even if they tell you everything is fine. My father would tell each of his four children things were fine, ‘not wanting to be a burden,’ it turns out. We have to be overseers of their healthcare as well as our own.”

The Beers List: A Good Place to Start!

The Beers list this reader mentions is a compilation of drugs that pose special hazards for older adults. If possible, doctors should avoid prescribing Beers list drugs for their senior patients (people over 65). The list, which was introduced by Mark Beers, MD, in 1991, is frequently updated (Journal of the American Geriatrics Society, Nov., 2015).

New drugs added to the list of PIMs (Potentially Inappropriate Medications) “best avoided in older adults” include:

Sleeping Pills:

  • Eszopiclone (Lunesta)
  • Zaleplon (Sonata)
  • Zolpidem (Ambien)

Antiarrhythmics (for irregular heart rhythms)

  • Amiodarone (to be avoided as a first-line therapy for atrial fibrillation)
  • Disopyramide (Norpace)
  • Digoxin (to be avoided as first-line therapy for A-fib or heart failure)

PPI-type Acid-Suppressing Drugs

The new recommendation is to avoid powerful acid-suppressing drugs beyond 8 weeks unless there is a strong justification. This would include:

  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Pantoprazole (Protonix)
  • Rabeprazole (Aciphex)

The authors of the 2015 Updateed Beers Criteria point out that long-term use of PPIs are problematic because: “Multiple studies and five systematic reviews and meta-analyses support an association between proton-pump inhibitor exposure and Clostridium difficile infection, bone loss, and fractures.”

You can learn more about the Beers list in our book, Top Screwups Doctors Make and How to Avoid Them in our bookstore. You will also find out about common drug interactions that can be lethal and drugs that can cause disorientation, forgetfulness, confusion and other symptoms of Alzheimer’s disease.

Side Effects from Amiodarone:

“I had heart bypass surgery in March and developed atrial fibrillation a couple of days after the surgery. I was immediately given amiodarone, which is FDA approved ONLY as a last resort drug for ventricular fibrillation, not for atrial fibrillation.

“I suffered amiodarone-induced major thyroid damage. I was also placed in grave danger when a doctor prescribed Cipro for an infection I developed later. Thankfully, my pharmacist caught the warning about an amiodarone/Cipro combination being potentially fatal and I was switched to amoxicillin.”

Cases like these reinforce the need to double-check with prescribers and dispensers about drug interactions. It could save your life.

Perhaps you know people over 65 who are taking multiple medicines. If so, what better holiday gift could you give them than our book, Top Screwups Doctors Make and How to Avoid Them. It might save their lives or prevent drug-induced cognitive decline. Can you think of a greater gift this holiday season?

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  1. Terry
    London UK

    I have been on tablets for High Blood Pressure for some years now, but over the past 8 months my doctor has changed my tablets quite a few times. My Blood Pressure readings have now improved but at a cost, I now feel tired and exhausted a lot of the time, muddled head, especially in the mornings and now suffer from Erectile Dysfunction. I feel unwell and quite depressed.
    I take the following :-
    Indapamide 1.5mg
    Bisoprolol 5mg
    Doxazosin 4mg
    Simvastatin 10mg

  2. LINDA
    Buffalo NY

    Your information regarding Levaquin provided invaluable information. I have some apparent permanent tendon damage. I am continually prescribed antibiotics that appeared to cause complications or allergic reactions. Until I brought up your article did SEVERAL DOCTORS CONFIRM THE KNOWN COMPLICATIONS!!!
    Your information helped save me from more damage !
    I now ask the pharmacy NOT TO FILL the electronic Rx’s until I confirm!
    Thank you!!

  3. Rhodie

    I dislike electronic prescriptions. Having a written Rx in my hands gives me a chance to look up purpose, side effects, etc. Electronic Rx results in lack of information before purchasing. We do not have Rx plan; electronic Rx for scalp itch I left at Wal-Mart–$76!

  4. Em

    First time I have heard of Beers. Glad to have read this information. I have been prescribed Lupron injections monthly, and recently methotrexate, Januvia and Glipizide. I also take Folic Acid, Cinnamon and garlic. My hands have swollen so large, I cannot get my wedding band or any rings on. Almost forgot I take Norvasc for blood pressure. No pharmacy has given me any information on side effects. They (the pharmacists) say it would be alerted in their auto system, if there were any problems. No one in 15 years of being on meds has ever said anything.. Boy! Am I glad to hear of Beers. And my wife takes Nexium and has for years. I am 74 and she is 72.

  5. R

    I am 62, and for 9 years my GI doc said I needed to be on a PPI to decrease my risk of esophageal cancer. Well, these stupid drugs didn’t help, and when I got a 24 hour monitoring study it turned out that at least half of the reflux was base and not acid and that the total amount of reflux wasn’t abnormal but the base reflux was doing the damage.

    Stopped taking the drugs and went to a low-acid diet and continued the lifestyle changes I was already doing. GERD and LPR are pretty well controlled but thanks to the damn PPI’s my bones, which were normal before starting them, after 9 years of use these meds showed osteopenia in the hips and osteoporosis in the spine. Back in 2003 when I first was diagnosed with GERD they were prescribed like candy. Only after I stopped taking them did the black box warnings start appearing. Just because a doc recommends that you take a drug doesn’t mean it is right, and all drugs have side effects so the benefits of treatment must outweigh the almost certain and difficult side effects.

    If I could do it all over again I would have never started those horrible PPI’s.

  6. Patricia
    Melbourne, FL

    I’m lucky to be 79 years old and only taking one tiny pill a day for hypothyroidism. Every time I pick up the renewal, I’m asked if I have any questions. I always use the same pharmacy so they know exactly what I do take if I need something changed or added. Also, I have a list on the computer of the supplements and the one medication I take. It also shows approximate time each is taken. I carry this to every doctor appointment, along with another list of medical history and another of surgeries. Any time I see a new doctor, they are given a copy.

    I’ve changed doctors several times in past few years (due to insurance company changes) and have been lucky that I like all of them. Each new one asked all the proper prior health questions. I had a very dear friend and a loving uncle that had bad effects from two different medications. We shouldn’t have to question every little thing. I was brought up to tell the doctor everything and do whatever you were told.

  7. Peggy

    I have an experience that I’d like to share…..some 10-12 years ago I lived in a different city. I went to the pharmacy to pick up my prescription and did the “grab and go” with it. When I got home I started to – as was my habit at the time – merge the rest of the existing medication into the new bottle. Well, when I went to do that with one medication I realized that it didn’t look right so I started checking and discovered that the medication in the bottle was for someone else yet the paperwork attached to the bag had my name on it.

    I immediately packed it up and went back to the pharmacy and told them they had put someone else’s medication in my bag. There were several people waiting for their prescriptions to be filled, and the pharmacy people tried to get rid of me, insisting that what I was saying could not have happened. I was persistent though, and so finally the pharmacist – to shut me up – took the bag and checked it. Much to her horror she discovered that not only was such a mistake possible but that it had happened. She went and to her relief found the other person’s bag still there – it hadn’t been picked up yet – and my medication was in it. So fortunately all she had to do was swap the bottles from the wrong bag to the correct bag. I know she could just see her license being suspended or revoked over this. This happened at the local store of a major pharmacy chain that I won’t identify because I no longer use them but it could happen with any pharmacy anywhere. I’ve tried to be careful since then, and I quit the merge thing immediately.

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