Do I really need all of these medications?

Albert Barber | posted October 23, 2009 |

As we age, we tend to accumulate more doctors and pills. This is due in part to the fact that we also tend to accumulate chronic diseases such as osteoporosis, high cholesterol, high blood pressure, etc. With more diseases to treat, this often times leads us to more specialists, and more pills to take.

Although multiple medications may be necessary to treat multiple disease states, it’s important that the use of multiple medications is done appropriately. Simply, the benefits of a medication should exceed the risks, including the actual or potential side effects. A good example of the appropriate use of multiple medications is when a laxative, such as senna capsules or bisacodyl, is taken to prevent or treat constipation from opiod pain drugs such as morphine. This side effect is very common with morphine and similar drugs, and typically does not resolve without the use of laxatives. Another example is the use of Vitamin D to improve the absorption of calcium to help strengthen our bones.

However, the use of multiple medications can be inappropriate, such as when a drug is used to treat the avoidable side effect of another drug. An example of this is using Celebrex to treat muscle pain caused by taking Lipitor. Muscle pain is a well-known side effect of Lipitor and other statin drugs, and if severe, is typically treated by lowering the dose or changing to a different type of drug to lower cholesterol. Adding a drug such as Celebrex is typically not very helpful for this type of muscle pain, and may actually cause other side effects such as fluid retention and elevated blood pressure. If another drug is then added to treat the fluid retention or elevated blood pressure, it is known as a prescribing cascade, which can have devastating consequences, especially for older adults.

In fact, a study in 1997 found that “for every $1 spent on drugs, $1.33 is spent managing the complications of drug therapy!!!”*

How can you avoid the inappropriate use of multiple medications?

• Ask your doctor if there are non-drug treatments that may be appropriate.
• If you see multiple doctors, take a current list of medications including non-prescription and herbal remedies so they are informed about all your treatments.
• Know what each drug is being used to treat and how it should be taken.
• Ask your doctor or pharmacist to review your medications periodically to assure that they are still needed, are not causing significant side effects, and the benefit exceeds the risk.
• Ask your doctor how long each medication should be taken. i.e. is treatment long-term or for a limited duration?
• Never start taking a non-prescription or herbal treatment without consulting your doctor or pharmacist who knows your health history and current medications.

*Bootman JL, Harrison, DL, Cox E “The health care cost of drug-related morbidity and mortality in nursing facilities” Arch Intern Med 1997 157 2095.