Polypharmacy VI

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 can be taken by seniors but only with caution.  While these drugs can have some benefit for some people, they often have side-effects limiting usage.  There are several 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 –compared to risk of bleeding, now no evidence to support its use when over age 80.

Dabigatran [Pradaxa] and Prasugrel [Effient] – blood ‘thinners’ for preventing blood clots – more bleeding compared to warfarin [Coumadin], if over age 75 and if chronic kidney problems.

Antipsychotic group of drugs, 2nd generation [concerns are only related to treatment of dementia agitation:  quetiapine (Seroquel), risperidone (Risperidal), etc.] – can lower salt levels [sodium]; increase risk of stroke, diabetes, premature death.

Carbamazepine [Tegretal], and many anti-depressants, such as paroxetine (Paxil), sertraline (Zoloft)], venlafaxine (Effexor)], amitriptyline (Elavil) – all can cause salt imbalances, dropping blood pressure, causing more falls.

Omeprazole [Prilosec] and other proton pump inhibitors – these suppress all stomach acid which increases risk of hip fractures (by blocking calcium absorption), pneumonia, and a severe bacterial diarrhea (c.difficile) – and now may contribute to dementia.

Although some have taken these drugs without problems for years to control their particular symptom, if one is having problems, or just wants to reduce the number of pills taken, it usually won’t hurt to try weaning off some of these and see whether you’re better—or worse.  But, best to work with your doctor to supervise this.

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