Polypharmacy Factors Pt 6

This is #6 in the series about why we should be concerned with seniors taking so many pills:   Beer’s List of Potentially Inappropriate Medications (the Category III Drugs).


Category III drugs are those which can be taken by seniors but caution should be exercised.  While these drugs certainly do have some benefit for some people, they often have side-effects limiting our ability to prescribe them for everyone.  There are 13 specific drugs or drug groups and again I’ll list only the more common ones; for a complete listing and description, go on-line (Beers Criteria).

– ASA [Aspirin] for preventing a first heart attack – when compared to its risks, there is now little evidence to support its use for those over age 80.

– Dabigatran [Pradaxa] – a newer blood ‘thinner’ for preventing blood clots – greater risk of bleeding compared to warfarin [Coumadin], in those over age 75; and safety concerns if there is any chronic kidney problem.

– Prasugrel [Effient] – another new blood ‘thinner’ – same concerns as dabigatran above.

– Antipsychotic group of drugs, 2nd generation [concerns are related only related to the treatment for agitation of dementia; drugs such as quetiapine (Seroquel), risperidone (Risperidal), or olanzapine (Zyprexa)] – can lower salt levels [sodium] significantly; also increase risk of stroke, diabetes, premature death.

– Carbamazepine [Tegretal], mirtazapine [Remeron], SSRI’s [Selective Serotonin Reuptake Inhibitors – antidepressant drugs, such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)], SNRI’s [Serotonin Norepinephrine Reuptake Inhibitors – a newer group of antidepressants, such as venlafaxine (Effexor)], TCA’s [Tricyclic Antidepressants – an older group of antidepressants, such as amitriptyline (Elavil – it has a greater risk of side-effects)] – all can cause salt imbalances, such as lower blood sodium levels, causing drop in blood pressure, and therefore need to be monitored.

– As I stated in previous articles, some folks have been on one or more of these drugs without any problems; and their particular diagnosis or symptom is controlled by that drug.  However, if someone is having problems, or just wants to try and reduce the number of pills being taken, it usually won’t hurt to try weaning off any of these on the list and see whether you’re better—or worse.  But, best to work with the guidance of your doctor to supervise and advise you as you do this.


And, to that end—next time:  how to safely reduce the number of drugs taken.