Do you know someone who swallows a handful of pills with breakfast? A parent perhaps, or a good friend? Maybe you worry that you are taking too many medicines. Have you ever bothered to actually count the total number of pills you take in any given day? If its more than three or four you could be on a medication merry-go-round.
Lots of Americans are taking too many medicines. According to Consumer Reports (Sept. 2017), more than half of US adults take at least one prescription drug regularly. The average number of prescriptions people in the CR survey took was four. That doesn’t even include the nonprescription medicines and supplements that many of us rely on conscientiously.
Older People Are Vulnerable to Too Many Medicines:
When you get close to 60 your body has begun to change. Kidneys may not work quite as efficiently to eliminate drugs. Your liver doesn’t always detoxify all the chemicals you are exposed to the way it did when you were 25. And the chances are good that you have been diagnosed with a couple of conditions: high blood pressure, elevated cholesterol or creeping blood sugar. Perhaps your thyroid gland isn’t working quite as well as it did in your youth. The CR article notes:
“In Consumer Reports‘ recent survey, for example, 40 percent of people ages 65 and older took five drugs or more compared with just 17 percent of those ages 45 to 55.”
“Compounding the problem is that older people are less likely than younger ones to ask a doctor about drug safety. Barely half of the seniors in our survey said they talked with their doctor about such concerns as drug side effects, but two-thirds of younger adults did.”
“Its not surprising, then, that older adults are twice as likely to suffer a side effect serious enough to require a trip to an ER, and seven times more likely to be hospitalized as a result, according to the Centers for Disease Control and Prevention.”
Stories from Readers Regarding Too Many Medicines:
One visitor to this website told us:
“My sister worked as a nurse. She interviewed patients who were going to have outpatient surgery and said 9 out of 10 people she interviewed – age not a factor – were taking 8 to 10 medications every day.”
Is that a problem? Some people doubtless need every drug they are taking, but many others may be utilizing medicines they don’t really need. In addition to the cost, there are health consequences. More than a million people land in the emergency department each year because of serious adverse reactions to their medicines. In 2014, nearly 124,000 people died from side effects.
A retired physician wrote:
“My aunt in Florida was doing poorly, so I took my mother to see her. I was asked to review the meds.
“She had 6 OTCs, 25 prescribed drugs with various dangerous or negating interactions and she was barely able to get out of bed. After I spent an afternoon documenting what her primary care doc knew, but would not change because specialists had prescribed the drugs, my aunt woke up and entered the conversation. I told her she needed two of the OTCs at most and less than a handful of prescriptions.
“Her response was almost out of the Jefferson Airplane song – ‘that’s alright, those don’t do anything anyway.’ The medication taper was painful and required ED visits but my aunt got off most of the benzos, narcotics and sleepers as well as most of the other multi-specialty prescription drug mess. She woke up and lived pretty well for the next five years.”
On Death’s Doorstep: Can You Stop Too Many Medicines?
The account above is not an isolated case. An expert in palliative care, Dr. Steven Pantilat, told us that many older patients in hospice are more alert after unnecessary medications are discontinued.
Years ago we received this message from a reader of this column:
“My sister and I were very concerned about my 73-year-old aunt and the tremendous number of medications she was on. She was in a terrible nursing home and was continually strapped in a wheelchair. She was always agitated and often spoke to people who had been dead quite awhile.
“The doctors said her hallucinations were caused by a stroke and dementia. Her family was in complete denial. My sister obtained your Guide to Drugs and Older People with the Drug Safety Questionnaire (online at www.PeoplesPharmacy.com).
“We moved her to a different facility. Two weeks after the medicines were stopped or the doses were lowered, she has become herself again. Thanks for helping us get our wonderful aunt back!”
Too Many Medicines; Not Just An Older Person’s Problem:
Overmedication is not just a problem for old folks. A surprising number of young people are also taking handfuls of pills. They swallow powerful drugs to suppress acid in their stomachs, help them get to sleep, lower their blood pressure and ease their depression.
It’s not enough to list all your medicines when you visit your doctor. Ask someone to check for drug interactions and inquire when and how you should discontinue each prescription.
How Can You Tell If You Are Taking Too Many Medicines?
It starts innocently enough. A routine visit to the doctor reveals that your LDL cholesterol is 125 and your blood pressure is running around 140/95. Your doctor prescribes rosuvastatin for the bad cholesterol. He adds lisinopril and hydrochlorothiazide (HCTZ) to get your blood pressure closer to 120/80.
After several months you discover that your back is starting to hurt and that your joints are a bit more painful than usual. You begin taking ibuprofen to ease your pain.
At your next doctor’s visit a blood test reveals that you are now borderline diabetic. You also have developed a nighttime cough. You may also have some abdominal pain and nausea. Your doctor prescribes metformin to get your blood sugar under control and Nexium for the digestive upset. He recommends Zyrtec for the cough, which he thinks might be due to allergies. He also tells you that your blood pressure is still not where he wants it to be.
As you can see, prescriptions start to pile up almost before you notice it. Sometimes the second medication will then cause symptoms for which the doctor prescribes a different drug. This is one way people end up taking three, four or five different pills. That is what happened in the hypothetical example above.
Rosuvastatin can cause arthralgia, nausea, abdominal pain, muscle aches and cramps. It can also raise blood sugar levels. So can HCTZ. Lisinopril can cause a cough, which won’t be solved with Zyrtec. Nexium and metformin have their own complications. The ibuprofen you are taking for the muscle pain and arthralgia brought on by rosuvastatin could be raising your blood pressure. The merry-go-round goes round and round.
What Can You Do to Control Medication Inflation?
We have prepared a People’s Pharmacy Drug Safety Questionnaire and Medical History form. It is free for download by going to this link.
You can also listen to the free podcast of Show 1098: Are You Taking Too Many Medicines? You can stream the audio or download the free mp3 file.
If you know someone over 55 who you think is taking too many medicines you may wish to access our Guide to Drugs and Older People. It has lists of drugs that are inappropriate for people as they age. It also contains a list of medicines that might affect brain function.
Not Just A U.S. Problem:
Marie in Sweden writes:
“The problem of overmedication is common in many countries. It has been going on for years and years. I don´t think the change will come from our authorities or the medical staff. I think it will have to come from the people. I live in Sweden.”
The People’s Pharmacy Perspective:
Always ask your health care professionals if you still need all the medicines you are taking. We are intrigued at how carefully nurses and techs make sure your electronic health record has everything you are currently swallowing. What disturbs us is that no one seems to bother checking for drug interactions or excessive medications. We are hoping that one day the art of deprescribing will become part of a provider’s standard practice. Never stop any meds on your own. Always find out how to discontinue a drug. Some medications have to be tapered very slowly over weeks or months.
Here is a link to an interview we did on this topic:
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