You may not need all the drugs you’re taking…
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). 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%.
As a geriatric pharmacist, I have evaluated the drug regimens of thousands of patients. Here are the medications that often are overprescribed…
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.
My advice: Try to lower your cholesterol with nondrug 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 I see 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.
My advice: If you are like most patients with hypertension, you probably need to take only a diuretic (such as chlorthalidone) 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.
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.
My 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.
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.
My 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.
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.