Learn which medications are on pharmacists’ ‘black list’
By Patricia Corrigan for Next Avenue
You fill a prescription, a medication you’ve relied on before. A few days later, you experience a troubling side effect. You read online that no one your age should take this medication.
Drug Side Effects and Older Adults
Two pharmacists say the aging process is to blame, and they reveal here the names of medications on their “black list” that older adults may want to avoid.
“Prescribing medications for people 65 and older can be more challenging, because some drugs can be more toxic or cause more side effects than when you were younger,” says Kirby Lee, a pharmacist and associate professor of clinical pharmacy at the University of California at San Francisco. “As your body ages, it absorbs medications differently. They can be metabolized differently by your liver and excreted differently by your kidneys, so you may be more sensitive to some medications.”
That’s what happened to me.
Antibiotic Causes Painful Achilles
One recent weekend, I experienced a relapse while on doxycycline, an antibiotic prescribed for a bacterial sinus infection. The doctor on call I spoke with prescribed a stronger antibiotic for me, levofloxacin (Levaquin), one I’d taken successfully a decade ago.
After four days on the new drug, a throbbing Achilles tendon awakened me in the wee hours. I hobbled to the computer and learned the drug is not recommended for people 60 and older. I am 68. Later that morning, I called my internist, who advised me to stop taking it and start helping the tendon to heal — no easy task, and one with no quick fix.
Our aging bodies are not the only challenge. Only about 7,500 physicians in the U.S. specialize in the care of older adults, according to the American Geriatrics Society. With 46 million Americans age 65 and older today, that works out to about one geriatrician per 6,100 patients.
That’s obviously not enough geriatricians now — and by 2060, some 98 million Americans will be 65 and over.
“Until you enter a nursing home or assisted living, you might not see a specialist good at treating older adults, because we don’t yet have a health care system designed to take care of older adults,” says Chad Worz. He is a consultant pharmacist with Medication Managers in Cincinnati and president-elect of the American Society of Consultant Pharmacists (ASCP).
More Assistance from Pharmacists
Based in Alexandria, Va., and with more than 9,000 members, ASCP is said to be the only international professional society devoted to “optimal medication management and improved health outcomes” for older people. Consultant pharmacists work in adult day centers, assisted living facilities, community pharmacies, hospice programs, home care programs, mental health facilities, nursing homes, pharmaceutical companies, physicians’ offices and rehab centers.
On the job, ASCP members evaluate individuals’ medication lists to determine which drugs can be dropped. “In that regard, I am an anti-pharmacist,” Worz says, laughing.
“Every day I look at the records for people on 14 or 15 medications and try to get them to eight or nine. Instead of stopping a drug that causes a certain side effect, doctors often prescribe a drug to fix the side effect,” he says. “I don’t blame the doctors. I blame the system, which does not incentivize patients to have sit-down conversations with doctors or pharmacists about medications.”
Medications You May Want to Avoid
Here are six classes of medications considered especially problematic for older adults:
- Benzodiazepines Prescribed — often over-prescribed — for anxiety and sleep disorders, this class of drugs includes diazepam (Valium), lorazepam (Ativan), alpraxolam (Xanax) and chlordiazepoxide (Librium). The medications can cause confusion and greatly increase the risk of falling.
- Non-Benzodiazepines Prescribed for insomnia, Zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) are highly addictive and also can cause bizarre sleep behaviors, including sleepwalking.
- Anticholinergics Diphenhydramine (Benadryl), acetaminophen with diphenhydramine (Tylenol PM) and some muscle relaxants that contain diphenhydramine (an antihistamine) can cause confusion, constipation, dry mouth, blurry vision or urine retention in older adults. Cumulative exposure to these drugs can lead to dementia.
- Nonsteroidal anti-inflammatory drugs Ibuprofen (Motrin), naproxen (Aleve), aspirin and other drugs in this class are “tough on kidneys,” Lee says, and increase the possibility of stomach bleeds. They are not recommended for long-term use. For management of arthritis pain, Lee recommends acetaminophen (Tylenol), physical therapy, acupuncture, aquatic therapy or acupressure.
- Antipsychotics This class of drugs is useful to treat significant psychosis or serious mental health conditions, but is too often prescribed for mild agitation, anxiety or depression. Lee suggests taking the lowest effective dose for the shortest term possible. “People get started on these and then they don’t top,” he says.
- Old drugs Though barbiturates are rarely prescribed any longer, these sedatives are still available and are highly addictive both physically and psychologically.
Worz notes that blood pressure medications also can cause fatigue or lead to falls.
And he suggests being cautious with the dosage for ranitidine (Zantac), often taken for heartburn. “Taking 150mg twice daily is a normal dose, but in an older person, kidney function may no longer be sufficient to eliminate the drug quickly.” That can lead to possible cognitive issues that can look like dementia.
“Nobody should have to live with a problem that is the result of taking a drug,” Worz adds. “Your doctor or pharmacist usually can find better drugs with fewer side effects to help you.”
For information about other medications that may cause problems for older adults, Worz recommends the “Beers List,” named for the physician who first published the list, which is updated periodically by the American Geriatrics Society.
Why That List of Side Effects Is Important
And what about that antibiotic that caused me so much trouble?
Worz notes that other antibiotics in the same class have been pulled from the market after causing changes in the nervous system, hallucinations and other problems. “Still, it’s impossible to predict exactly how a medication may affect someone, and even a lengthy list of potential side effects may not be specific enough,” he adds.
I can’t be angry with the physician who neglected to take my age into consideration, because I share in the blame.
When I picked up the prescription, I waved off a consultation with the pharmacist, saying I’d taken this antibiotic before. Then, after reading just a sentence or two of the lengthy list provided to me of possible side effects, I tossed the paper into a recycling bin.
That is one of two typical responses, Lee says. “I’ve seen people blow it off — or get so scared they won’t take anything. The information on side effects is based on factual data and written for legal purposes, but it will help you sort out common and less-common side effects, learn what side effects are considered severe and be aware of contraindications.”
Once you read the material, Lee adds, you can weigh the side effects against the benefits of taking the medication. “You also can ask the pharmacist or your doctor what taking the medication might mean for you, and what alternatives there are,” he notes.
Don’t Keep Secrets from Your Doctor
Lee stresses the importance of providing your doctor with an updated list of everything you take, including prescribed medications, over-the-counter drugs and dietary supplements. Also, alert your doctor about any drug allergies or bad reactions to medications you’ve had.
As always, talk to your doctor before you stop taking any prescribed medications. And, remember: no one bit of advice fits all.
“Keep in mind that complications from medications are general trends due to body changes by the time you are 65 or 70,” Lee says. “Some people are likely to experience these complications, but others may have a body that functions like that of a 35-year-old. Always look at your metrics and go from there.”