Nearly 60% of the prescription medications taken by patients aren't needed.
That's what researchers discovered in a study published in Archives of Internal Medicine. The study also revealed that 88% of patients said they felt healthier when taking fewer drugs.
The fact is that adverse effects from medications are the fourth-leading cause of death in the US (after heart disease, cancer and stroke).
This means that, every year, approximately 100,000 deaths in the US are caused, in part, by dangerous drug reactions—more deaths annually than homicides, car accidents and airplane crashes combined.
About 6% of patients who take two medications daily will experience a drug interaction. If you're taking five medications a day, the risk rises to 50%.
According to Armon B. Neel, Jr., PharmD, a certified geriatric pharmacist, the following are medications that often are overprescribed and can produce serious side affects…
Statins
The cholesterol-lowering statins, such as atorvastatin (Lipitor) and simvastatin (Zocor), are among the highest-selling prescription drugs in the US. They are not as effective as you might think...and the potential side effects, including muscle pain and memory loss, can be serious.
A recent study, published in Pharmacotherapy, found that 75% of patients who took statins reported memory loss or other cognitive problems. The same study found that 90% of patients who stopped their medication had rapid mental improvements.
Statins can be life-saving drugs for patients with high cholesterol and existing heart disease or other cardiovascular risk factors. But generally, they are not effective for primary prevention (preventing a heart attack in healthy patients with few risk factors).
Before starting a statin, ask your doctor about the drug's Number Needed to Treat (NNT). The NNT for Lipitor is 168. This means that 168 patients would have to take it (for 4.1 years) to prevent one cardiovascular event. Those are impressively bad odds, particularly when the risk for muscle pain/memory loss can be as high as one in 10.
Advice: Try to lower your cholesterol with non-drug approaches. These include taking fish-oil supplements and eating less saturated fat and more fiber. Take a statin only if you have high cholesterol and other cardiovascular risk factors, such as a family history, high blood pressure and/or diabetes.
Blood Pressure Drugs
About 40% of the patients Dr. Neel sees are taking at least four different drugs to control hypertension. Some patients need this many drugs to lower blood pressure, but they are the exceptions. If you are taking more than two drugs for blood pressure, you probably are taking the wrong drugs.
Example: Beta-blockers for hypertension. Millions of older Americans take these drugs, even though the drugs often cause fatigue, dizziness and other side effects. In addition, doctors often prescribe both an ACE inhibitor (such as captopril) and an angiotensin receptor blocker (such as losartan), even though they work in similar ways. Patients using this combination are 2.4 times more likely to have kidney failure-or die-within six months as those taking just one of them.
Advice: If you are like most patients with hypertension, you probably need to take only a diuretic (such as chlortalidone) and perhaps a calcium channel blocker (such as diltiazem). Don't assume that you need additional drugs if your blood pressure still is high-you might just need a higher dose-though some patients do need other medications.
Important: Some patients who reduce their salt intake, exercise and lose weight can take lower doses of medication. A study published in The New England Journal of Medicine found that salt restriction for some people has about the same effect on blood pressure as medication does.
Painkillers
Ibuprofen and related analgesics, known as nonsteroidal anti-inflammatory drugs (NSAIDs), are among the most commonly used medications in the US. People assume they're safe. They're not.
One study found that 71% of patients who used NSAIDs experienced damage to the small intestine, compared with just 5% who didn't take them. These medications also increase the risk for stomach bleeding, ulcers and hypertension.
Advice: Take an NSAID only if you need both the painkilling and anti-inflammatory effects for a flare-up of knee pain, for example.
Take the lowest possible dose, and take it only for a few days at a time.
If you're 60 years old or older, you may need to avoid these drugs altogether. The risk for stomach or intestinal damage is much higher than in younger adults. A safer medication is tramadol (Ultram), a prescription analgesic that doesn't cause gastrointestinal irritation.
Millions of Americans take narcotic painkillers, such as codeine, oxycodone (OxyContin) or other narcotic analgesics. They are used for post-surgical pain, dental pain, etc. They can cause constipation even at doses that are four times lower than the doses needed for pain relief. Constipation that continues for more than one or two weeks can result in an intestinal blockage from hardened stools.
All narcotic analgesics slow the intestinal contractions (peristalsis) that move nutrients and wastes through the digestive tract. A study of cancer patients found that 95% of people who used these medications experienced constipation.
Advice: If you need these drugs, ask your doctor to prescribe the lowest possible dose... and ask whether you can use a stool softening medication such as docusate Colace) and take a stimulant laxative such as bisacodyl (Ex-Lax, for example, if you're not having regular bowel movements. The combination of stool softener and stimulant laxative is more effective than either one used alone.
Also important: Drink a glass of water every few hours, and get regular exercise. Fluids and exercise moisten stools and increase the frequency of bowel movements.
Sedatives
Valium and related drugs, known as benzodiazepines, are among the most dangerous medications for older adults.
Reason: They aren't efficiently broken down (metabolized) in the liver. This means that high levels can accumulate in the body.
Patients who take these drugs daily for conditions such as insomnia or anxiety are 70% more likely to fall-and 50% more likely to have a hip fracture-than those who don't take them. Also, patients who use them regularly have a 50% chance of experiencing memory loss.
Sedatives such as diazepam (Valium), triazolam (Halcion) and zolpidem (Ambien) should never be taken for extended periods.
Advice: If you are going through a stressful time, ask your doctor to write a one- or two- week prescription for a short-acting medication such as lorazepam (Ativan). It is eliminated from the body more quickly than other drugs.
For long-term insomnia/anxiety, ask your doctor about venlafaxine (Effexor). It's good for depression as well as anxiety, and it's safer than sedatives for long-term use.
Antidepressants
Doctors routinely prescribe SSRI antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil), to patients who don't really need them.
One study, based on data submitted to the FDA, concluded that these and other antidepressants are no more effective than a placebo for most patients. Yet the risks, including falls, bone fractures and even seizures, are high, particularly in older patients.
Important: Depression often is episodic. Patients who have suffered from a traumatic event–the loss of a job, divorce, the death of a spouse-will often have a period of depression that eventually clears up without treatment.
My advice: Start with nondrug approaches. If you're going through a rough patch, see a psychologist or meet with a pastor or another type of counselor. For many patients, talk therapy is as effective as medication.
According to Robert Stevens Gold, RPh, a hospital pharmacist and author of Are Your Meds Making You Sick?, the following medications can also produce serious, often surprising, side effects…
Blood Thinners
Warfarin (Coumadin), a "blood thinner" that inhibits blood clotting and often is prescribed to patients with heart disease or who have had a heart attack. Warfarin, as well as other anti-clotting drugs, can make the blood so thin that bleeding occurs from the stomach, intestine or gums. And since bleeding can take longer to stop, blood can leak from a capillary and cause a bruise without an injury.
An article by Canadian researchers published in Annals of Internal Medicine analyzing the results of 33 previous studies, found that patients taking warfarin had about a one in 39 chance of serious bleeding. About one in eight patients with major bleeding episodes died.
Solution: Warfarin can be a life-saving drug if you need it, but you should work closely with your doctor to find the dosage that is best for you. Also, it's crucial to be aware that other medications, supplements and even foods can thin your blood. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Motrin), and clopidogrel (Plavix), an antiplatelet drug-all of which have bleeding as a side effect. Before taking any other drug, let your doctor know that you're also taking warfarin.
Caution: Many herbs and supplements, such as fish oil, licorice, ginseng and coenzyme Q10, can increase/worsen the effects of warfarin.
Also important: Foods that are high in vitamin K, such as spinach and kale, affect the rate at which your blood clots and could require a change in your dose of warfarin. If you take a blood thinner, speak to your doctor about the effects of other medications, supplements and foods on your blood.
Antibiotics
The sulfonamide class of antibiotics (Bactrim is one of the main ones) can trigger an immune reaction called Stevens-Johnson syndrome. This side effect is rare-it affects only between one and three patients per 100,000-but requires immediate medical attention. The immune system causes a burning rash that spreads and often gets infected. Sores and blisters in the mouth can spread to the stomach, lungs and colon. Some patients die from it.
Because it's so serious, everyone should know the warning signs-a cough, headache, fatigue, blisters and joint pain followed by a rash.
Advice: Get to the emergency room immediately. You may be hospitalized and switched to a different medication.
Levofloxacin (Levaquin) is a broad-spectrum antibiotic given for infections. The fluoroquinolone class of antibiotics, which includes levofloxacin and ciprofloxacin (Cipro), has been linked to torsades de pointes, a rare but dangerous heart irregularity (arrhythmia) that can cause instant death in some cases.
Warning: Patients who take one of these antibiotics along with a thiazide diuretic, such as hydrochlorothiazide (Microzide), may have a higher risk for heart irregularities.
Recent development: A study published in The New England Journal of Medicine has found that azithromycin (Zithromax and others), an antibiotic used to treat bacterial infections, may increase risk for irregular heartbeat and sudden death in patients with, or at risk for, heart disease.
Solution: If you take any of these antibiotics and experience a change in your heart's rhythm (a feeling of fluttering in the heart or a heart rate greater than 100 beats per minute), go to the emergency room. Episodes that last for more than about 10 seconds can cause a loss of consciousness and sometimes seizures.
Heartburn Drugs
Patients with gastroesophageal reflux disease (GERD) or heartburn sometimes take metoclopramide to reduce discomfort and accelerate the healing of ulcers in the esophagus. The medication works by blocking the effects of dopamine. Doing this reduces nausea and helps food pass more easily from the stomach through the digestive tract.
Metoclopramide causes Tardive dyskinesia (uncontrolled muscle movements, especially in the face) in about 20% of patients who take it for three months or longer. It blocks the effects of dopamine, a brain chemical that plays a role in cognition and movement, the loss of which also occurs in Parkinson's patients.
Caution: Patients who combine metoclopramide with prochlorperazine (Compazine), used for some mental disorders as well as nausea, are more likely to have movement disorders because it also blocks the effects of dopamine.
Solution: Switch to a different heartburn drug-for example, an antacid or a medication such as cimetidine (Tagamet), an H2 blocker, that does not typically block dopamine.
Important: Uncontrolled movements caused by medication may not appear for up to six months. If you are experiencing tremors or other movement disorders, ask your doctor to review all of your medications, not just the ones that you've recently started.
Diabetes Drugs
Patients with diabetes often take metformin, an oral medication that decreases the production of glucose in the liver and increases the ability of cells to use insulin. Metformin has a black-box warning (the most serious warning on medication labels) about lactic acidosis, a rare but dangerous complication that's fatal in about 50% of cases. It occurs when a metabolic by-product (lactate) accumulates in the bloodstream. Diabetic patients with kidney disease have the highest risk of getting it.
Early warning: Fatigue and severe muscle pain even when you're sedentary.
Advice: Call your doctor immediately if you're taking metformin and develop muscle pain. You might need to discontinue the medication. Patients who take metformin should have blood tests to check serum creatinine every three months-the tests will show if lactate is being removed from your body.
Also important: Don't take the heartburn medication cimetidine (Tagamet) if you're using metformin. The combination increases blood levels of metformin by up to 40%. You can switch to a different heartburn drug, such as famotidine (Pepsid).
Insulin is another diabetes medication that can produce serious side effects, such as hunger, nervousness and heavy sweating.
Patients who use insulin to lower their blood sugar often forget that it's an extremely potent drug. Unless you use it exactly as prescribed, it can lower blood glucose to dangerous levels, causing hypoglycemia. This triggers the hunger, nervousness and heavy sweating.
Hypoglycemia occurs occasionally in every diabetic who uses insulin-it takes time to learn how to use insulin appropriately. Doctors routinely advise patients to take diabetes-education classes, in which they learn how to recognize the signs of high and low blood sugar...how and when to test blood sugar and the best times to take medication.
Chewing Gum to the Rescue!
Dimenhydrinate, a drug commonly used in medication to prevent nausea, vomiting and motion sickness, can now be delivered in the form of chewing gum rather than pills.
Advantage: Chewing gum is more convenient and allows for faster absorption than pills.
Advice: If you're using a fast-acting form of insulin, always have something to eat within 30 minutes. Otherwise, the medication will lower your blood sugar too much.
Also important: Keep a "quick fix snack, such as a box of fruit juice or a package of crackers, in your pocket, purse or briefcase. A snack quickly will elevate your blood sugar if you develop symptoms of hypoglycemia.
Drugs For Bone Health
Alendronate (Fosamax), taken to prevent/treat osteoporosis, is known to cause stomach ulcers in about 1% of patients and ulcers in the esophagus in up to 2%. These are small percentages, but the risk rises when patients also take an NSAID, such as ibuprofen or naproxen (Aleve).
Solution: If you need a drug such as alendronate to preserve bone strength, changing how you take the medication can reduce the side effects
Examples: Take alendronate first thing in the morning when your stomach is empty, washing it down with six to eight ounces of plain water. Taking it with some beverages or foods, particularly orange juice or acidic foods, increases the risk for ulcers. Don't lie down for 30 minutes after taking it-this can cause stomach acids to reach, and damage, the esophagus.
Also important: Avoid NSAIDs. Take acetaminophen (Tylenol), a non-NSAID painkiller.
