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Geriatric junkies

MagazineMarch 2014 (Vol. 24 Issue 12)Geriatric junkies

Half our elderly population take two or more drugs, causing side-effectsthat are mistaken for actual conditions and treated with still more drugs

Half our elderly population take two or more drugs, causing side-effects that are mistaken for actual conditions and treated with still more drugs. Here are the drug interactions to look out for, the steps to avoiding these common side-effects and effective alternative treatments

Q

Both my parents are quite elderly-in their early 80s now. They saw their GP a few years ago with what we all thought were just very minor problems, and they both came back with prescriptions for some medications. They have been taking those medications exactly as directed but, after a while, other health problems appeared. They went back to the GP and both of them were prescribed some additional drugs, which they have also dutifully taken as instructed. Then some further problems arose which they again discussed with the GP. To my astonishment, they were given yet more drugs to take, while none of the older ones were taken away. This very recently happened once more . . . and ended with still more drugs. Is this a case of drugs producing side-effects and more drugs given to quell those side-effects, which produce their own adverse reactions, necessitating yet more drugs?

T.D., PhD, Norwich

A

Since you haven't specified what drugs your parents were prescribed and are now taking, I am unable to respond specifically to your parents' problem(s). But if your elderly parents need to stay on orthodox drugs, here are some guidelines that you and they should bear in mind.

Polypharmacy-being prescribed more than one drug at a time-is common among the elderly because of the presumed presence of multiple disorders. Around half of the elderly take several prescribed or over-the-counter (OTC) drugs at the same time and often for long periods of time. As you suspected, many of the so-called diseases diagnosed arise from drug interactions that are perhaps being overlooked by both the GP and pharmacist. And adding more drugs only compounds the original problem.

Check out the table on the left for a summary of the most common drug interactions seen with the drugs usually prescribed to the elderly and how to manage them in older people.

The highest use of medications is among the institutionalized elderly. The average nursing-home patient is said to receive eight different drugs a day. In the case of the average mobile elderly person, it is seven different drugs a day (four on prescription and three OTC). This is not only due to the multiple illnesses older people are thought to have, but also because elderly patients are often consulting a number of doctors at the same time. In the case of your parents, though, it sounds as if they always consult
the same GP.

There are yet other adverse drug reactions as well as drug-withdrawal syndromes, such as angina pectoris from suddenly stopping beta-blockers, hypertension due to stopping calcium-channel blockers and even withdrawal symptoms due to stopping addictive drugs like narcotics and benzodiazepine. There are also other, extraneous hazards like the increased risk of a fractured hip with benzodiazepine use.

But probably the most common contributory factor among the elderly is when medical practitioners inappropriately prescribe a drug to 'treat' an unrecognized drug effect-for example, giving a tricyclic antidepressant for depression due to a beta-blocker or a powerful tranquillizer for benzodiazepine-related agitation.

Drug interactions to watch out for

Drug combination

What to do

Angiotensin-converting enzyme (ACE) inhibitors + non-steroidal anti-inflammatory drugs (NSAIDs) for joint pain

Check blood pressure on day 1 of taking the NSAID

Antacids + iron salts

Take iron several hours before the antacid (preferably in liquid form)

Benzodiazepines + alcohol

Avoid alcohol

Beta-blockers + prazosin (Hypovase, Minipress; for high blood pressure, benign prostatic hypertrophy and Raynaud's phenomenon)

Take these drugs as far apart as possible and monitor blood pressure changes on standing

Beta-blockers + NSAIDs for joint pain

Check blood pressure

Cimetidine (Tagamet) + procainamide (for abnormal heartbeats like atrial fibrillation)

Reduce dosage of procainamide by one-third before starting cimetidine

Clonidine (Dixarit) + tricyclic antidepressants

Avoid taking these at the same time

Digoxin + quinidine

Avoid taking these at the same time

Digoxin + tetracycline

Avoid taking these at the same time

Digoxin + anticholinergics

Use liquid or rapidly dissolving digoxin preparations

Lithium + thiazide

Loop diuretics like furosemide, bumetanide and torsemide (Lasix, Bumex and Demadex) are preferable to thiazide, and careful reduction of lithium dosage may be necessary

Salicylates (Aspirin) + warfarin

Avoid taking these at the same time

Theophyllines (bronchodilators) + beta-blockers

Avoid beta-blockers in patients with reactive airways diseases like wheezing and asthma

12 steps to avoiding drug side-effects

1- Make sure there is a clear diagnosis backed by laboratory tests before a prescription has been issued

2- Keep a careful record of the patient's drug history

3- Read package inserts to find out how the drug works in the body

4- Check the labels affixed by the pharmacist

5- Ask to have the lowest working dosages for elderly patients

6- Simplify the drug regimen and insist on a regular review of the drugs to make sure they're all still necessary

7- Avoid polypharmacy whenever possible

8- Use medication containers like egg boxes when preparing daily doses

9- Instruct the whole family on the correct drug regimens

10- Return old medicines to the pharmacy or at least get them out of the house

11- Be aware of the risk of overdose in elderly patients known to have psychiatric conditions

12- Above all, recognize-and make sure the elderly patients know this too-that medicines can cause as well as alleviate illness.

Alternative ways to help your elderly parents

Osteopathic manipulative therapy(to help range of motion, respiratory and muscle energy problems) and particularly the craniosacral technique, including CV4 compression, are invaluable treatments for the elderly.1

Homeopathyoffers what I have found to be a reliable multisystemic remedy for the complaints of growing old-Acidum Sarcolacticum-which I use at a 12CH potency to good effect. Its clinical keynotes, revealed in experimental provings on healthy subjects, all point to problems of ageing and include multiple joint degeneration (such as arthritis), general asthenia (abnormal physical weakness or lack of energy), pruritus (itching), keratotic eczema (horny skin rash) and frequent nighttime urination.2

References

1

AAOJ, 2005; 18: 16-20

2

J Am Inst Homeopath, 1966; 159: 3-4

further reading

Ann Intern Med, 1991; 114: 956-66

Ann Pharmacother, 1989; 23: 847-54

N Engl J Med, 1991; 324: 1326-31

Geriatrics, 1989; 44: 57-61, 64

Prescribing for the elderly. British National Formulary. London: BMA, 2000; 39: 16-7

Harald Gaier, one of the UK's leading experts on alternative medicine and a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London. Visit his website at www.drgaier.com.

If you have a question for our Medical Detective, write to us at the usual address or email
letters@wddty.co.uk.


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