Do you know someone who swallows a handful of pills with breakfast? A parent perhaps, or a good friend? Maybe you worry that you are taking too many medicines. Have you ever bothered to actually count the total number of pills you take in any given day? If its more than three or four you could be on a medication merry-go-round. One reader shared this story about her mother.
25 Different Rx Pills = Too Many Medicines!
Q. Some years ago, my aunt was doing poorly so I took my mother to see her. Because I’m a doctor, I was asked to review the meds. She had six OTCs and 25 prescribed drugs with various dangerous or negating interactions. She was barely able to get out of bed.
Her primary care doc knew all the meds were a problem but would not change them because specialists had prescribed them. When my aunt woke up and joined the conversation, I told her she needed less than a handful of prescriptions. That didn’t bother her, as she didn’t think they were doing her any good.
The medication taper was tricky and required ER visits, but my aunt got off most of the benzos, narcotics and sleeping pills as well as most of the other multi-specialty drug mess. She regained her alertness and lived well for over five years. Drug interactions are underappreciated, especially as a problem for older people.
A. We couldn’t have said this better! It’s far too easy for older people to take too many medicine that may not work well together. Someone should monitor for medication incompatibility and lobby for deprescribing when appropriate.
To make that process easier, we offer our top 11 tips for preventing dangerous interactions in our book, Top Screwups. You may find it in your local library or in the books section of the store. Although drug-drug combinations are especially dangerous, interactions with foods, herbs or other dietary supplements can also pose problems.
One new medicine that can conflict with many other drugs is Paxlovid (ritonavir + nirmatrelvir). This pill is prescribed to help people recover from COVID-19. It interacts with dozens of medications including atorvastatin, buspirone, clonidine, estrogen, prednisone and sildenafil.
Another Example Of Too Many Medicines:
Q. Years ago, my mom came to visit – with 18 bottles of prescriptions. During the visit, her health deteriorated, and I convinced her to give me a list of her pills.
I plugged them into a program on the AARP website and found there were some dangerous interactions between several of her pills. Once we started checking what each one was for, she consulted her doctor and weaned herself off some they agreed she didn’t need. Within a month she went from not being able to function or speak normally to acting like a young woman!
A. Thank you for sharing your mother’s story. The more medicine people take, the greater the risk of serious drug interactions. Your mother was in a high-risk situation with 18 different meds on board.
Many people find it hard to believe someone could be swallowing so many different pills each day. And yet when you start adding up your medications, OTC remedies, vitamins and dietary supplements you might be surprised how many unique substances you are putting in your body.
But Wait…There’s more!
This message came in a few weeks ago. We get messages like this so often that it feels the tide coming in:
Q. You’ve written about older people taking too many medicines. My parents were each on 14 different drugs in their nineties! I kept begging them to speak with their doctor, but his answer was always, “if it’s working, don’t stop.” To me this attitude seemed unscientific and stupid.
When they went into assisted living, the doctor there reduced their medications to the only two medicines they each really needed. As a result, both of them felt much better.
My dad had been on three different drugs to combat the side effects of a prescription he didn’t need to begin with. I understand that doctors don’t want to mess with success, but this is totally ridiculous.
A. Your parents’ experience is not as unusual as it might seem. Many older people end up taking a fistful of drugs, leading to an increased risk for side effects and interactions. Many doctors, PAs and nurse practitioners are reluctant to remove drugs from a long list. We hear the phrase “don’t mess with success” far too often. What does “success” mean?
Many physicians worry that if they start cutting back on the number of prescriptions someone is taking, there could be problems. The mantra above: “If it’s working, don’t stop,” is far too common. Is that always true?
A study published in JAMA Internal Medicine (Feb. 6, 2023) showed that “deprescribing” can be done safely without triggering adverse events, hospitalizations or increased deaths. It’s not a do-it-yourself project, though, and must be supervised by a knowledgeable healthcare professional.
“Deprescribing” is a New but Important Concept:
Drug safety experts have a new word in their vocabulary: deprescribing. For decades, doctors were encouraged by drug company sales reps to prescribe the latest “wonder” drug. And of course we are all inundated with prescription drug ads on television telling us to “ask our doctor” about drug X, Y or Z! But some health professionals are starting to talk to their colleagues about deprescribing.
An article in the highly regarded journal Neurology (online, Sept. 2, 2020) describes the impact of anticholinergic drugs on “cognitively normal participants.” The authors report that such medications increase the risk of mild cognitive impairment and cognitive decline. They go on to conclude:
“Findings underscore the adverse impact of aCH [anticholinergic] medications on cognition and the need for deprescribing trials, particularly among individuals with elevated risk for AD [Alzheimer’s disease].”
We find it more than a little disturbing that there are relatively few deprescribing studies we can turn to for advice. Then again, it is not in the interest of the pharmaceutical industry to study how to stop taking their medicines.
An article in the European Journal of Pharmacology (Oct. 8, 2020) describes PIMs (potentially inappropriate medications) in older people. In an analysis of 4,760 older hospitalized psychiatric patients these researchers report that one-third were taking a PIM. The most frequently prescribes PIMS included zopiclone (Imovane, closely related to the sleeping pill eszopiclone, aka Lunesta), lorazepam (Ativan), haloperidol (Haldol) and diazepam (Valium).
Should We Worry About Taking Too Many Medicines?
Lots of Americans are taking too many medicines. According to Consumer Reports (Sept. 2017), more than half of US adults take at least one prescription drug regularly. The average number of prescriptions people in the CR survey took was four. That doesn’t even include the nonprescription medicines and supplements that many of us rely on conscientiously.
And yet I do not know anyone who doesn’t worry a bit about memory concerns. Perhaps a parent or some other relative has Alzheimer’s disease. When you can’t remember a name, a date or an event, there is a momentary panic. Have you ever tried to place a name to a face? It can make you wonder if you are losing it. We even have a name for such events: “senior moments.” They can be scary!
Older People Are Vulnerable to Too Many Medicines:
When you get close to 60 your body has begun to change. Kidneys may not work quite as efficiently to eliminate drugs. Your liver doesn’t always detoxify all the chemicals you are exposed to the way it did when you were 25. And the chances are good that you have been diagnosed with a couple of conditions: high blood pressure, elevated cholesterol or creeping blood sugar. Perhaps your thyroid gland isn’t working quite as well as it did in your youth. The CR article notes:
“In Consumer Reports‘ recent survey, for example, 40 percent of people ages 65 and older took five drugs or more compared with just 17 percent of those ages 45 to 55.”
“Compounding the problem is that older people are less likely than younger ones to ask a doctor about drug safety. Barely half of the seniors in our survey said they talked with their doctor about such concerns as drug side effects, but two-thirds of younger adults did.”
“Its not surprising, then, that older adults are twice as likely to suffer a side effect serious enough to require a trip to an ER, and seven times more likely to be hospitalized as a result, according to the Centers for Disease Control and Prevention.”
Stories from Readers Regarding Too Many Medicines:
One visitor to this website told us:
“My sister worked as a nurse. She interviewed patients who were going to have outpatient surgery and said 9 out of 10 people she interviewed – age not a factor – were taking 8 to 10 medications every day.”
Is that a problem? Some people doubtless need every drug they are taking, but many others may be utilizing medicines they don’t really need. In addition to the cost, there are health consequences. More than a million people land in the emergency department each year because of serious adverse reactions to their medicines. In 2014, nearly 124,000 people died from side effects.
On Death’s Doorstep: Can You EVER Stop Too Many Medicines?
An expert in palliative care, Dr. Steven Pantilat, told us that many older patients in hospice are more alert after unnecessary medications are discontinued.
Years ago we received this message from a reader of our syndicated newspaper column:
“My sister and I were very concerned about my 73-year-old aunt and the tremendous number of medications she was on. She was in a terrible nursing home and was continually strapped in a wheelchair. She was always agitated and often spoke to people who had been dead quite awhile.
“The doctors said her hallucinations were caused by a stroke and dementia. Her family was in complete denial. My sister obtained your eGuide to Drugs and Older People and the Drug Safety Questionnaire (online in our Health eGuides section).
“We moved her to a different facility. Two weeks after the medicines were stopped or the doses were lowered, she has become herself again. Thanks for helping us get our wonderful aunt back!”
Too Many Medicines; Not Just An Older Person’s Problem:
Overmedication is not just a problem for old folks. A surprising number of young people are also taking handfuls of pills. They swallow powerful drugs to suppress acid in their stomachs, help them get to sleep, lower their blood pressure and ease their depression.
It’s not enough to list all your medicines when you visit your doctor. Ask someone to check for drug interactions and inquire when and how you should discontinue each prescription.
How Can You Tell If You Are Taking Too Many Medicines?
It starts innocently enough. A routine visit to the doctor reveals that your LDL cholesterol is 125 and your blood pressure is running around 140/95. Your doctor prescribes rosuvastatin for the “bad” cholesterol. He adds lisinopril and hydrochlorothiazide (HCTZ) to get your blood pressure closer to 120/80.
After several months you discover that your back is starting to hurt and that your joints are a bit more painful than usual. You begin taking ibuprofen to ease your pain.
At your next doctor’s visit a blood test reveals that you are now borderline diabetic. You also have developed a nighttime cough. You may also have some abdominal pain and nausea. Your doctor prescribes metformin to get your blood sugar under control and Nexium for the digestive upset. He recommends Zyrtec for the cough, which he thinks might be due to allergies. He also tells you that your blood pressure is still not where he wants it to be.
As you can see, prescriptions start to pile up almost before you notice it. Sometimes the second medication will then cause symptoms for which the doctor prescribes a different drug. This is one way people end up taking three, four or five different pills. That is what happened in the hypothetical example above.
Rosuvastatin can cause joint pain, nausea, abdominal pain, muscle aches and cramps. It can also raise blood sugar levels. So can HCTZ. Lisinopril can cause a cough, which won’t be solved with Zyrtec. Nexium and metformin have their own complications. The ibuprofen you are taking for the muscle pain and arthralgia brought on by rosuvastatin could be raising your blood pressure. The merry-go-round goes round and round.
What Can You Do to Control Medication Inflation?
We have prepared a People’s Pharmacy Drug Safety Questionnaire and Medical History form. It is free for download by going to this link.
You can also listen to the free podcast of Show 1098: Are You Taking Too Many Medicines? You can stream the audio or download the free mp3 file.
If you know someone over 55 who you think is taking too many medicines you may wish to access our Guide to Drugs and Older People. It has lists of drugs that are inappropriate for people as they age. It also contains a list of medicines that might affect brain function.
Not Just A U.S. Problem:
Marie in Sweden writes:
“The problem of overmedication is common in many countries. It has been going on for years and years. I don´t think the change will come from our authorities or the medical staff. I think it will have to come from the people. I live in Sweden.”
The People’s Pharmacy Perspective:
Always ask your health care professionals if you still need all the medicines you are taking. We are intrigued at how carefully nurses and techs make sure your electronic health record has everything you are currently swallowing. What disturbs us is that no one seems to bother checking for drug interactions or excessive medications.
We are hoping that one day the art of deprescribing will become part of a provider’s standard practice. Never stop any meds on your own. Always find out how to discontinue a drug. Some medications have to be tapered very slowly over weeks or months. And sometimes it will be necessary to take quite a long list of medications just to stay alive.
Here is a link to an interview we did on this topic:
Show 1066: How to Fight Overmedication with Deprescribing
And here is a link to our book Top Screwups with detailed tips on how to stay safe and protect those you love!
Share your own story below in the comment section.