01 Jun (BOTTOMLINE HEALTH) – When your doctor pulls out his/her prescription pad, you probably assume that your health problem will soon be improving. Sure, there may be a side effect or two—perhaps an occasional upset stomach or a mild headache. But overall you will be better off, right? by Armon B. Neel, Jr., PharmD
Not necessarily. While it’s true that many drugs can help relieve symptoms and sometimes even cure certain medical conditions, a number of popular medications actually cause disease—not simply side effects—while treating the original problem.
Here’s what happens: Your kidney and liver are the main organs that break down drugs and eliminate them from your body. But these organs weaken as you age. Starting as early as your 20s and 30s, you lose 1% of liver and kidney function every year. As a result, drugs can build up in your body (particularly if you take more than one), become toxic, damage crucial organs such as the heart and brain—and trigger disease. Older adults are at greatest risk for this problem because the body becomes increasingly less efficient at metabolizing drugs with age.
But no one is exempt from the risk. To protect yourself—or a loved one…
Many drugs can cause symptoms, such as short-term memory loss, confusion and agitation, that patients (and physicians) frequently mistake for dementia. The main offenders are anticholinergic medications, which treat a variety of conditions by blocking the activity of the neuro-transmitter acetylcholine. Hundreds of medications are anticholinergic, and it’s likely that any class of drugs beginning with anti- is in this category—for example, antihistamines and antispasmodics. Cholesterol-lowering statins also can cause dementia-like symptoms.
Other offenders: Beta-blockers (for high blood pressure or cardiac arrhythmias)…benzodiazepines (for anxiety)…narcotics…tricyclic antidepressants…anticonvulsants…muscle relaxants…sleeping pills…fluoroquinolone antibiotics…heartburn drugs (H2 receptor antagonists and proton-pump inhibitors)…antipsychotics…nitrates (for heart disease)…and sulfonylurea derivatives (for diabetes).
Dr. Neel’s advice: If you or a loved one has been diagnosed with dementia, the patient should immediately undergo a comprehensive medication review—drug-induced dementia usually can be reversed by stopping the offending drug (or drugs). A competent physician or consultant pharmacist can always find an alternative drug to use.
Surprising threat: Even general anesthesia can cause weeks or months of dementia-like confusion (and an incorrect diagnosis of Alzheimer’s) in an older person as the drug slowly leaves the body. The anesthesia is collected in the fat cells in the body, and normal cognition may take months to return. The longer a person is under anesthesia, the longer it takes to recover.
Medications known as biologics are frequently used to treat autoimmune diseases such as inflammatory bowel disease, or IBD, (including Crohn’s disease and ulcerative colitis) and rheumatoid arthritis. This class of drugs includes adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade).
Important finding: The use of biologics was linked to more than triple the risk for lymphoma, breast, pancreatic and other cancers in a study that was published in The Journal of the American Medical Association.
The danger: While these medications may have a role in the treatment of autoimmune diseases, they often are carelessly prescribed by primary care physicians. For example, a biologic that is intended for IBD may be mistakenly prescribed for irritable bowel syndrome (IBS), a far less serious digestive disorder.
If you are prescribed a biologic for IBD: Before starting the drug, ask for a comprehensive workup to confirm the diagnosis. This may include lab tests, imaging tests (ultrasound, CT or MRI), a biopsy and a stool analysis (to rule out C. difficile and other bowel infections that would require an antibiotic). Do not take a biologic for IBS.
If you are prescribed a biologic for rheumatoid arthritis: Before starting the medication, ask your doctor for a comprehensive workup to confirm the diagnosis, including lab tests and imaging tests (X-ray, ultrasound or MRI). Do not take a biologic for osteoarthritis. Besides increasing cancer risk, the suppression of the immune system opens the door for serious bacterial and viral infections.
Many commonly prescribed drugs increase risk for type 2 diabetes. These medications include statins…beta-blockers…antidepressants…antipsychotics…steroids…and alpha-blockers prescribed for prostate problems and high blood pressure.
Safer alternatives to discuss with your doctor, consultant pharmacist or other health-care professional…
If you’re prescribed a beta-blocker: Ask about using a calcium-channel blocker instead. Diltiazem (Tiazac) has the fewest side effects. The 24-hour sustained-release dose provides the best control.
If you’re prescribed an antidepressant: Ask about venlafaxine (Effexor), a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) antidepressant that treats depression and anxiety and has been shown to cause fewer problems for diabetic patients than any of the older selective serotonin reuptake inhibitor (SSRI) drugs.
If you’re prescribed an alpha-blocker: For prostate problems, rather than taking the alpha-blocker tamsulosin (Flomax), ask about using dutasteride (Avodart) or finasteride (Proscar). For high blood pressure, ask about a calcium-channel blocker drug.
Nonsteroidal anti-inflammatory drugs (NSAIDs), frequently taken to ease pain due to arthritis, other joint problems or headaches, are widely known to damage the digestive tract. What’s less well-known is that NSAIDs have been found to increase the risk for cardiovascular disease.
Dr. Neel’s advice: No one over the age of 50 with mild-to-moderate pain should use an NSAID.
Fortunately, there is an excellent alternative. A daily dose of 50 mg of the prescription non-narcotic pain reliever tramadol (Ultracet, Ultram) and/or 325 mg of acetaminophen (Tylenol) works well and has less risk for adverse effects. Acetaminophen, taken in appropriate doses (less than 3,000 mg daily) without alcohol use, is safe and effective. I also recommend 3 g to 4 g of fish oil daily—it has been shown to effectively treat joint pain. Talk to your doctor first because fish oil may increase risk for bleeding.
THE VERY BEST DRUG SELF-DEFENSE
If you’re over age 60—especially if you take more than one medication or suffer drug side effects—it’s a good idea to ask your physician to work with a consulting pharmacist who is skilled in medication management. A consulting pharmacist has been trained in drug therapy management and will work with your physician to develop a drug management plan that will avoid harmful drugs. These services are relatively new and may not be covered by insurance, so be sure to check with your provider. To find a consulting pharmacist in your area, go to the Web site of the , American Society of Consultant Pharmacists, and click on “Find a Senior Care Pharmacist.”
Also helpful: Make sure that a drug you’ve been prescribed does not appear on the “Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Originally developed by Mark Beers, editor of The Merck Manual of Medical Information, the list has been recently updated by The American Geriatrics Society. To download the list for free, go to here.
About the Author: Armon B. Neel, Jr., PharmD, a certified geriatric pharmacist, adjunct instructor in clinical pharmacy at Mercer University College of Pharmacy and Health Sciences in Atlanta and founder of the Georgia-based MedicationXpert, LLC, a private practice focused on pharmaceutical care for outpatients and institutional geriatric patients. Dr. Neel is also coauthor of Are Your Prescriptions Killing You? How to Prevent Dangerous Interactions, Avoid Deadly Side Effects, and Be Healthier with Fewer Drugs (Atria). www.MedicationXpert.com
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