You probably go through your closet periodically, weeding out clothes that no longer fit. But how often do you take stock of your medicine chest? If you can’t remember the last time you did an inventory of your pill bottles, you may want to add that to your to-do list. You could find that some of your medications are as inappropriate as a pair of 4-inch heels.
“It’s always a good idea to periodically question whether you need to be on a drug or on as high a dose of the drug,” says Dr. Sarah Berry, assistant professor of medicine at Harvard Medical School.
WHY OUR DRUG REQUIREMENTS CHANGE
Like some items in your wardrobe, the drugs that suited you at one point may not work as well as you go through life. “Guidelines for drug therapy change, and bodies change,” Dr. Berry says.
Your kidneys and liver are responsible for clearing drugs from the body. As you age, these two organs clear drugs more slowly. As a result, drugs remain at higher levels in your blood, for a longer time, so a dose of a drug that was optimal for you 20 years ago may be too high today.
People also gain fat and lose muscle mass, which contains water, with age. This shift also changes the way drugs are distributed to and broken down in body tissues.
And if you have developed some chronic conditions, you may be taking more prescription drugs and over-the-counter medications than you did 20 years ago. Each of those drugs has the potential to suppress or enhance the effectiveness of other drugs you take. For example, there are hundreds of over-the-counter supplements and prescription drugs that can change the speed at which the anti-clotting drug warfarin (Coumadin) is metabolized.
SOME DRUGS TO APPROACH WITH CAUTION
Because drugs stay in the body longer as we age, their side effects can be more severe. The following are especially likely to have significant side effects:
1. Benzodiazepines. This category of medications to treat anxiety or insomnia includes long-acting drugs like Valium (diazepam) and Klonopin (clonazepam) and shorter-acting ones like Xanax (alprazolam). They’ve been associated with increased risk of falls, confusion, and memory loss. They also tend to create dependence, and you can have withdrawal effects if you stop taking them.
“These are drugs we should question,” Dr. Berry advises. If you are taking one, work with your doctor to taper off.
2. Medications containing diphenhy-dramine. Developed in the 1940s, diphenhydramine has been sold over the counter as Benadryl for allergy relief for decades. It also makes people drowsy, so it’s been incorporated into sleeping aids like Zzzquil and Sominex. It constricts blood vessels, leading to confusion, blurred vision, and other side effects.
“It’s the one drug I advise my older patients never to use,” Dr. Berry says.
3. Antidepressants. Tricyclic antidepressants, including amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Sinequan), and imipramine (Tofranil) can cause drowsiness and sudden drops in blood pressure, increasing the risk of falls and accidents. Selective serotonin reuptake inhibitors, or SSRIs, like fluoxetine (Prozac), were once thought to be safer, but recent research has indicated that they’re also associated with an increased risk of falling.
4. Sleeping pills. The so-called Z-drugs–zolpidem (Ambien), zaleplon (Sonata), and zopiclone (Imovane)–have many of the side effects of benzodiazepines, including next-day drowsiness.
“The increased risk of falls and fractures is high, especially when you first start,” Dr. Berry says. In 2013, the FDA lowered the maximum recommended dose of Ambien for women from 10 mg to 7.5 mg due to concerns for driving safety and mental acuity with the higher dose.
THE BROWN-BAG SOLUTION
Putting all of the prescription and over-the-counter drugs and supplements you take into a bag and bringing it to your next medical appointment is a great way to make sure you’re taking only the drugs you need. Sometimes the drug or dose your provider thinks you use isn’t exactly the same as the one you’re taking. Bringing in everything is a good way for the doctor to see everything you take.
And you should ask your doctor the same two questions about every drug in the bag, Dr. Berry says: “Do I need to be taking this?” and “Could I get by with a lower dose?” – Harvard Women’s Health Watch
