Dr. Jacqueline Gerhart: How Do I Know If I'm Having A Negative Drug Reaction?
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I just saw an ad that said, "Taking five or more meds exposes older adults to a 50 percent chance of a negative drug reaction." How do I know if I'm having a negative drug reaction?
Dear Reader: The ad you saw is referring to a concept called polypharmacy. Think about polypharmacy like a storage closet. You put things in a storage closet because you think you might use them someday. Over time, things pile up - and you aren't exactly sure what's on the bottom.
Similarly, you collect medicines. You have new ones, expired ones and some random ones left over - all shoved into your medicine cabinet. You may forget which ones you take and why.
I've had patients bring a big box of medications to my office and plop it down for me to sort through. It's as if I'm the host of "Antiques Roadshow" - they think I'm going to pull out one magic pill bottle, dust it off and exclaim, "Never fear, you are cured!"
Unfortunately, we doctors do not have magic pills that cure all ailments. Instead, we need to use multiple modalities (both pill and non-pill) to collaboratively improve one's health.
Most medications have a specific "mechanism of action" by which they work in your body, each with a different goal. It's our job to look at your health and to balance the benefits and risks of treatment.
But when working with the elderly, the possible risks of treatment are often greater. This is because the older our kidneys and liver get, the slower they are at eliminating drugs and toxins. Plus, an elderly body is more sensitive to various drug side effects. Yet, as physicians, we often prescribe laundry lists of medications to the elderly.
Why is this? Well, there are many influences. First, seniors are worried about their health, so they seek treatment more often. In a UnitedHealthcare survey, seven out of 10 seniors stated their health was a major concern for them. In fact, health was rated the highest concern, even higher than finances.
Second, physicians are prescribing more medications. Data from the PRIME Institute for Families shows that in 2010 the average senior was given 38.5 prescriptions and spent an average of $2,810 on medications. This is up from 28.5 prescriptions and $1,205 spent on medications in 2000.
Third, we are prescribing more mental-health medicines that can affect one's level of consciousness. In 2010, Americans spent more than $16 billion on antipsychotics, $11 billion on antidepressants, and $7 billion for attention deficit/hyperactivity disorder meds. This is a 22 percent increase over 10 years.
Unfortunately, many of these medications can cause drowsiness, insomnia, gastrointestinal upset, tremor, rapid heart rate, seizures or dependence and addiction issues.
For example, I often see elderly patients on multiple medications for both pain and anxiety. Often, these medications alter consciousness.
So what's better? Having difficulty doing your daily tasks and interacting with friends and family - or having a bit of anxiety or pain. For every patient that balance is different.
To review and discuss your medications, make an appointment for a "med check." Then you and your provider can weigh your personal benefits and risks for each medication. You both might find that less is more.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 11/20/2012