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

Imagine you are a space alien from the Planet Xelziga. You land somewhere in North America and turn on your television monitoring system. As you attempt to learn the basics about human behavior, you might quickly conclude that people in the United States are burdened with a lot of diseases. But there is virtually a pill for every ill. What our space aliens would not learn from TV commercials, however, is what remedies are most effective and which are the most dangerous drugs in the drugstore.

Aging Baby Boomers Are At Risk from Dangerous Drugs

The information on TV commercials wouldn’t alert our new visitors that some medicines have significant dangers, especially for older people. Too many Americans are also unaware of the hazards of over-medicating senior citizens. We recently received this frightening message from a nurse:

A Nurse Speaks Up:

I am an RN with certification in gerontological nursing. I was working in an urgent care clinic on a Saturday when a woman brought her mother (who was in her eighties) in for evaluation because in the previous 24 hours, she began to experience dizziness and needed physical support to keep from falling.

“On review of her medications, I found that her physician had ordered Librium to treat nervousness. This medication is on the Beers list of those that should be avoided in the elderly.

“The daughter said that was the only new medication her mother was taking, and the dizziness started after she took her first dose. I shared that with the urgent care physician, but he discounted the medication as a cause for her change in condition. He told me, ‘It can’t be Librium–the dose is too low.’ He instructed the patient and her daughter to continue the medication.

“Alarmed by the doctor’s instructions, I took a substantial professional risk by telling the daughter not to give her mother any more of the medication for the rest of the weekend. I urged her to speak as soon as possible with the prescribing physician to ensure he knew about her mother’s condition and the timing of the onset. I feared the patient could have suffered injury due to the effects of medication.”

Benzos: Dangerous Drugs for Older Adults

Chlordiazepoxide (Librium) is a benzodiazepine drug used to treat anxiety. Like similar drugs such as diazepam (Valium) or clonazepam (Klonopin), it can make people unsteady on their feet, especially older adults. That could lead to a fall with potentially tragic consequences for a frail elderly woman. We commend the nurse for “sticking her neck out” to protect the patient.

The Beers List of Dangerous Drugs:

Just what is the “Beers” list this nurse referred to in her account? It is named for Dr. Mark Beers, a physician who was concerned about drug reactions that could be especially dangerous for his older patients. In 1991 Dr. Beers introduced the criteria that bear his name. These were drugs which would be potentially inappropriate for older patients.

Geriatricians are quite familiar with the Beers list. They have also created another acronym: PIMS (potentially inappropriate medications). The list is periodically updated. As we learn about other dangerous drugs for people over 65, these PIMS are added to the list. The American Geriatrics Society updated the list in 2015 (Journal of the American Geriatrics Society, Nov. 2015).

New Potentially Dangerous Drugs:

Here is what the American Geriatrics Society noted when it updated the Beers Criteria in 2015:

New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug–drug interactions documented to be associated with harms in older adults.”

“…Beers Criteria PIMs have been found to be associated with poor health outcomes, including confusion, falls, and mortality. Avoiding PIMs in older adults is one strategy to decrease the risk of adverse events.”

Added to the list of PIMS “best avoided in older adults are:

Non-Benzo “Z”-Type Sleeping Pills

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

Here is what the expert panel had to say about such drugs:

The nonbenzodiazepine, benzodiazepine receptor agonist hypnotics (eszopiclone, zaleplon, zolpidem) are to be avoided without consideration of duration of use because of their association with harms balanced with their minimal efficacy in treating insomnia.”

We wonder how many physicians are aware of this update. Because many older people often complain that they don’t get a good night’s sleep, such PIMS are frequently prescribed for insomnia.

PM Pain Relievers and Brain Fog:

Many older adults also suffer aches and pains, so it is no wonder that nighttime pain relievers are best sellers in the pharmacy. Diphenhydramine (DPH), is a common component of “PM” pain relievers. It has strong anticholinergic activity.

Older people who take such sleep aids regularly may wonder why they don’t feel as sharp as they should. Family members may conclude that their loved ones are developing dementia, when the true culprit could be the medication. Not surprisingly, products containing diphenhydramine are on the Beers list.

PPIs (Proton Pump Inhibitors) for Heartburn:

It will come as a shock to many health professionals to learn that the revised Beers Criteria from 2015 includes long-term use of PPIs. The experts note that:

“An addition…is the avoidance of the use of proton-pump inhibitors beyond 8 weeks without justification. 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.”

PPIs Include:

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

A Reader Responds to the Beers List:

E.M. shared this perspective:

This is the first time I have heard of Beers. I am glad to have read this information. I have been prescribed Lupron injections monthly. I have also been prescribed 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. Oh, I almost forgot I take Norvasc (amlodipine) for blood pressure control.

“No pharmacy has given me any information on side effects. They (the pharmacists) say they would be alerted in their auto system if there were any problems. Over the 15 years I have been on some of these drugs I have never been alerted to any concerns. Boy! Am I glad to hear of Beers. And my wife takes Nexium and has for years. I am 74 and she is 72.”

Drugs that may have been perfectly appropriate 15 years ago may pose a problem for someone over 65. Thanks for sharing your thoughts E.M.

Beware Reduced Kidney Function and Dangerous Drugs!

When was the last time you had your kidney function tested? The experts who compiled the updated Beers list note that as people age kidney function can change. Rarely do your kidneys become more efficient as you get older. That means dosage adjustment is essential, especially for dangerous drugs.

In addition, older brains may have less resilience to withstand highly anticholinergic drugs. These may make them confused and forgetful. We have a list of anticholinergic drugs on our website:

Where Can I Find A List of Anticholinergic Drugs?

No one should ever stop any medication without careful consultation with the prescribing physician. But it is essential to ask about PIMS the next time you get a prescription. Make sure it is not on the BEERs list. If it is, ask your prescriber why you should be taking the medicine. If there is a good explanation, great. If not, inquire if there might be an alternate medicine that is not on the list.

Dangerous Drugs for Older Adults?

Which other drugs may be inappropriate for seniors? We have prepared a Guide to Drugs and Older People with a list, along with more detailed explanations. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (71 cents), self-addressed envelope:

Graedons’ People’s Pharmacy, No. O-85

P. O. Box 52027

Durham, NC 27717-2027.

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

Here is a free Guide to also download:

Drug Safety Questionnaire and Medical History

This questionnaire should go with you to every doctor visit. Share your own experience below. Has someone you know been given dangerous drugs?

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  1. SandraLeeBrown

    I think Tom in Vermont, Rita in Buffalo and Henry in Mocksville say it the same as I feel: and that is there are jsut too many people going to too many doctors and taking too many drugs. Thanks to listening to your programs and this format on the web, we are able to be far more educated re these drugs. We must NOT be like sheep “cause we all know what happened to them!”

  2. Mary

    A cardiologist just ordered 2.5 mg low dose Concor at night for heart issues. It is a beta blocker.
    I regularly check morning glucose levels.

    The first day it was elevated. I was a bit alarmed. The 2nd day even a bit higher. I then checked Google and found they DO affect blood glucose levels.

    The 3rd night I only took 1/2 and it was still elevated next morning.

    Not worth bringing on diabetes to counteract other issues. I am 79.
    Will be asking the doctor for a different option. He told me the drug did not mess with blood sugar. Maybe he should Google it himself?

  3. Sally

    People, TAKE HEED! This is an excellent article in so many ways! Having been given the wrong mix of Rx’s put me in the emergency room. No Dr. would attribute it to the drugs (which they are somehow being compensated for dispensing). They ALWAYS say it’s ALCOHOL no matter how much or little you drink. I recently proved a Dr. wrong after her prescribed Trazadone & said I could take up to three a day. GREAT! Pop one if it’s a rough day, take one at bedtime and one when I wake up in the middle of the night. A month later I had bloodwork taken and it was so bad I was scared to death (not quite). My prior bloodwork was fine. . .the only change in my life was taking Trazadone. So I quit it cold turkey. Went back a month or so later for another blood test. Results were normal, Dr. was shocked, kept asking what changes I made in my lifestyle. Answer? I STOPPED TAKING THE TRAZADONE! Folks, Drs. are writing Rx’s for this like it’s candy! Do your research. It could have killed me!

  4. Sharon

    I am 65 years old. I was diagnosed with mitral valve prolapse/anxiety and depression in 1988. I have been on anti depressant and anti anxiety (clonazapam .5mg) since then. I also suffer terribly from migraine headaches and take preventive zonegran daily to prevent them. It sounds great theoretically to wean oneself off of all drugs but HOW do you do it without a physician’s assistance? I would LOVE to be off all of my medication with the exception of the antidepressant. What type physician would help me get off of the other medication? Also, although I know clonazapam has such a bad reputation – what is an alternative? Is there a drug that can reduce anxiety that is safe? Any advice would be appreciated.

  5. marian

    2 doctors 2 different opinions 1 says”statins could actually improve your memory due to reducing cholesterol and plaque.Another says(as in drug literature) statins can cause cognitive impairment?? who is right??

  6. marian

    anyone with thoughts on statins for people over 80 -your comments would be appreciated

  7. Joyce M

    Is there any information on the blood pressure medicine (tekturna HCT). I have been on it for about 4 yrs. I also take atenolole. Any comments on that.

  8. Henry
    Mocksville, NC, USA

    These comments and thoughts are in keeping with the thesis of “RETHINKING AGING”, by Dr. Nortin Hadler, in which he postulates that we should stop regarding old age as a disease, and allow those of us who make it into the 7th, 8th & 9th decades of human existence to do so with grace and respect, and not with chemistry and “fixes” that the human body was never meant to tolerate.

    • Marie - Sweden

      Thanks for your comment. I totally agree. I have also read – Rethinking Ageing” although I live in Sweden.
      Many countries (who can afford) have problems with overprescribing and it`s not just about the elderly – it starts much earlier. The pharmaceutical industry can pay for research. “brainwash” people and market in many different ways.
      I think the change will have to come from ordinary people – read many different books and try to make up your own mind. Remember it`s your body.
      Here are some books:
      Selling Sickness (Alan Cassels and Ray Moynihan)
      Seeking Sickness (Alan Cassels, also read his articles on http://www.commonground.ca)
      Death by Prescription (Terence H. Young)
      Doctoring Data (Malcolm Kendrick)
      Statins Toxic Side Effects (David Evans)
      There is also an interesting book by Armon B. Neel and Bill Hogan (can´t rememember the title now)

  9. Rita
    Buffalo, NY

    At 75, I am studiously avoiding prescription meds. Even left a practice that was too quick write prescriptions. Current PCP is well aware of this and so far is not pushing meds. I have seen first hand what all these meds can do and none of it is good.
    Thank you for all you do!

  10. Sally

    A correction to my recent post. My husband was experiencing tachycardia (heart rate over 100) in having his heart pacemaker checked which works to prevent bradycardia (heart rate under 60).

  11. Sally

    Your articles have made me such a good advocate of our health. I don’t know what we would do without your readily available, life-saving articles in newsletters we receive and information easily found on your website under health concerns.

    My 80-year-old husband has a heart pacemaker and was having it checked out last week when the esteemed electrophysiologist noted he was in Afib, and his heart rate was 120 and 130: bradycardia we have never noted in the many times my husband daily checks his blood pressure. In conferring by phone with his regular cardiologist, he wrote a prescription for
    200 mg of Amiodarone. Perhaps by luck, the script never reached our pharmacist so he did not start the drug.

    In the meantime, I googled the medicine and found your comments detailing how dangerous and toxic are the effects of this particular drug, some of which are irreversible. I then went to my handy copy of the Beers list and found it as listed as a potentially inappropriate medication in older results according to their strong quality of evidence. Over 60 comments from patients on your website confirm severe adverse reactions.

    I then sent a three-page fax, including the very long Black Box Warning from the FDA and quoting portions of your older newsletter article on the subject, to our cardiologist, voicing our concerns because no other measures have been used at this point to control this particular new problem. We told him we felt the risk outweighed the benefit of taking this drug and would like to do more testing and seek another alternative treatment.

    We are awaiting a reply. I know his cardiologist was not surprised by my fax because I often present questions in treatment (often from the knowledge I receive from you), and he is patient enough to have discussions with us without feeling intimidated. It makes for a good partnership.

    Thanks and continue to keep us informed in order to improve and protect our own health!

  12. Trace

    In February 2017 I was prescribed Lisinopril (blood pressure) and Atorvastatin (cholesterol) due to a minor stroke. Two weeks later I stopped both due to serious side affects, pain in my legs. I am already crippled (foot drop) due to a injection of cortisone to my lower back. The heaviness and pain to my legs has lasted a year and continues. Due to my foot drop and now the leg pain I can’t walk very well. Even with the foot brace I wear I still stumble. If I try to exercise the pain gets worse for several days. My leg muscle tissue is deteriorating. The statin meds have poisoned my system, and I may never recover from this. I am 72 yrs old, and I feel other elderly folks should stay away from statins. If they attack your body like mine you may end up crippled, even without a foot drop.

  13. Sean

    I take 25mg of Seroquel a night to help me sleep and have for over 10 years. I read that this medication has moderate AC activity and would like to get off of it, but when I tried, I became agitated and very sick. Has anyone successfully gotten off this med, and if so, how? When I voiced my concern with my doctor, she told me that because the dose is so low I didn’t need to worry. I am still scared.

  14. Michelle

    What is considered an “older” adult?

  15. Dorothy

    I took diphenhydramine in Tylenol PM for several years and then decided to go right to diphenhydramine which is a cheap little pill. It wasn’t too long before I noticed that my fingernails were becoming paper thin with longitudinal ridges. I quit the drug right away, and it has taken a long time for the nails to improve but still have ridges that are less pronounced. Now when I read about kidney disease, I find that this is a symptom. Yes, be careful of drugs that can affect kidney function.

  16. Cheryl

    It is MY experience with parents and in laws that they are put on medications and are NEVER taken off. As they became more frail these drugs were not reassessed at their every 6 month visits.

    I now see this trend with my husband and me as we approach 70 years old. I question every med for both of us. A perfect example for my husband was a PPI he was on for many years. I researched how to wean him off that med with minimal setbacks and he got off successfully.

    As soon as he had one very difficult time with his stomach when I was diagnosed with cancer his doctor tried to put him back on a high dose of Prilosec. He limited it to 2 weeks and then got himself back off. They all must have stock in these drugs they prescribe like candy.

  17. Cindy

    My mother-in-law was in her early 90s when she went to the hospital with a bladder infection. When she came out she had been put on 2 new medications. I did not catch that at first. She was on only one blood pressure Rx before she went in. Before she went in she would take walks around the apartment complex where she lived.

    It was noticed that she began spending most of her day in bed once she got out of the hospital. When I learned about these new meds, did some research using People’s Pharmacy and other resources I wrote to the prescribing doctors and told them why I was taking her off of them. I backed her off of them.

    Within a couple of days she was herself again. She is now in her 103rd year and is still only on one blood pressure medication. She has no pain. I am thoroughly convinced she would be dead by now if these medications had been continued. The cardiologist who prescribed one of them wrote back and told me he would no longer be responsible for her if I was going to interfere.

  18. Kenneth
    central Illinois

    In my role as psychiatrist, I have twice had a patient referred to me for dementia and was able to “cure” the problem by discontinuing the meds with anti-cholinergic effects. In one case it was a woman who was taking five capsules of Benadryl containing OTC sleep meds a night (and still complained that she couldn’t sleep). In a second case it was a man who had pressed his physician to increase Amatriptyline (an antidepressant) to quite high levels because it was the only thing that allowed him to get to sleep.

    In my own experience, following prostate surgery I was able to stop Flow-Max and clearly experienced that I got “smarter.” I had not been at all aware that the med was affecting my performance. In the year that I was taking Flow-Max I had made enough prescription errors that I was considering retiring from practice. There have been no prescritption errors since stopping the medication.

    I’m definitely considered “a senior” in terms of age. I have great kidney function. I’m on no other prescription meds. Even with those healthy parameters, my cognitive capacity was affected by an anti-cholinergic medication. Of course I’ve become very attentive to this issue as I continue to care for patients who often clamor for the benefit of these anticholinergic medications.

    • Mary

      Dr Hyla Cass, another psychiatrist, has rescued some of her patients from drugs that brought on dementia or other undesirable side effects.

  19. Jane

    Perhaps there should be some sort of independent (i.e. not financially connected to the health care machine) resource where people could readily find out potential harms from drugs and their interactions, with that contact info either on the packaging or as a hand out accompanying prescriptions. Some info on what benefit can be realistically expected should also be included.

    In reading meta analyses, Cochrane reviews etc. it seems many “essential” or “necessary” drugs are marginally effective at best. To me it often looks like the majority of prescriptions are most efficient and necessary to line the pockets of big pharma and their investors rather than be of any real benefit to patients. Patients need to own their complicity as well. Yes, it’s so much easier to “just take a pill” rather than take charge of life style choices, but drugs don’t create health. They mask or alleviate symptoms. If our society spent even a fraction of medical money on nutritional and lifestyle education it might improve collective health even if profits took a hit.

  20. Tom

    I am going to throw a grenade into this conversation. I am 68 years old, take NO pharmaceutical
    medications and was involved in the care of both of my parents as their health deteriorated. Millions of people in the U.S. would be better off to carefully wean themselves from all of their prescription drugs and do the work of reforming their diet and lifestyle.

    I have been reading the People’s Pharmacy for a number of years (great stuff, Joe and Terry !!!), and I find it heartbreaking
    to read comments from folks who have been harmed by ignorant MDs. In many cases this ignorance is a result of their medical training. The tide is turning, and many are starting to realize that the pharma-emperor has no clothes. Political and corporate corruption and malfeasance are killing hundreds of thousands of us each year. God help us. Vibrant health is our birthright.

  21. Damita

    I always try to avoid pharma and testing. There are tests that elders should not do as well, such as bone marrow aspiration and bone marrow biopsy. Elders risk bone fracture and other difficulties. No diagnosis is worth risking a hip fracture. Thank you for the great info.

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