Can you pare down your medications?
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.
Like some items in your wardrobe, the drugs that suited you at one point may not work as well as you go through life.
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.
With age, people also gain fat and lose muscle mass, which contains water. 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.
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.
2. Medications containing diphenhydramine. 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,” said Dr. Sarah Berry, assistant professor of medicine at Harvard Medical School.
3. Antidepressants. Tricyclic antidepressants, including amitriptyline (Elavil), clomipramin (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 said. 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.
A great way to make sure you’re taking only the drugs you need is to put all of the prescription and over-the-counter drugs and supplements you take into a bag and bring it to your next medical appointment. 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 said: “Do I need to be taking this?” and “Could I get by with a lower dose?”
— Harvard Women’s Health Watch
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